Hearing aids are frequently broken down into five groups of technology. This has nothing to do with the size or style of the hearing aid, but with the needs of the individual. This quiz can give you an idea of how advanced the technology would need to be in hearing instruments that are best for you! ***THIS QUIZ IS FOR GENERAL INFORMATION AND SHOULD NOT BE TAKEN AS MEDICAL ADVICE. ALWAYS CONTACT A HEARING CARE PROFESSIONAL BEFORE FITTING ANY HEARING AIDS*** Question 1: Where do you spend the majority of time during weekdays? A. At my residence B. At an office C. At a food service or customer service job D. At a garage, construction zone, shipyard, plant or other trade job location E. I am constantly changing environments at my job Question 2: What activity would you be most likely to do on the weekend? A. Read a book or use an e-reader B. Garden or tend to your yard C. Go to brunch with a few of your close friends D. Attend a get-together for your family, social group or religious group E. Attend a live music concert Question 3: How much do you keep up with modern phones and Smart devices? A. I prefer a landline, flip-phone or desktop computer B. I have a basic smartphone but prefer not to use it C. I have a smartphone or tablet that I use regularly D. I use a smartphone or tablet and sync it with other Bluetooth devices E. I aim to have my house and car completely synced using Smart devices Question 4: How important is it that a hearing aid sounds "true to life"? A. Unimportant, I just want to hear B. I don't care if it's "true to life", but it has to have decent audio quality C. I want a hearing aid to sound natural but if small things are off, that's okay D. I wouldn't wear anything that isn't "true to life" E. I work in an audio career that requires me to have objectively "true to life" hearing Question 5: How often do you eat at a sit-down restaurant? A. Almost never B. Less than monthly C. Monthly D. A few times a month E. Weekly or more Question 6: How important is music in your life? A. I rarely listen to music B. I enjoy quiet music in the background C. I collect CDs or vinyl, or I have a subscription to a streaming music service like Spotify D. I actively seek out new music, both live and recorded E. I play music or am an active member of my local music scene Question 7: Do you ever go out on the town with groups of friends? A. Never B. Not usually, but I may go out with one or two friends on occasion C. Yes, but on rare occasion D. Yes, I go out with groups of friends somewhat regularly E. I try to go out with groups of friends every weekend Question 8: How often do you travel long-distance (100 miles or more)? A. Only for emergencies B. Only during the holidays C. A few times a year D. At least once a season E. More than once a season To calculate your score: Answered "A" - 1 point Answered "B" - 2 points Answered "C" - 3 points Answered "D" - 4 points Answered "E" - 5 points Your score should be between 8 and 40 points. IF YOU SCORED BETWEEN 8 AND 14 POINTS: You are someone with essential needs. Based upon your lifestyle, the most important goal for you is simply to hear in basic environments. If you have been struggling with your hearing for some time, it's possible that you may have withdrawn to a certain degree to make your acoustic environments easier. You would probably do with the cheapest hearing instruments, just be sure you are fitting for the life you want to have, not a life you live due to your hearing difficulties. Hearing aids to look at: Primax by Signia / Inium Sense by Oticon IF YOU SCORED BETWEEN 15 AND 20 POINTS: You are someone with basic needs. Based upon your lifestyle, you may want to look into basic hearing aid features such as noise reduction or directional microphones to help you when you are in more difficult environments, but could probably get by in most places without. You may enjoy Bluetooth features but it's no deal breaker. Hearing aids to look at: Siya by Oticon / Muse iQ by Starkey IF YOU SCORED BETWEEN 21 AND 27 POINTS: You are someone with mid-range needs. Based upon your lifestyle, you are the average hearing aid user. You are in some simple environments, some moderate environments and some difficult environments. While you don't need the highest end of audiological technology, you do need something versatile. You would probably make some use of Bluetooth accessories, or at a minimum, utilize a phone app to adjust your hearing aids. Hearing aids to look at: Opn by Oticon / Picasso by Starkey IF YOU SCORED BETWEEN 28 AND 33 POINTS: You are someone with advanced needs. Based upon your lifestyle, you are more active than most people, but don't necessarily need every bell and whistle. It would be advisable to have a hearing aid with some form of AI, advanced noise reduction, and a windscreen. You may have a level of pickiness about the richness of the hearing aid sound, so it's important to ask your Hearing Care Professional about "channel count" or the number of sounds the hearing aid can process at once. You should make use of Bluetooth accessories and check the compatibility of your hearing aids, your phone and any other Smart devices. Hearing aids to look at: Nx by Signia / Opn S by Oticon IF YOU SCORED BETWEEN 34 AND 40 POINTS: You are someone with premium needs. Because of your lifestyle, career, or preferences with hearing instruments, you should really look at the highest end hearing instruments only. Adaptive AI will need to be integrated into your hearing aid to keep you from making constant manual adjustments. Bluetooth accessories are a must. If you are traveling frequently, you should take a serious look into rechargeability. If you work with audio, it is extremely important to ask your Hearing Care Professional about "handle count", which is the prescriptive points of adjustment. If you have an odd shaped audiogram, you may need 20 or more handles to fit your prescription and have true objectivity. If you can't afford the top tier solution, make a mental note of the features you're willing to go without and discuss those in depth with your provider. Hearing aids to look at: Livio AI by Starkey / Styletto Connect by Signia

Folks, we live in a cruel world. We live in a world where people judge and form opinions of people's goodness based upon simple notions. In a world where everyone, at some point, struggles with their health, we still fight stigma every day. Merriam-Webster defines stigma as: "A mark of shame or discredit" and claims "stain" to be a synonym. A stigma arises when doing something good for us may bring attention to a not-so-savory health concern. From a personal place, I have always been overweight. When I was a teenager, I was 15-20 lbs overweight, but because children are cruel, it felt like 100 lbs. When I left high school and went off to my undergraduate program, I spent years eating poorly in the dining halls with all my friends, and gained weight. Then I suffered from a serious illness at 20, and gained more weight. I'm about to turn 26, and have just now begun my gym and diet regiment legitimately for the first time. Now I have 60 lbs to lose. It's entirely due to stigma. At no point did I feel that I was "doing things the healthy way" during these 8 years between high school and now. So why would I continue my behavior? Well, I knew that every time I went out with friends and requested no cheese, no fries or no sauce, it would bring attention to the fact that I am overweight and open me up to comments about what I should and shouldn't be eating by friends who don't see my activity levels day to day. I so didn't want to face my weight that I spent years preferring to feel unhealthy and unattractive over doing something about a very fixable health problem. 12 lbs down, 48 to go! What in the world does this story have to do with hearing loss? Unfortunately, hearing loss is a stigmatized health problem. It would be naive to state that there are not people out there that still associate hearing loss with being less intelligent, less socially adept, and "a burden of old people". This negative view of hearing loss does nothing good for people suffering from hearing loss. Just like my struggles with my weight, people know that every time they change the volume on a hearing aid, the hearing aid chirps, or they have to remove it because of overexposing settings, it opens them up to unwarranted comments about their hearing or hearing aid. To this day, people fight me on smaller instrument sizes or smaller power matrices because they just don't want to take their hearing by the horns. It hurt me, as a hearing aid specialist, when someone deprives themselves of auditory input to go "down a size", but then again, I have shoved myself into a pair of Spanx many times in my life to go "down a size" instead of working out. We sadly, live in a world of quick fixes. Health requires a lifestyle to back it up. Everyone struggles with something, and if you're the person who knows they need to walk around with earplugs because you have a family history of hearing loss, or work somewhere very loud, there is nothing wrong with that. Earplugs and hearing aids exist to help people, not bring out the worst in people. From the bottom of my heart, I pray that everyone who is avoiding getting help with their hearing because of stigma finds the strength to overcome the cruelty of a world that pushes the unhealthy aside. It feels so wonderful to have control over your health. At times it's incredibly overwhelming, because you are the only one to blame for the missteps that everyone takes on the path to health, but when you have the power to overcome something you are labeled with by our world, nothing can stop you!!!

If you are communicating regularly, it's because everyone else is yelling at you. Home may be okay, but even the lightest background noise knocks you out of conversation. TV is jumbled, you probably use a Bose or TV ears to watch it. The phone needs to be on speaker. You have stopped going out to eat or attending parties because it's just too difficult. Unfortunately, it sounds like this person is suffering from a severe hearing loss. It's not a question of whether or not you have a hearing loss. It's a question of whether you could ever do anything about it. It's probably been a problem for so long that it would be overwhelming to fix, right? Maybe at first, but your brain has more plasticity than you expect. Many people don't see the problem until they hit the moderate level of hearing loss, as that is the volume of most communication. Unless you suffered from an infection, medical issue or a sudden hearing loss, you probably know that you have had hearing difficulties for some time. Some people are so convinced that hearing loss is appropriate with aging that they wait decades to do something. Moderate hearing loss is when your hearing becomes a nuisance. Severe hearing loss is when your hearing is now a hindrance. What should you look for in a power hearing aid? When you're dealing with power hearing aids, it's important to begin thinking about the pressure in the ear. Power products can emit a lot of pressure at times, and they usually are fit with some kind of earmold to keep the sound in. This requires a bit of a learning curve for your brain. A power BTE or ITE is probably what you need. These products can be a little bit less discreet but are always full function, which means they are a better bang for your buck. Speaking of "bang for your buck", many people believe the most powerful hearing aids are the most expensive. You can actually fit power aids at every level, but there are some things to consider. Frequency compression is a feature that many power aids need, which takes the highest sounds and drops their pitch to reduce the chance of feedback occurring. This may be mandatory to get your best fit, and should be asked about if you know you're severe. Also, consider how loud the hearing aids could potentially make background noise. You may also want background noise reduction to keep the hearing aid from getting distorted. Severe hearing losses require some work. You may not have heard certain sounds in years. Your brain will not pick those sounds back up overnight. Be patient and honest with your hearing care provider about your progress. It's okay if you cannot wear the instruments a full 8 hours the first week. Just build towards realistic goals and work towards an appropriate wear-time. Nova works with mild, moderate and severe patients every day. For more details about our products, click around the rest of the website or call us at 757-222-5991

Communication isn't gone, but it's beginning to go. Your spouse is complaining about having to repeat themselves time and time again. Smaller sounds of nature- the bubbling of a creek, the chirping of tree frogs at night, and the rush of wind, are virtually non-existent. The TV commercials are loud enough but the programs are hard to understand. You know you have an issue- and it's time to do something. These are the signs of a moderate hearing loss. Things are beyond the small nuisances of communicative discrepancies. Now, it is noticeable at all times. Most people begin to treat their hearing at a moderate or moderately-severe level, so if you've waited until now, don't fret too much. You are still a great candidate for hearing instruments. Moderate hearing losses are where the risks for things like Dementia and increased falls begin. This is also the point where people notice a degree of disability in their lives, and will gain the greatest quality of life change with their new instruments. What should you look for in a moderate hearing aid? Moderate hearing aids are the most commonly fit, and therefore, tend to have the most options. If the hearing loss has relation to aging or noise exposure throughout time, your best option is a RIC hearing aid. If the loss is due to issues from childhood, some sort of custom option like a CIC may be a better fit. These are the two most popular hearing aid styles on the market. Moderate users don't need to necessarily pay more than mild users, but moderate hearing loss can come with secondary issues, such as tinnitus or recruitment (the increased sensitivity to loud sounds), and if that is the case, you may be looking at something more expensive to address those secondary issues. Tinnitus hearing aids especially are often unavailable in the cheapest technology. Moderate patient may or may not have lost sounds in their "acoustic memory". You may have forgotten the sounds of scratching paper, trickling water, or nature, and if that is the case, it may take some time to reacquaint yourself with those sounds. Be easy on yourself in the first 2 weeks. Your brain is getting used to the increased stimulation. If you are a glasses wearer, this could be relatable, as new glasses often come with a slight headache and over-sharpness for the first week. Nova works with mild, moderate and severe patients every day. For more details about our products, click around the rest of the website or call us at 757-222-5991

Sound isn't gone by any stretch of the imagination. You just may refer to it as "muffled", "muddy" or "unclear". When it comes to communication you're generally fine, ergo the noisy restaurant or crowded festival, but you can't help notice that every once in a while you get mixed up in conversation because you're a couple of letters off. It has caused embarrassment or confusion before. Maybe you notice that when the TV is on or a computer is streaming in the background, it's not possible to hear on the phone. Maybe you notice music sounding less sharp than before. These are all the signs of a mild hearing loss. This is often the first few years of presbycusis, or hearing loss due to age. Many people don't see the problem until they hit the moderate level of hearing loss, as that is the volume of most communication; however, you are actually doing the best thing by looking into hearing aids at the mild level. Think about it- you wouldn't ideally want to find out you have a clogged artery when it's 90% full. It's better to know when it's much less severe so you can preemptively treat it. With something like hearing loss, that frequently gets worse with time, this is the best way to handle it. What should you look for in a mild hearing aid? First of all, mild hearing aids should be able to fit the smallest sized shells, so something like an IIC or a miniRIC should do just fine. You also want to ensure good ventilation so your ears can breathe. This allows the ears to take advantage of the hearing it still has. When you vent a hearing aid it sounds much more natural, and mild patients should take advantage of this while they don't need the power. Mild users don't always need the cheapest, nor the most expensive thing. In general, mild users tend to be younger, so if you are into technology, using a smartphone with an IIC can make your hearing solution completely invisible but still functional for you, and able to keep your brain listening. One huge advantage with fitting when you're mild is that there is not a period of "re-learning" sounds that you've lost. You should be able to experience the sharpness of good hearing right away. This makes the first month much more seamless and better for everyone involved. Nova works with mild, moderate and severe patients every day. For more details about our products, click around the rest of the website or call us at 757-222-5991

So you want to protect your ears but don't know where to begin. How can you ensure that your hearing protection is enough for a sound? First off, whatever hearing protection you use will have an NRR rating on the box. This is a "Noise Reduction Rating" and it approximates the amount of decibels that are taken off of a sound. An NRR rating label should look like this: IMPORTANT NOTE: These NRR ratings require you to subtract 7dB from the score. This 7dB has to do with the physical sound pressure hitting the body that cannot be approximated in a lab. With the label above, you should expect consistent protection of 8dB, not 15. The goal of hearing protection is to make the environmental noise safe for the amount of time you spend there. If you are working an 8-hour shift in an environment, the noise level should be 90dB or under. For every additional 3 decibels over 90dB, that safe time is cut in half. Many hearing conservation products have variable levels or filters of attinuation, which means that you can protect yourself from different levels of sound. For example, Westone's TRU Hearing Protection line has filters with 16, 20 and 25 NRR. Why wouldn't you just use the strongest hearing protection for all circumstances? Depending on what you're doing, you may not want to block that much sound out. Hunters needs to hear what is around them, but subdue the blast of the firearm. Musicians want to stay protected but hear the sounds they are making. People in industrial settings may need to communicate with co-workers but protect themselves from machine noise. Let's do an example of a real-world hearing protection situation. Get out your math caps! Let's say that you work at a shipyard that regularly has a machine running at 101dB. You work an 8-hour shift. You are trying to decide if an headset with a 21 NRR rating would be enough. First subtract 7 from the NRR rating- leaving 14dB of real-world attenuation. Next subtract that from the actual exposure. 101dB- 14dB= 87dB This is under 90dB which means that it's a safe level of attenuation for that environment. Last note on hearing protection: Pay close attention to the method of insertion. All these products require a full sealing of the ear canal or their ratings are pointless. Generally, the whole product should be in the ear canal, and nothing should be sticking out. This issue is, honestly, bigger than the issue of supplying protection at all in modern times. If your job provides earplugs, please put them in correctly!!!

Happy July, everyone! As any American knows, Independence day is just around the corner. In Virginia and North Carolina, fireworks are allowed to be set off by professionals. Virginia allows non-projectile fireworks such as sparklers, and North Carolina allows a bit more. Whats funny to me is that the law itself, per the American Pyrotechnics Association (for Virginia), had nothing regarding noise requirements. It turns out many jurisdictions have rules regarding the time of day fireworks can be set off for noise ordinance purposes. That being said, many commercial shows fall outside of those requirements anyway, and professional fireworks can easily fall into the 150dB range. At the point of explosion, this can be louder than many small caliber firearms. Furthermore, firework volumes can vary wildly in relation to things like heat and humidity. Firework noise would probably sound louder in the humidity of Miami than the dry heat of Las Vegas. Do fireworks have to be so loud? Well, no. There are a few companies out there who specialize in "quiet fireworks". In fact, quiet fireworks have accompanied loud fireworks in traditional shows for years, such as "Flying Fish" fireworks, which have a small wiggling tail, and a glittering burst, and have been used for years to accompany larger displays. The difference between the release of fireworks that are quiet and loud have to do with its chemistry. Loud fireworks have large, bursting explosions, and quiet fireworks have more color but less volume. In fact, our own hearing isn't the only reason to keep fireworks quiet. In 2011, a small town in Arkansas was "rained on" by several thousand blackbird carcasses after a New Years Eve fireworks show. The prevailing theory was that the noise either startled them to death, or caused them to run into buildings out of a fear reaction from the noise. It certainly wouldn't be surprised, as I'm regularly comforting my terrified cats every July. Defenders of pyrotechnic noise often claim that the loud ending provides the traditional crescendo that is associated with the show. At the end of the day, no one, not even the makers of the fireworks, really know the noise rating of the fireworks show they are preparing. It is up to the viewer to apply appropriate hearing protection. In general, the viewing location of a fireworks show ***SHOULD*** have a noise rating around or below 120dB. Subtract the NRR rating from 120 to get your exposure. 97 dB is the volume that is safe for thirty minutes of exposure, the approximate length of a firework show. Please remember that children's ears are more sensitive than adults! And enjoy your independence day!!!

Completely-in-the-Canal Hearing aids, or CICs, are VERY popular, and for good reason. These instruments are tiny! Many people come into the clinic dead-set on CIC instruments, for better or for worse. CICs are the small class of custom in-the-ear instruments that go into the canal, and if anything is visible, it's just the end of the face plate. Some especially deep CICs, usually referred to as IICs, or Invisible-in-the-Canal instruments, are completely blended in, or have a deep face plate that doesn't show externally. Who are CICs made for? CICs were never made exclusively with invisibility in mind. When custom instruments came out, there were people who wanted the custom fit, but found the full shell and half shell instruments to have too much bass or be too powerful. CICs were made for those with a mild loss and who didn't want or need the extra size. Today, CICs can be nearly as powerful as their full shell and half shell counterparts (many of our CICs have 10-15 dB of gain difference from the max-out position on the larger customs in that line). People who come in for CICs today are not people generally looking for a less powerful solution or for less bass. CIC-oriented clients usually come in because of the size. CICs, from an audiological perspective, do best on people who come in with a mild-to-moderate flat or reverse sloping loss. Essentially, they must have some degree of bass frequency impairment. If you have no bass frequency impairment or are VERY severe across the board, you are not the best fit for a CIC. That being said, you may have a high frequency loss and be in a CIC. It may be working perfectly fine for you! Today's technology allows for a lot of wiggle room when it comes to the prescription; however, you cannot ignore the basic acoustic principles of filling the ear canal. Just like an earplug, filling the ear canal with a CIC that is off will still stop up the high-pitched sounds but not the low-pitched ones. This can lead to trouble in background noise, which is often in the low frequencies, and can lead to people feeling like their own voice quality is "in a barrel" or "in a tunnel". The biggest downside to CIC instruments in comparison to all other types of instruments is the availability of secondary features on the CIC because of the size. Speakers have become small, microphones have become small and computer chips have become VERY small. Bluetooth transmitters are not yet small. Batteries are only capable of being so small. While computer chips are small, its circuitry is rigid, which can cause it to take up an oblong space inside the instrument. On top of all of this, the speaker and the microphone have to remain a certain distance apart or else they could feedback. Sound like a lot to engineer? It's especially difficult when you're working with 15-20 mm of space! Bluetooth is pretty much, as of 2019, unavailable in CIC instruments. Rechargeability is unavailable as well. Windscreens are usually unavailable or at least simplified. Certain microphone patterns, such as backwards-facing microphones, may be unavailable because the CIC has no backwards-facing parts that are external. At the end of the day, it is between you and you hearing care professional to determine whether a CIC or another type of hearing instrument is the best fit for you. If you are a candidate for a CIC or an RIC and you are leaning towards a CIC because of size alone, ask your Audiologist or Hearing Aid Dispenser about the features of the RIC versus the CIC. Weigh the features and the size against each other. There are certainly jobs that require heavy public speaking, sales or customer service where the size requirement of the instrument may heavily outweigh its features. At the end of the day, the most visible hearing loss is always the one that goes untreated! (Quick author's note: If I sold anything other than hearing aids, I would probably want a CIC over a RIC for aesthetic, so I get the hype).

Screeching, chirping, squealing, ringing. Feedback. Everyone's heard it, no one likes it. Older hearing aids do it every time you hug your friends, chew food or get too close to a wall. Newer hearing aids often will have cut out features for feedback. Why does feedback exist? What causes feedback? There are actually a few kinds of feedback. The most common one is acoustic feedback. This is the usual feedback you here when the hearing aid gets in the proximity of another person or a wall. Have you ever been to a meeting that is set up with a PA system, and someone covers the microphone and it screeches through the whole system? This is what is going on with the hearing aids, just larger scale. When a microphone picks up the sound of itself, it begins to loop its own mechanical noise. The looping of that noise picks up, gets louder and louder, and then after a moment, becomes that horrible squeal we all love to hate. I like to think of feedback as an auditory representation of the infinity mirror trick. It's caused by its own reflection. This type of feedback is a natural acoustical phenomenon, therefore, it's hard to avoid completely. There is nothing that can stop all feedback in all circumstances. Many hearing aid manufacturers have specific feedback reduction features in their instruments to pick out feedback and reduce the gain of it when it's present. This year, Oticon released their Opn S platform, powered by the Velox S chip, which has a new means of feedback reduction. These graphs are called spectrum. The colors represent how much of each frequency there is through time. Dark red would show the highest density of sound and dark blue would show the lowest density. In the dark gray circle is a period of feedback. As most modern hearing aids, there is a longer solution to keeping the feedback from continuing indefinitely. This period of feedback lasts about a third of a second, which isn't too bad, but certainly audible. The second chart shows the new OpenSound Optimizer from Oticon at work. The hearing aid sensed that initial increase of energy, as show by the small red line at the start of that circle, but once it noticed the feedback, it began to introduce a feedback breaker, which is marked by the small green lines. The breaker turns off that specific frequency for a millisecond, and then turns it back on. These breakers are so short that they aren't audible to the majority of the population, but keep that frequency from gaining enough power to feedback until the longer term feedback reducer kicks in. This reduces the feedback from a third of a second, to less than a tenth of a second. There is another type of feedback that hearing aid uses can experience. Does your hearing aid have a telecoil? This is a specialized copper coil that connect the hearing aids to non-Bluetooth phones, such as a landline or office phone. Telecoils would use a magnetic pulse to draw in the incoming signal of the phone. They also still use telecoils in many churches, meeting rooms, airports and even the NYC subway! Having a telecoil has one downside which is potential magnetic feedback. This is still feedback, but sounds more like a grinding or humming than a squealing. Places with large flourscent lights are most likely to trigger magnetic feedback, such as a home improvement or club store. Unfortunately, there is no real cure to this type of feedback, as the industry is moving towards Bluetooth compatibility instead of telecoils, but older hearing aids may still have telecoils. In all actuality, magnetic feedback is a good thing, because if you walk into Costco and your hearing aids begin to grind and hum, that means the telecoils are working well, which is what you want! The real cure is making your spouse do the club shopping!!!

The Virginia Department of the Deaf and Hard of Hearing (VDDHH) is a special agency for members of the commonwealth that struggle with communication and hearing located in Henrico, Virginia. While VDDHH doesn't currently help finance actual hearing instruments for Virginians, they are still an excellent resource for many different things. Virginia Relay has been a partner of VDDHH since 1991. Virginia Relay works with a TTY (Text Telephone), and a relay agent. You use the text telephone to essentially text your responses to a relay agent, who read this text to the recipient and then writes back the response. This is great for older individuals who are not familiar with cell phones or greatly prefer landlines, but cannot hear, or properly communicate within the conversation. This isn't just great for people with a hearing loss. The relay agent can also restate spoken speech for individuals who can speak but have issues with things such as Parkinsons, stuttering, Muscular Dystrophy, or had any throat or laryngeal surgery. Services are available in English and Spanish. You can receive your TTY phone through VDDHH. The Technology Assistance Program (TAP) helps Virginians with hearing and communication difficulties who are below a certain income level. They can provide TTY phones for Virginia Relay along with other technologies to qualified individuals, such as blinking alarm clocks, blinking doorbells, or blinking phone "ringtones", along with highly amplified phones. If you do not qualify for the income requirements, these TAP devices can still be purchased on a 30 day loan-to-purchase basis. ***All Veterans with hearing difficulties who provide proof of honorable discharge are automatically eligible for TAP, regardless of income.*** VDDHH also keeps an up-to-date list of ASL interpreters who are both nationally and VQAS (Virginia Quality Assurance Screened) qualified. VQAS has four levels of interpreters. Level One would be for someone who needs basic information, and Level Four would be for any complex messages or conversations foregoing anything legal or life-threatening. VQAS can interpret to ASL or transliterate spoken English. For legal services, a program called CART is available to get real-time interpretation to be available for court proceedings. CART interpreters are also available through VDDHH. Anyone with deafness or communication disorders should at least scan the VDDHH website for resources. Most of their services are mandated and free for Virginians who need it.

You are just fine right? It's not that you can't spend a few thousand dollars. You're getting by now, so why pay so much to have a machine do what you can do yourself, right? You KNOW the dementia study, you KNOW about increased falls, but just can't reconcile it in your head. Did you know that the average hearing aid candidate gets fitted seven years after the decline begins? Why? There's a few reasons. First of all, what we refer to as the "speech banana", the intensity of most communication, is primarily at the mild to moderate level. Someone who is borderline or mild may not have any difficultly with speech sounds, or may only struggle with specific letters. The degradation of hearing is so slow for most people, that it may take seven years to hit a loss with mild to moderate severity, but by the time you have reached that level, you have already lost around 20% of your ears, and that will likely never return. With that slow slope, it's so hard to notice a difference day to day, and easy to deny the problem. The second reason I see people holding off on hearing aids is because they don't want to look "old". The public perception of hearing aids is that they still look like this: Even if hearing instruments still looked this bulky, nothing looks as old as cupping your ear and yelling "WHAT?" a dozen times a day. Luckily, even the largest hearing aids today are not this large. As far as looking "old" goes, there are styles of hearing aid that are very modern and discreet. You could always look into a CIC solution, which is molded into the ear canal, such as an Oticon Opn custom, or Signia Insio. Using smartphone apps can also further disguise your hearing instrument by taking the place of making manual adjustments. Fiddling with the instrument itself always brings attention to it. The final reason behind people refusing to get hearing instruments is simple denial. Some patients cannot be convinced of an actual problem, even if they are far beyond the speech banana, and are completely uninterested in the aesthetic. You cannot know what you don't know, and you cannot know what you don't hear if you are not hearing it. At the end of the day, the patient will never receive a successful fitting if they cannot reconcile that they are missing sounds. Birds, alarms, cars, crickets, the wind...these aren't so functionally important, but they are the types of sounds that you may not even know you are missing. If you go into a hearing healthcare office, even at the suggestion of a spouse or child, give your specialist a chance to prove what you've been missing. It's easier to see what someone doesn't have from a third perspective, which is why the SPOUSE (and not you) probably saw the problem to begin with!

Any hearing aid user knows that background noise is the bane of their hearing aids' existence. Any personal sound amplifier user knows that more volume does not mean more understanding. Why is background noise such a problem? The struggle with background noise is that there is no specific type of noise that is always "in the background". Any noise can be background noise. In the example above, the signal noise (i.e. the important noise), would be the wife of the listener; however, there is a lot of kinds of background noise present. The heating system is making noise, the TV is making noise, and there are also three other speakers in the room that are background noise, but still speech. How can a machine pick between speech and noise when speech is all over the place? Since the end of the 1990s, directional microphones have been the cure to this problem. Directional mics only catch the sound coming in from a single direction. In the case above, the hearing aids would be set with directional mics aiming the same way as the listener's eyes. In essence, as long as he was looking at his wife, she would be louder than the others in the room. Most hearing aids through the 2000s had directional microphones to allow for this ability, given the needed space. The user would switch between an omni mode (hearing all 360 degrees), and a directional mode. If the user knew when to change modes, this usually worked well, but some individuals didn't have the ability to remember the program uses, and would leave the hearing aid permanently on the omni mode, losing the ability to hear in noise, and devaluing the instrument. While this was a fantastic option for most wearers, there was still a lingering problem. What do you do with multiple signals? Say that it's Thanksgiving Day, and instead of just talking to your wife, you're at the table with your wife, your kids, her brother, his kids, and the new grand-baby. Will directional mics work there? You'd have to anticipate the speaker before they began to talk and turn your head to face them. It probably won't work. This has been the new goal for several manufacturers in the 2010s. How can a hearing instrument classify signal and noise without relying on just directionality? It requires very, very fast processing. Oticon, one of Nova's manufacturers, created the OPN hearing aid in the mid 2010s, which didn't just use directions, but it classified between speech and non-speech and used the volume of the speech when entering the mic to decide if the speech was signal or background noise. Following that, Signia and the other major 5 labels of hearing aid all are going to be entering 2020 with some type of classification ability, so you are no longer relying on one speaker at a time. This is often referred to as "adaptive" or automated directionality. Maybe can be changed on a smartphone without using up a "program" on the actual instrument. Unless you truly are a homebody, any modern hearing aid wearer needs directionality of some sort. This is not something to be cheap about. It's not worth being overstimulated in noisy environments to save a few hundred bucks. If you can manage a traditional directional microphone system, just be sure your hearing aid dispenser makes it very easy for you to switch between the omni and directional modes. If you don't feel as though you can work the switch, look deeply into automated directionality. In the last ten years, this is one of the greatest steps in audiology that the industry has made, and for people that struggle with dexterity or memory, it makes things incredibly easy. As always, discuss directional needs with your audiologist or hearing aid dispenser!

Beethoven? Van Gogh? It seems like there are no celebs with hearing loss. Amazing how small hearing aid technology is today, isn't it? There are actually quite a few people with hearing loss that you may know: Former President Bill Clinton - Clinton has presbycusis, or hearing loss due to aging, and wore CIC hearing aids in office! Think about it, more confidential information probably passed through those circuits than anything else in the late 1990s. Glad Bluetooth wasn't around yet! Eric Clapton - Last year (2018), legendary guitarist Eric Clapton finally came out publicly as having hearing loss and tinnitus from years and years of noise exposure. He is now an advocate for hearing aids and hearing conservation. Lou Ferrigno - TV's "The incredible Hulk" has worn hearing aids since he was 4 year olds. He lost his hearing due to a childhood infection. He attributes a lot of his strength to working through his disability...and this is Lou Ferrigno! Rob Lowe- Rob Lowe has single sided deafness in his left ear, but good hearing on the right side. He says he can usually rely on his good side to hear, except in background noise. Hey Rob! Signia just release a CROS CIC system that's invisible. Call me! Rush Limbaugh- Famous conservative commentator Rush Limbaugh came out publicly as "virtually deaf" in 2001. He was a candidates for binaural cochlear implants, and has been able to restore some of his hearing. The cause of his hearing loss is debated, either due to an immune disorder, or toxicity from opiate medication. Whoopi Goldberg- Whoopi Goldberg has spoken on the air a few times about hearing loss and hearing aids. She claims to have put her ear right up to the speakers when listening to music. She likes to speak to kids about turning down volume on phones and music players. Stephen Colbert- Stephen Colbert has single sided deafness in his right ear from a surgery that was attempting to repair his eardrum. Supposedly, his right ear is a very weird shape to date.

Most modern hearing aid wearers use Behind the Ear hearing aids. They're easy to fix, quick to clean, and fit even the highest degrees of hearing loss. Every Big 7 brand has BTE hearing aids, most smaller brands have BTE hearing aids, and even the majority of Personal Sound Amplifiers use microphone consoles similar to BTE hearing aids. Because BTE hearing aids are easy to assemble, they are easy to fit with the latest and greatest technologies. Many BTEs are rechargeable, and most BTEs today have either full Bluetooth connectivity or NFMI, which allows the unit to be controlled by a remote smartphone app. BTEs are often the cheapest AND the most expensive type of hearing device depending on technology. Overwhelmed yet? Don't be. Most BTEs are one of two categories: RITE hearing aids: The majority of the adult hearing aid market today is in a RITE style hearing aid, also known as RICs (Receiver-in-canal) or SIEs (Speaker-in-ear). They are smaller than traditional BTEs. RITEs have a small wire that connect the console to a speaker, which sits inside the ear canal. Usually a small silicone dome holds the speaker in place. Because the speaker is on the end of the wire, RITEs are usually small. The battery, or rechargeable power cell, and digital signal processing chip are in the console. RITEs can have molds that either click onto the receiver wire, or are built into it. Traditional BTE hearing aids: Traditional BTEs are primarily aimed at the pediatric market because it's easier for growing children to repurchase acrylic earmolds than to buy new hearing aid during every growth spurt. BTEs are designed to fit the highest severities of hearing losses in adults, or specific circumstances (more on that in a moment...). Traditional BTEs usually have a custom-cut acoustic tube and mold attached to the BTE console, but can also be worn "open fit", with a skinny tube and RITE-style dome. The speaker is at the top of the acoustic tube, in the actual console, which forces BTEs to be slightly bigger. The speaker, microphone, and digital signal processing chip are all in that console. Tight fit! When would an adult fit a BTE over an RITE? RITEs are clearly the smaller and more attractive choice. On top of that, RITEs have the least mechanical noise because the speaker and microphone are so far apart. So when would anyone prefer a traditional BTE? Believe it or not, RITE are notoriously over-fit by many MANY hearing aid dispensers in Hampton Roads and beyond. Why? The first type of person to not fit with RITEs is someone prone to getting the speaker dirty. Are you in a RITE hearing aid that gets clogged every other month? Are you always replacing wax traps? Anyone with an overproduction of earwax is going to find a RITE to be a huge pain in the ear. The speaker is only covered by a silicone dome. If you see wax on your music earbuds when you remove them, you will see wax in your speaker when you remove your hearing instrument. People with sinus drainage in their ears or Eustachian tube dysfunction that backs up into the ears would also do better with a BTE over an RITE. This is the other common reason to fit kids in BTEs. They are most prone to certain types of ear infections and drainage. After years of fittings, trust me, you will not mind trading another centimeter of size to give up all those cleaning appointments. The second type of person to not fit with a RITE is someone with severe low frequency loss. RITEs are comfortable because the ear is so open, but the bass sounds have a tendency to just bleed out, especially when the RITE is fit with a dome instead of a mold. If you know you have a severe low frequency loss, and you want to downsize into a RITE, enjoy calling every sound "tinny" for the next 5 years. At the end of the day, you and your hearing care professional should consider either style of hearing device. RITEs are a fantastic choice for the majority of hearing aid wearers, but don't allow yourself to be misfit because of a size concern!

You've been to a few chain retailers, an audiologist or two, and have been told you need technology that is "Top-of-the-Line". You have to try to swallow spending over $4000 an aid on hearing instruments, or try to buy a personal sound amplifier for $200 off an ad you saw on Facebook. Is there really no middle ground between $8,000 and $200, or is someone taking you for a ride? Who are Top-of-the-Line hearing aids made for? Let's begin with the good news. Your hearing will not "slide" into that $4000 an aid range if you don't do something about it. It may slide to the point of needing a new set one day down the road, but worse hearing doesn't mean higher prices. Most higher end (Big 7) manufacturers don't just sell one "Top-of-the-Line" product. In fact, it's usually and entire group of hearing aids with different batteries, sizes, and custom features. There is never a "best" hearing aid. There is always a "best" fit. That being said, Top-of-the-Line hearing aids are usually the best fit for similar types of people. 1. High Fidelity Audio Quality The most obvious person who has "top-of-the-line needs" is a musician, audio engineer or audiophile. Most of these people would notice the difference between a decent hearing device and true premium technology. Top-of-the-line hearing aids are frequently the only ones in their brand who have extended bandwidth, or higher high-frequency sound. This makes everything go from clear but flat, to rich and full. It's the different between listening to a live concert on your tablet and attending that concert. 2. Handles Top-of-the-line hearing aids also have the highest "handle" count in their brand. These are the points of adjustment for your audiologist or hearing aid dispenser. Musicians and audio engineers need what is referred to as "flat" hearing, or hearing that is equal loudness at each frequency, so they can get an objective ear for the audio they are working with. The more handles in a hearing instrument, the closer we can match to targets, and the closer we can match targets, the more your hearing will become objective and flat. Outside of people who work with audio, there are times where people with a less common etiology for their hearing loss and an "unusual" audiogram shape may need Top-of-the-Line for the same reason. If your audiogram is not a smooth line and looks more random, Top-of-the-Line may be the only way you can be fit to your prescription, as the fitting formula and real-ear may struggle to approximate you into a lower tech fit. 3. Speech in Noise If you do not struggle in all types of background noise, quiet or loud, then Top-of-the-Line is not necessary for you. These hearing aids always have the most advanced background noise reduction, and are made to automatically cut out noise in any environment. This is perfect for people who struggle in many types of environments, but who cannot keep up with adjusting the hearing aids every time they change their environment. With that being said, you also want to ensure you'll use the background noise reduction to its fullest. If you severely struggle in background noise, but are only really in it during special occasions, then you may do better by getting a mid-level hearing aid and a separate external microphone for a few hundred bucks more, and using that microphone as your "background noise reducer" in that special occasion. 4. Echoic Areas There is a specific population that always sees benefit in Top-Of-The-Line technology, and that is anyone who frequently works in an echoic area. This can include in subway systems, megachurches, malls, conference rooms, or large university classrooms. Echo is a very difficult thing to process out, as hearing aid are always on the lookout for speech sounds. Again, this can be important or unimportant depending on what you do. If you're a pastor who has 500 congregants all talking in a room with high ceilings and stained glass walls, you may want to look into Top-of-the-Line. 5. Acclimatization and AI The last population that may want to look into Top-of-the-Line hearing aids are people who are active in different acoustic environments, but may not have the capacity to make any manual adjustments. Most Top-of-the-Line hearing aids use Artificial Intelligence or "Acclimatization" to teach the actual instrument the person's preferences. In extreme cases, these technologies can be perfect for someone who has no dexterity or no ability to change any settings.

It's funny how custom In-The-Ear instruments cause people to think one of two ways about pricing. I have had people come to me and expect the smallest, most invisible instrument to be the most expensive, and at the same time, have had people who think the most powerful, most filling instrument should be the most expensive. Which is it? Is someone who waited a little too long going to be automatically footing an $8,000-$10,000 bill for a larger Full Shell? Or is the individual who works as a realtor, group speaker or clergyman going to get stuck with that bill for the invisible IIC? If an Audiologist or Hearing Aid Dispenser ever relates size to price in this day and age, RUN!!!!! Originally, before programmable hearing aids were ever an option, size did correspond to pricing. When ITE instruments came out in the 1960s, there were pricey in comparison to transistor-powered body aids and behind the ear product. Analog technologies sometimes required size for a decent bass frequency response. Here are a couple ITE designs from the 1960s. At that time, when ITCs, CICs and IICs were just a dream, circuitry did have to fit in the shell, so the theory that "More Power = More Price" does have some truth behind it. When it comes to the idea that smaller technology is more expensive, there is truth behind this theory too. Many times, smaller and more discreet technology is more expensive than the bulkier technology. This can be true with braces and glasses. To this day, many chains of hearing aid brands still upcharge for an IIC, which is the smallest, most invisible hearing aid available on the current market. You may be told that this is due to the small size, but it's often due to states requiring a class be taken before extra-deep impressions are allowed to be shot, limiting the providers and price points available for IICs. In these cases, a CIC is only a hair larger and can be made in dark, well-contoured colors. In today's market, when debating over a custom made instrument, the price should only be dependent on the technology inside your custom instrument. Technology has gotten so small, and the difference between a standard speaker and a power speaker is minuscule. Look at the end of a receiver of a Receiver in the Ear instrument. That tiny square box is your speaker. These are the same speakers that are inside the shell of your custom instrument. That being said, there are still differences between modern IICs and modern ITEs in function. Certain technologies still do not fit in IICs, such as Bluetooth or Telecoils. On top of that, IICs generally have no wind shields available, but that is less due to size and more due to the IIC fitting so far in the ear as to not be disturbed by wind, but may still not be the idea choice for someone in the wind constantly, like a landscaper, fisherman, or motorcyclist. The choice of custom instrument size should be a matter of your low-frequency prescription 1000Hz and under, your audiologist or hearing aid dispenser's recommendation, and quite simply, what you are most comfortable wearing. If you decide on top-of-the-line custom hearing aids, it should be because you will be using it in many challenging acoustic environments. If you are ever pushed into an uncomfortable price point on the basis of reducing or augmenting the size of your custom instrument, once again, RUN!!!!!