Ear Job (2): Hearing Aids

[This continues the post from a few weeks ago, when I first got into the issue of my hearing.]

The school year 1963-64 (7th grade for me) was notable for a bunch of reasons. Certainly there was the JFK assassination, which I didn’t really “get” at the time. It was the year when I first read Catch-22, first read James Thurber, first read Will Cuppy. Although I can’t pin it down, exactly, I think it was in 7th grade when I first decided I wanted to Be A Writer (whatever the hell that meant).

And I got my first hearing aid.

For about six years, since my 1st-grade teacher Mrs. Burkholder noted the hearing problem (or rather, the lip-reading solution), Mom and Dad had been schlepping me across the Delaware River every now and then to Philadelphia — specifically, to Jefferson Hospital.

There, the docs had tried their darnedest to isolate the source of the problem: damaged auditory nerves? cochlear injury or simple insufficiency? something with the brain itself, maybe? was it congenital, built into the genes, or did “something happen” somewhere along the line to make what had once been normal hearing less-than-normal?

Bottom-line answer to all those questions was that I had what’s commonly called nerve deafness, regardless of what caused it. And since they couldn’t — still can’t — actually repair or replace auditory nerves, the only reasonable solution was a hearing aid.

As is still the case, the doctors back then reported that I was hearing-impaired in both ears. Yet oddly, at the time, they determined my right ear to be stronger than my left. So the right ear was where the aid went.

(The idea is not to bring both ears into rough parity. The idea is to boost at least one ear to as close to normal hearing as possible.)

Those were primitive times for hearing-aid buyers, at least in South Jersey. The principal source of information, apparently, was advertising. Not surprisingly, then, my parents purchased this first aid from a Beltone salesman in a nearby town. (Beltone was easily the most-advertised manufacturer then.) The aid was maybe two-three inches long, plastic, vaguely tannish pink, and it went behind the right ear (hence the hearing-aid wonk term “BTE,” for “behind the ear”); a clear plastic tube curled up over my ear and connected the aid proper to the “ear mold,” a plastic plug in the shape of the entryway into my ear.

This hearing aid worked through simple amplification: it made everything louder. (The first time the family dog barked when I was wearing it, it felt like someone had set off a firecracker next to my head. The ear rang, which I’d heard ears could do but had never experienced for myself.) It had two controls: on-off and a dial to control the volume. Note the word “everything” a couple sentences back: if I turned it up to hear the TV better, the sound of a shout or a slamming door or the ringing of the telephone were also boosted — making it correspondingly difficult to hear the TV. And there was a strange echo effect, too, like listening to the outside world through a big tin fruit-juice can with both ends cut off.

So the sound quality wasn’t the greatest. Still, that wasn’t the biggest obstacle to my using the hearing aid — not at first.

Again, I was at the time only 12 years old. And this was the early 1960s. So my hair was short — crewcut for a few years, then something called a “flattop” cut.

Thus, my initial obstacle to wearing the aid was plain old pre-teen vanity: there was no hiding the fact that I wore one. And no one else I knew, not even my oldest family members and certainly none of my classmates, no one else wore one.

(This remains by and large true. Even now, I’ll sometimes be changing the battery — which requires me to remove the aid — and someone will come into my office. The other person, suddenly realizing I can’t hear and also thrown off by the absence of a Miss Manners to handle the etiquette of situations like this, will back-pedal and (I guess) mutter apologetically. As I tell people, the whole thing makes me feel like I’ve been interrupted in the process of screwing in my wooden leg.)

Over there at the left, you’re looking at a pair of antique “ear trumpets” (made from papier mache, of all things) which surfaced in an auction in Scotland a few years ago. One Sebastian Pryke, “a fine antiques specialist,” told the BBC at the time that “it was impossible to find an exact date or location for the trumpets, which gives the user amplified stereo sound.” Mr. Pryke went on to say:

I suspect they were specifically made for someone who had a very keen idea of what they wanted. Someone who was lacking in vanity as well as hard of hearing.

A keen idea of what they wanted. Yes. I’d be well into my 30s by the time I adopted a similar common-sense priority.

By then, the relative strength of my ears had switched. The left hadn’t lost much more hearing ability than it ever had, but the right was functionally deaf. (Hearing-aid specialists and audiologists have told me that “it never happens” that an ear can grow dependent on the use of an aid. What I believe probably happened was that I’d simply deafened myself on that side, by keeping the volume up too high, for too long.)

Luckily, by then both microelectronics and audiology had advanced to the point that an easy solution presented itself, in the form of so-called “BiCROS” hearing aid technology. To understand this term, start with the acronym itself. As one site says:

CROS is an acronym for “Contralateral Routing Of Sound.” “Contralateral” is just a fancy word that means “on the other side.” Thus, very simply, a CROS hearing aid takes the sound arriving on one side of your head and feeds it into your opposite ear.

A BiCROS hearing aid is used when both ears have lost some hearing, but one is significantly stronger than another. In this case, both ears are amplified: each ear has a microphone pickup, but the signals from both mikes get channeled only to the stronger ear.

The first BiCROS aid I owned was made by a company called Telex. (That division of Telex has since been acquired by a company named Phonak.) That isn’t my Telex BiCROS in the photo at the right, but it does illustrate how much of a step forward I’d taken from the previous model to this new Telex. It was a wireless BiCROS model: the signal from the (weak) right ear was transmitted on an FM channel through my head to a receiver in the left-ear aid — which also had its own mike.

The good news was that I could now “hear” roughly equally well no matter what side the sound came from. The bad news? I didn’t know which side it had come from. If you clapped your hands at my right, then clapped them at my left, the clap sounded exactly the same.

(This continues to be a problem, by the way. If I’m in a room with several people — especially if I’m preoccupied and/or can’t see all of them equally well and/or don’t know their voices — and one of them calls my name, typically I must pause a beat or two to try to pick up some non-verbal cue about which way to direct my attention.)

Eventually, like the person who used the Victorian ear trumpets a few paragraphs back, I got the point: It was flat-out stupid to worry about how the things looked. Get the best hearing aid you can afford, and make a point of affording the best became — and remains — my mantra.

Oh, the word “afford” comes with problems of its own, naturally. For one thing, to the best of my knowledge there is not a single health-insurance program in the country (not Blue Cross, not Blue Shield, not any HMO) which covers hearing-aid purchases. And these newer precision units can be expensive, too. The pair I’ve had for a couple years now, well, I’ll just say they run to four figures. So you need to plan for them.

But these are pretty super-duper hearing aids, I’ve gotta say.

They’re from Phonak — the company which bought Telex’s wireless BiCROS line. This pair has a wire connecting them, which runs across the back of my neck; through that wire passes (in one direction) battery power and (in the other) the signal from the right-side mike. (I don’t care if anybody sees the wire. I just want to hear as well as possible.)

Most importantly, they’re digital instead of analog. This means several things, not least that they’re programmable. Unfortunately, I can’t program them myself; I need to take them to my audiologist, who connects them to her computer, clicks a bunch of things with her mouse, and voila: a perfectly tuned sound system.

What do I mean by a “program” in this context? The models I’m using, with the options I’ve chosen, have five programs I can select from, by pushing a button on the surface of the left side:

1. Telephone setting (more about this in a later post)
2. Voice frequencies preferred: sounds in the range most common for human voices are emphasized, others are minimized — but only in the primary (left) aid. (The right side is off.)
3. True BiCROS: both hearing aids are active.
4. Fully automatic signal processing: active, like program 2, only in the primary aid. This is the setting where the real magic occurs. The aid itself samples and analyzes the sound environment many many times a second and adjusts itself accordingly. For example, a constant hiss will be understood as background noise, and suppressed; very loud noises (to which many hearing-impaired people, strangely, are extra-sensitive) are instantly dampened; and so on.

I had a couple of other choices available. One was a “mute” program, which shut off all sound. This sorta-kinda worked like an Off switch, except that it still drained the battery. Seemed impractical to me so I passed. Another was a “music” program, which would be of special interest if I were myself a musician or an audiophile. Again, limited utility: pass.

The default program (by my choice) is #3. After all, I figured, the main reason these aids are so expensive is because I’m paying for two of them (which, in turn, is because I want full 360-degree coverage); why not use both, more often than not?

Even as I’m preparing to publish this post, I keep thinking of more stuff to add. I’ll just come back and do that later, over time. It’s already awfully long! In the meantime, I hope you’ll appreciate the photo below — again, not my actual hearing aid (duh) — which just seemed to symbolize a natural progression from basic tube-connected ear trumpet to wacky electronic super hearing aid.