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Senior Health & Medicine
Study Finds Hearing Aids are Underused by Senior
Citizens that Need Them Most
Upwards of 50 percent of hearing aid users are
not satisfied
 June
2, 2006 Hearing loss increases with age and affects approximately 31.4
percent of senior citizens over age 65 and 40 to 50 percent of people
75 and older. In nursing homes, this number is believed to be 70 to 90
percent. Yet, only one in five Americans who could benefit from a
hearing aid has one and just one-third of those use them.
Hearing loss can contribute to strained
relationships with family and friends, depression and even a
deterioration of basic well-being, according to a new literature review
conducted by the Medical Technology Assessment Working Group at Duke
University.
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Researchers found consistent evidence that hearing
loss contributes to a decline in quality of life, particularly among the
elderly.
However, they also found no research in existence
documenting how hearing devices can enhance everyday experiences.
Approximately six million people in the United
States use a hearing aid, most for treating moderate hearing loss, but
35 to 50 percent of hearing aid users are not satisfied, the study
found.
(See
brief history of the hearing aid below news report.)
Hearing loss is one of the most prevalent chronic
health disorders in the United States. According to the National
Institute on Deafness and Other Communication Disorders (NIDCD),
approximately 28 million Americans have some degree of hearing
impairment.
Hearing aids are being underused, in part the Duke
team reasoned, because of social attitudes that reflect
misunderstandings about hearing loss (e.g., beliefs that hearing loss is
inevitable later in life) and because of the cost and possible
inconvenience of hearing aids.
"One area of critical need is understanding the
barriers to hearing aid use that contribute to irregular use of hearing
devices by those who have them," said Linda K. George, Ph.D., professor
and project director of the study. "Until these areas are better
understood, continued innovations in hearing aid devices will be
hampered."
The report noted that it would not be surprising to
find that the use of devices for hearing loss is associated with
substantial increases in productivity and other social contributions,
but as yet, the issue has not been validated by research.
Investigators also found that research to date
devotes little attention on matching consumers to specific types of
hearing devices (e.g., cochlear implants, hearing aids) and the extent
to which consumers can choose among devices. The Duke team urged more
research be undertaken to understand the impact of hearing devices on
social, emotional and physical disabilities, as well as the consumer
effects of patient education on the use of these devices.
As found in other disease fields examined by the
Duke team (including sensory, musculoskeletal, renal, cardiovascular,
and cancer), available information on device evaluation lags
substantially behind advances in technologies. For example, most of the
evidence available to the researchers was based on hearing devices that
have been superceded by newer versions.
The study examined the impact of medical
technologies on treatment of hearing loss, with emphasis on the elderly
population, and is part of larger study funded by a grant from InHealth:
The Institute for Health Technology Studies, to examine the effects of
medical technology on patients, particularly those who have completed
treatment or received care. InHealth is a nonprofit research and
education organization that studies the role, impact and value of
medical technology through non-restricted grants to independent,
academic investigators.
"Hearing aids are a great example of how medical
technology can have a profound effect on quality of life for millions of
people," said Executive Director, Martyn Howgill. "We need a better
understanding of why people are not using hearing devices in order to
improve hearing aid technology in ways that would surely aid untold
millions of potential recipients."
For complete report,
click here.
About the Duke University Medical Technology
Assessment Working Group: Researchers at Duke University are assessing
the impact of medical technology on patient populations in five major
disease categories: cardiovascular disease and stroke, sensory
impairments (hearing and vision loss), musculosketal diseases,
neoplastic diseases (cancer), and diabetes. To estimate medical
technology effects, the team reviews statistics from the Medicare
Current Beneficiary Survey and the National Long Term Survey, and review
literature from scholarly publications. The project is under the
direction of Linda K. George, Ph.D.
About InHealth: Founded in 2003, InHealth: The
Institute for Health Technology Studies (formerly known as The Institute
for Medical Technology Innovation) is a 501(c) 3 nonprofit organization
that supports independent, peer-reviewed insights and research into the
value and impact of medical technology in quality health care. InHealth
is funded by unrestricted philanthropic gifts.
www.inhealth.org
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A Brief History of Hearing
Aids |
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Hearing aids have been used
to compensate for hearing loss for a long time.
Electronic hearing aids were
developed after the invention of the telephone by Alexander
Graham Bell in 1876. However, until the 1950s their use was
limited due to their large size, heavy weight, and limited
efficiency. After transistor hearing aids were introduced in
the early 1950s, the use of hearing aids increased rapidly
because smaller transistor 13 size and lower battery voltage
requirements permitted dramatic miniaturization compared
with earlier devices. According to American Hearing Aid
Association data, in 1953 there were an estimated 225,000
hearing aids sold in the U.S. Of these, 100,000 were
alltransistor, 75,000 were hybrid, and 50,000 were
vacuum-tube models. One year later, in 1954, an additional
335,000 hearing aids were sold, 325,000 of them
all-transistor models (Bernard Becker Medical Library,
2005).
Before the mid-1980s,
hearings aids did little more than amplify sound. These
analogue systems used a microphone to turn incoming sound
waves into an electrical current to be amplified. A speaker
then transformed the electrical current into sound waves in
the ear canal. In 1996, the first digital hearing aid
emerged. Instead of turning sound waves into electrical
currents, they are converted into binary signals, processed
by a speaker, and transformed into sound waves. The quality
of sound is better in digital systems. In 1999, GN Danavox,
Inc. of Minnetonka, Minnesota launched the first hearing aid
consisting of a miniature computer with both hardware and
software (Bernard Becker Medical Library, 2005).
Types of Modern Hearing Aids
There are four basic styles of hearing aids (NIDCD, 2005):
In-the-Ear (ITE) hearing aids fit in the outer ear and are
used for mild to severe hearing loss. The case that holds
the components is made of hard plastic. These are suitable
for adults; for children, the casing would need to be
replaced as the ear grew.
Canal Aids fit into the
ear canal and are available in two sizes. The In-the- Canal
(ITC) hearing aid is customized to fit the size and shape of
the ear canal 14 and is used for mild or moderately severe
hearing loss. A Completely-in- Canal (CIC) hearing aid is
largely concealed in the ear canal and is used for mild to
moderately severe hearing loss. They are also recommended
for adults, but not children.
Behind-the-Ear (BTE)
hearing aids are worn behind the ear and are connected to a
plastic ear mold that fits inside the outer ear. BTE aids
are used by people of all ages for mild to profound hearing
loss. Poorly-fitting BTE ear molds may cause feedback;
i.e., a whistle sound caused by the misfit of the hearing
aid or by buildup of earwax or fluid.
Body Aids are used by
people with profound hearing loss. The aid is attached to a
belt or a pocket and connected to the ear by a wire. Because
of their large size, they are able to incorporate many
signal processing options but are used primarily when other
types of aids are not effective.
Two of the above models
the ITC and CIC represent 80% of the hearing aid market in
North America, with BTE making up most of the other 20%.
More recently, implantable hearing devices have been
developed to overcome the inconvenience associated with use
of external aids. These target people with sensorineural
hearing loss who cannot be considered for cochlear
implantation and otherwise would be assigned a traditional
hearing aid.
Three types of sound
processing are currently used (NIDCD, 2005):
Analogue/Adjustable: The audiologist determines the volume
and other specifications needed in an individuals hearing
aid, and a laboratory builds the aid to 15 meet those
specifications. The audiologist retains some flexibility to
make adjustments.
This type of circuitry is
generally the least expensive (below $1,000).
Analogue/Programmable: The
audiologist uses a computer to program the hearing aid. The
circuitry of analogue/programmable hearing aids will
accommodate more than one program or setting. If the aid is
equipped with a remote control device, the wearer can change
the program to accommodate a given listening environment.
Analogue/ programmable
circuitry can be used in all types of hearing aids.
Digital/Programmable:
Instead of converting sound waves into an electric current
to be amplified, digital aids transform them into binary
numbers that enable dramatically heightened auditory quality
and allow people to hear better in noisy environments (by
use of binary filters). The audiologist programs the hearing
aid with a computer and can adjust the sound quality and
response time for an individual. Digital hearing aids use a
microphone, receiver, battery, and computer chip. Digital
circuitry provides the most flexibility for the audiologist
to make adjustments in the hearing aid. Digital circuitry
can be used in all types of hearing aids and is typically
the most expensive (approximately $2,000-3,000).
There are three commonly
used hearing aid circuits:
the Linear Peak Clipper
(PC),
the Compression Limiter (CL), and
the Wide Dynamic Range Compressor (WDRC).
A linear circuit is simply
an amplifier; i.e., it makes everything louder. This circuit
is the least sophisticated and cant filter background
noise. A compression circuit also amplifies everything, but
with less distortion because of the way it processes sound.
This circuit is also better
able to accommodate a patient's range of hearing. Basically,
the circuit makes the sound loud enough for the patient to
hear, but never gets louder than a patients comfort level. |
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