Tips and hints for first-time hearing aid users
- Koorosh Nejad
- May 2, 2024
- 11 min read
Updated: Sep 11
As an audiologist, I have been attending to several patients who started using hearing aids for the first time in their lives. This article is my reflection on common questions and in a way some of the challenges that this group of patients may have. You could also benefit from this article If you are searching for the right hearing aid and have pre-purchase questions.
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FAQ for first-time hearing aid users
Can I use a hearing aid only on one ear?
Can I use my hearing aids only when watching TV or meeting friends?
Why don't my hearing aids stay in my ears?
My hearing aids sound very loud. Why?
When using hearing aids, I hear my voice like in a box. Why?
I can hear better with hearing aids, but still don't understand the words. Why?
The little wire of the hearing aid on top of my ear hurts. What can I do?
Are behind-the-ear hearing aids better than in-the-ear?
I accidentally took a shower with my hearing aids. Are they damaged?
How can I tell if the wax filters of my hearing aids need to be replaced?
From where can I purchase additional earwax filters and domes?
How far into the ear should the speaker of the hearing aids go?
My hearing aids whistle. Why? How can I fix this?
How often should I clean my hearing aids?
How often should I replace the earwax filter of my hearing aids
How often should I replace the little dome on my hearing aids?
My hearing aids are too loud, and I feel sick when I use them. Why?
Do my hearing aids connect to my mobile phone?
How often should I visit my audiologist?
I want to use hearing aids, but there isn't enough space behind my ear.
Can I use a hearing aid only on one ear?
Yes, if you have hearing loss only on one side, and no, if you have hearing loss on both sides. I'd say it's very simple: if your eyes need glasses, you buy a pair of glasses, and the ears are the same. If you have hearing loss on both sides, you need to use hearing aids on both sides. The brain needs to receive clear sounds on both sides to better understand speech, maintain a sense of direction, and receive the cues needed to keep the body balanced.
Can I use my hearing aids only when watching TV or meeting friends?
That is a tricky question. Let me elaborate on this one. Most people start considering hearing aids when their hearing threshold (the quietest sound that you can hear in different frequencies) is in the Moderate range (40-70 dB). Your brain has likely experienced a decline about 5 to 10 years ago, but you didn't notice the gradual decline until now. When you use the hearing aids for the first time, your brain needs to readjust to the processed sound. This "readjustment" is only possible if you use the hearing aids continuously. Using the hearing aids occasionally at social events or when watching TV can help you hear better, but the ultimate understanding of the speech will happen when you wear the aids regularly and go through further adjustments they need to improve speech understanding. Please see this article about the impact of managing your hearing loss late on your brain.
Why don't my hearing aids stay in my ears?
We call it a retention issue. Here are some of the reasons why your new hearing aids do not stay in your ears:
The dome on the little speaker that goes in the ear is not the right size, e.g. too small or too big for your ear canal
The wire that connects the hearing aid to the little speaker is too short, so it is pulling the speaker out of your ear canal
The shape of your ear canal is like a funnel, but in some people, this shape is a very wide funnel that doesn't hold the dome inside. I would suggest visiting your audiologist, as there are several options to improve the retention of the hearing aids in the ear, including eartip, micromolds, easy fit sleeves, coating, etc.
You have a buildup of earwax that pushes the speaker unit of the hearing aid out. You need to visit your audiologist, and if there is an excess of earwax, do a microsuction cleaning.
My hearing aids sound very loud. Why?
If you are a first-time user of hearing aids, I would expect you to say that. If the hearing aids don't feel loud, then there may be an issue. They should feel loud because it has been a long time since your auditory cortex (in your brain) has not been receiving a true level of sound from your ears. Usually, it takes about 2-3 weeks for a new user of hearing aids to get used to the sound of the hearing aids, from a loudness and occlusion point of view (hearing your voice). Nevertheless, if they feel the aids are too loud or disturbing, then you can ask your audiologist to adjust them or set them for a gradual increase to your full prescription.
When using hearing aids, I hear my voice like in a box. Why?
I understand that it is annoying for you to hear your voice (called occlusion), but this is a common experience for first-time users of hearing aids. The little speaker or the tube placed in your ear canal alters the acoustics of the ear canal. The dome blocks the ear canal if your hearing aids are fitted with a "closed dome" to keep the amplified sound in the ear canal. This causes you to hear your voice. Some hearing aids provide some settings for your audiologist to trim the occlusion to some comfortable levels through sound processing. The good news is that the neuroplasticity of your brain makes it realise that this is your voice and tune it down in about 2-3 weeks from the start of using hearing aids. You can visit your audiologist to adjust the hearing aids if the sense of occlusion is very severe.
I can hear better with hearing aids, but still don't understand the words. Why?
Ok, that's a tricky one. If you hear the sound but still understand the speech is challenging, it could be because of several reasons (and/or):
Your hearing aids may not be fitted or adjusted properly. It could be the choice of fitting or level of volume, the prescription or a mix of all the above. Please make sure that your audiologist does a real ear measurement (REM) for you.
Hearing aids don't do miracles; they do not and cannot restore your hearing, period. You must be patient and allow your auditory cortex to embrace the processed sound. In my experience, some patients need to use hearing aids for about 3 to 6 months before they notice a better speech understanding with hearing aids. The longer the user waits until using the hearing aids for the first time, the longer the adjustment takes. Please see this article that relates to the impact of hearing loss on the cognitive processing resources in your brain.
Remember, we hear with our ears but understand the speech and sound with our brains. There is a chance that the hearing aids are adjusted optimally and set properly, and sound is clear when it leaves your ears and reaches your brain, but your auditory cortex has gone through some deterioration (where the understanding of the sound happens in your brain). If the above items 1 and 2 are checked, then you may need to visit your audiologist and possibly refer to an ENT specialist for testing Auditory Processing Disorder (APD). Signs of such a deterioration in your brain are that you need people to speak more slowly to understand their speech. Or, your brain is not able to process speech as sharply as before in a noisy restaurant, despite the best hearing aid being optimally tuned for your level of hearing loss. You may need to go through some auditory processing training. In addition, the use of assistive listening devices (ALD), or a remote microphone such as Phonak Roger, is highly recommended for such patients, as the device does some degree of noise processing and sends a cleaner version of the speaker's sound straight to the hearing aids of the patient.
The little wire of the hearing aid on top of my ear hurts. What can I do?
This is the case where the wire is chosen too short. Please ask your audiologist to revisit the fitting and check the length of the wire.
Are behind-the-ear hearing aids better than in-the-ear?
Not necessarily. There are a lot of factors in choosing a pair of behind-the-ear versus a pair of in-the-ear hearing aids. Best to have a consultation with an independent hearing care professional.
I accidentally took a shower with my hearing aids. Are they damaged?
Most of the premium hearing aids are IP68, which means they can be in 0.5m depth for one hour and still function properly. Please see this article if you accidentally find your hearing aids in the water.
How can I tell if the wax filters of my hearing aids need to be replaced?
It is simple, one morning, when you put the hearing aid in your ear, you don't hear any sound. You notice that one side (both sides rarely get blocked at the same time) is very quiet compared to the other side. You remove the little dome from the tip of the speaker, and you can see that the little speaker tip is blocked with white or yellow material that could be a mix of earwax and skin flakes. Simply replace the earwax filter with the spare pack that you received when you purchased your hearing aids.
From where can I purchase domes and earwax filters?
There are several online outfits for hearing aid consumables; there are a lot of suppliers on Amazon. Please see our hearing aids support page to access links to spare parts for different hearing aid models.
How far in the ear should the speaker of the hearing aids go?
The little speaker in RIC or RITE hearing aids needs to go fully inside the ear canal until the connecting wire nicely sits on your skin. The length of the ear canal is about 2.5 cm, while the length of the speaker unit is about 1.5cm, so you can rest assured that you won't be damaging your eardrum by pushing the speaker fully in. If the hearing aids are not fully in, the patient won't be able to hear loud enough with them, and there is a high chance of whistling.
My hearing aids whistle. Why? How can I fix this?
If your hearing aids whistle, it can be from one of the following issues. A visit to your audiologist would be a good idea:
You might need to push the little speaker farther into the ear canal. Also, the length of the wire may be too short, resulting in the aid pulling the dome out of the ear canal.
The little dome at the tip of the speaker may be too small, resulting in the sound escaping from the ear canal and causing feedback; please replace the domes with one size larger. They should be comfortable but make a good seal in your ear canal.
The gain of your hearing aids may need readjustment; visit your audiologist.
Your ear canal may be a special shape, and retention of the speaker in the ear canal is naturally challenging. Your audiologist can try different retention strategies to keep it in.
Your ear canal may be occluded with excessive buildup of earwax, causing misplacement of the speaker unit and poor seal of the dome and the sound coming out of the ear canal instead of travelling into the ear canal.
How often should I clean my hearing aids?
If you work in a dusty environment or have a lot of dandruff, I'd suggest cleaning your hearing aids daily or at least weekly with a brush to dust them. Also, with an antibacterial wipe, the body and the silicon dome. If you know that your ears create excessive earwax, then you might want to remove the silicon dome and clean it from skin flakes and earwax every other day or at least once a week.
How often should I replace the earwax filter of my hearing aids?
This entirely depends on two factors: a. how much earwax is created by your ears, and b. How often do you clean your hearing aids? The little speaker that goes in the ear has a little white piece on its tip that is replaceable. I advise my patients to keep it on until it is blocked, i.e. no need for regular replacement, unless it's needed. People with a lot of earwax need to regularly clean the little silicon dome and inspect the earwax that might have passed through the dome and settled on the tip of the speaker. Daily cleaning and inspection can avoid premature and frequent replacement of the ear wax guard/filter.
How often should I replace the little dome on my hearing aids?
The silicon domes used on the tip of the little speaker can easily last about 6 to 9 months. It is recommended to replace them every 9-12 months when they become hard and brittle, or if you experience an ear infection.
My hearing aids are too loud, and I feel sick when I use them. Why?
This is a common concern of first-time users of hearing aids. Often, deterioration of your auditory system happens very gradually and over years before you notice and want to manage it with hearing aids. At that point, the brain has been adjusting to the lack of sufficient sound reception from your ears (say, increasing the volume). When you put the hearing aids in for the first time, the brain perceives a louder level of sound that it feels normal. It would take about 2 to 4 weeks for most patients (in my experience) for your brain to readjust to the normal level of hearing that the hearing aids are adjusted to.
Do my hearing aids connect to my mobile phone?
Most NHS hearing aids do not support Bluetooth connectivity. On the contrary, most of the premium hearing aids come in battery-powered and rechargeable versions and do support telecoil and Bluetooth, and the most recent ones do support LE Audio Bluetooth and Auracast. Best to check with your audiologist if you're not sure whether your hearing aids support Bluetooth and hands-free phone calls.
How often should I visit my audiologist?
I'd say every 12 to 18 months for a fresh hearing test and reprogramming, unless you have underlying health issues or feel that your hearing has suddenly changed.
I want to use hearing aids, but there isn't enough space behind my ear.
As part of the initial consultation, I ask questions about the lifestyle of the patient. That in addition to some other technical parameters such as the level of hearing loss, the size of the ear canal and so on, determines if the behind-the-ear or in-the-ear hearing aid is suitable for the patient. After all, I always suggest the patient be open-minded and try both, especially for first-time users of hearing aids. Some people have small ears and may use eyeglasses with thick temples. There are several factors to consider. The good news is that these days there are several options for in-the-ear as well as super small microRITE hearing aids for behind-the-ear that can satisfy almost any patient.
References
Arlinger, S., Lyregaard, P.E., Billermark, E. and Öberg, M., 2000. Fitting hearing aids to first-time users. Scandinavian Audiology, 29(3), pp.150-158.
Houmøller, S.S., Wolff, A., Möller, S., Narne, V.K., Narayanan, S.K., Godballe, C., Hougaard, D.D., Loquet, G., Gaihede, M., Hammershøi, D. and Schmidt, J.H., 2022. Prediction of successful hearing aid treatment in first-time and experienced hearing aid users: Using the International Outcome Inventory for Hearing Aids. International journal of audiology, 61(2), pp.119-129.
Reese, J.L. and Hnath-Chisolm, T., 2005. Recognition of hearing aid orientation content by first-time users.
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