Coping with permanent hearing loss

When treatment is impossible or ineffective, most patients whose hearing loss is diagnosed as permanent can be helped by a hearing aid or aids and/or by other assistive devices.

Hearing aids and assistive devices

There are many different types of hearing aid and they can be worn behind the ear, in the bowl of the ear or in the ear canal itself. The type of aid prescribed in each individual case will depend on the severity of the hearing loss, and whether one or both ears are affected. In the case of one-sided deafness, a CROS (Contralateral Routing of Signals) aid can be of benefit in certain situations. The microphone is located on the side of the worse ear and the signal from it is fed to the better ear. In a BICROS aid, the better ear receives an additional signal from a second microphone placed on the better-hearing side. These systems can mean that users are able to hear sounds directed to the impaired ear more easily, without turning the better ear towards the sound, and they also provide extra cues for locating the direction of sound sources.

Even when the hearing loss is relatively mild, people with Sudden Sensorineural Hearing Loss often have difficulty in hearing telephones and doorbells, alarm clocks and other environmental sounds, but it may be unnecessary to wear a hearing aid all the time. There is a wide range of special equipment available, such as amplified doorbells, vibrating alert systems, loop systems and headphones. Social services may help to pay for, or provide, equipment. For more information contact your social worker for deaf people or your local social services department. The Government's Access to Work scheme may help to pay for equipment you need for work or for job interviews.

The Royal National Institute for Deaf People (RNID) produces some helpful information on the subject of assistive devices (contact details below). There are a number of suppliers from whom you can purchase equipment. For example, RNID Sound Advantage sells a wide range of individual and environmental aids to hearing.

Lipreading

In combination with an efficient hearing aid, lipreading plays an important part in the rehabilitation of deafened people. In terms of understanding speech, the most important sounds are the consonants. As these are formed by the lips, tongue and teeth, they can be seen, and therefore reading the lips can provide vital clues for the understanding of speech.

Many deafened people find it very difficult to learn to lipread, but it is worth persevering, as the improvement in communication can be significant. Lipreading classes can also be very good places to meet other people who have had similar experiences to yourself. The Association of Teachers of Lipreading to Adults (ATLA) is the body which regulates the profession in the United Kingdom.

Hearing Therapy

Getting a hearing aid or aids is only the beginning of a long and often difficult process of rehabilitation for deafened people, particularly when both ears are affected. A qualified Hearing Therapist can play a vital role in this process. A Hearing Therapist uses a variety of methods to work out an individual programme for each patient to assist them in managing their hearing loss, improving their communication skills and enabling them to participate fully in their daily activities. Hearing Therapists can offer:

• help with hearing aids
• auditory training (working with the remaining hearing)
• counselling both for the deafened person and their family
• advice about environmental aids
• lipreading instruction
• tinnitus management

Some hearing therapists may also specialise in cochlear implants, helping with balance problems or working with patients with learning disabilities or dual sensory loss. Although not all NHS Trusts employ Hearing Therapists, most are situated in either the Audiology or Ear, Nose and Throat departments of hospitals.

Cochlear implants

The cochlear implant is one of the major scientific triumphs of the last few decades. They are increasingly being used to help adults with acquired total or profound hearing loss in both ears, as well as in children born profoundly deaf or acquiring deafness before the development of speech. They work by electrically stimulating the auditory nerve (nerve of hearing).

In the great majority of cases of Sudden Sensorineural Hearing Loss it is the 'hair cells' in the cochlea which are affected. However, even when the very last of these tiny hair cells have been lost, there remain nearly always a number (perhaps 10 per cent) of auditory nerve fibres, which can be stimulated by the electrodes implanted into the cochlea in cochlear implantation.

The implantation of the electrodes and associated 'hardware' is only the beginning of a long process of intense rehabilitation. It may take as long as two years, or even more, before optimum results are obtained. Cochlear implantation is essentially a team effort, involving otologists, audiologists, speech therapists, psychologists and, with children, teachers of the deaf.