Hearing Aid Acclimatization and Adaptation

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.It is a rare occasion when a first-time hearing aid user is able to tolerate their full prescription at their initial hearing aid fitting appointment.  The thought that you could go from a hearing loss, that you have probably had for a number of years, to the full amount of amplification required to treat that hearing loss instantaneously just isn’t realistic.  So let’s discuss what to expect when acclimating to a new set of hearing aids.  

The first thing to expect is things will sound louder.  There is a solid possibility that the Auditory Processing Centers of your brain have been under-stimulated for a long time.  All of a sudden, you will be asking them to wake back up to start doing their job again without even a warning.  Just like when you wake up in the morning, and you need to let your eyes adjust to light, your brain will need to adjust to sound after a long layoff.  

When programming my patients up to their full prescription at their hearing aid fitting, using Real Ear Measurement, 9 out of 10 patients need their amplification levels reduced to a more tolerable level.  In fact, this is one of the most common excuses that Hearing Care Providers use when arguing against Real Ear Measurements.  However, the way I see it, Real Ear Measurement performed at the initial fitting is an end goal not the starting point.

When I’m fitting my new patients, I program the amplification levels of their hearing aids up to their full hearing loss prescription.  This ensures the devices, and the way those devices are setup, are capable of reaching their targets.  However, I typically need to reduce the level of amplification before the patient leaves my office.  Most often, there is a 3-7 dB reduction in overall amplification across the frequency range.  

Then, at several follow-up visits, this amplification is added back in 2-3 dB increments.  By the end of each patient’s 45 day fitting window, almost all hearing aid wearers reach their full prescription, which is where they will hear their best.If you want to learn more about Real Ear Measurement, you can find my video here:  https://youtu.be/cHR0Oa6I-wY

‍The second thing to expect is that some things will sound annoying.  Some of the more common things that you may find annoying are the sound of the Toilet Flushing, your Car Running, your Refrigerator Running, Silverware Clanking, and of course, the sound of Crinkling Paper.  In some cases, the sound of a hearing aid user’s voice can also be annoying since you will be hearing your voice at a level that you probably haven’t heard in a long time.  Fortunately, most hearing aid users adapt to this sound pretty quickly.  

The third thing that you may be able to expect is better hearing in background noise.  In a 2017 research study titled Auditory Distraction and Acclimatization to Hearing Aids, by Dawes & Munro in Ear & Hearing, they identified a subset of new users with moderate hearing loss, who wore their hearing aids at least 6 hours per day, experienced significantly improved Speech in Noise ability by approximately 3-decibels of signal to noise ratio, compared with a control group of experienced hearing aid users. Improvements in Speech in Noise were associated with more consistent HA use and more severe hearing loss.  It appears as though wearing hearing aids consistently has the possibility of improving your ability to hear in background noise, and a 3 dB SNR improvement is a BIG DEAL!

The fourth thing you should expect when adapting to hearing aids is for all this adaptation to occur within approximately 30 days.  Dr. Bryan Taylor, one of my favorite Audiologists that I have been following for a long time, performed a Literature Review in 2007 where he identified that the research indicates adaptation to hearing aids occurs within 30 days.  While there is no substantial amount of research that indicates adaptation past 30 days, it could be a good thing.  Typically this means that you could be fully acclimated to your hearing devices very quickly.

However, just because you don’t continue to adapt to hearing aids over time, it doesn’t mean that you wouldn’t receive long-term benefit cognitively.  There are a number of studies linking untreated hearing loss to cognitive decline.  There are also studies that exist that suggest that treating hearing loss with hearing aids can help to slow down the rate of cognitive decline.  So, if you are a hearing aid user, and you are having a tough time, just hang in there.  Once you get over the hump, you should do great!