June 01, 2014

What Did You Say?

Jeffrey M. Allen

As people age, they tend to develop various medical or physical condi- tions, many of which interfere with quality of life and may impact the ability to practice law. Frequently, however, technology can effectively mitigate the impact of some of these conditions on our lives. For a variety of reasons—least reasonably, vanity—some people refuse to accept available mitigations.

One of the things I have found very interesting is that most of us do not hesitate to wear glasses as a result of impaired vision. Yet many who wear glasses or contact lenses to assist with reading balk at the idea of wearing a hearing aid, even though hearing may have deteriorated as much or more as vision.

As we age, many of us will develop hearing loss. In most cases, the loss is not disabling, but it can prove limiting in both social and professional situations. At a personal level, it can interfere with our ability to communicate with friends and family and impair our ability to enjoy such things as theater productions, movies, or even television. Yes, we can always turn the TV up, but if we live with people who do not have hearing issues, they will as likely complain about that as they will about asking them to repeat things not heard the first time. Professionally, hearing loss can make it more difficult to deal with clients, meetings, conferences, CLE courses, and even telephone calls. For a litigator, the situation can prove particularly significant, as uncorrected hearing loss can lead to misunderstanding statements made by judges, witnesses, or other attorneys, as well as your client.

The World Health Organization published a study in 2012 revealing that the problem has a worldwide presence. That study drew the line for disabling hearing loss at a loss of greater than 40dB (decibels) in the better hearing ear for adults (defined as people over the age of 15). Generally, audiologists consider a loss of up to 25dB as “normal,” a loss of 26–40dB as a “mild” hearing loss, 41–55dB as a “moderate” loss, 56–70dB as “moderately severe,” 71–90dB as “severe,” and over 90dB as “profound.” Symptomatology of those terms reflects the following deficits:

  • Mild: difficulty hearing or understanding soft speech, whispers, and normal speech over background noise.
  • Moderate: difficulty understanding regular speech up close or in a quiet office environment.
  • Moderately severe: difficulty understanding everyday conversations or hearing a telephone ring.
  • Severe: can only hear loud sounds such as very loud speech, sirens, or a door slamming.
  • Profound: difficulty hearing sounds such as a power mower or a motorcycle.

While you may get the idea that you have a hearing problem from your own observations or the comments of your family and friends, a hearing test by an audiologist provides the most accurate way to determine how serious a loss you have. An audiologist can determine the presence and extent of any hearing loss and usually identify the affected frequencies (most often older adults will experience more severe high frequency loss first).

To give you some perspective on how common hearing loss has become, an article published by the American Family Physician in June 2012 entitled “Hearing Loss in Older Adults” noted that approximately 28 million adult Americans have hearing loss. Further, hearing loss represents the third most common health problem in older adults (after hypertension and arthritis). The article also states that one-third of adults between 61 and 70 years old and more than 80 percent of those over age 85 suffer from hearing loss, and men tend to suffer greater hearing loss and from an earlier onset age than women. A study published in 2014 by the National Institute on Deafness and Other Communication Disorders (NIDCD) reported that some 17 percent of American adults (36 million people) report a degree of hearing loss and that the percentages increase to about 30 percent of adults age 65–74 and 47 percent of adults over age 75. The NIDCD estimated that some 15 percent of Americans between the ages of 20 and 69 have high frequency hearing loss due to exposure to loud sounds or noise at work or in leisure activities. Most significantly, the NIDCD study reported that only 20 percent of those who could benefit from a hearing aid actually wear one.

I find it very interesting that so many more people find it a larger psychological hurdle to use an assistive listening device than to use glasses or contact lenses. I use the term “assistive listening devices” to reflect the fact that some, but not all, devices qualify as “hearing aids.” Ear trumpets and very large hearing aids have gone the way of the Model T. Assistive listening devices have become very unobtrusive in recent years and, in many cases, almost undetectable, especially when worn with a longer hair style.

People who have a relatively minor hearing loss can often mitigate or sometimes solve the problem by acquiring high-grade non-prescription sound amplifiers, some of which are very diminutive in size. Generally lacking the level of adjustability of a prescription hearing aid, non-prescription sound amplifiers are not suitable for correction of serious hearing losses. For those who have a relatively minor hearing impairment, however, they may prove just the thing, at a fraction of the cost of prescription hearing aids. A word of warning, however: you can find very cheap hearing amplifiers that are inexpensively made and often do not work very well. If you want a good set of non-prescription hearing amplifiers, you should plan on spending between $500 and $1,000. While that may sound like a lot, it represents a fraction of the cost of the newer, better, more diminutive digital hearing aids (which can cost several thousand dollars for a pair). As with prescription hearing aids, the smaller and less obvious hearing amplifiers generally cost more than the larger ones. Vanity does have its costs.

In talking to audiologists, I have learned anecdotally that the two most popular designs for hearing aids are those that are completely in the ear canal (sometimes referred to as CIC) and those that fit unobtrusively behind the ear with a clear plastic and very hard to see tube carrying the sound into the ear. I actually have tried several devices myself and found that I have a personal preference for the behind-the-ear style, as I like the sound quality better. The CIC hearing aids fit in and fill the ear canal, and my impression of the sound quality (at least on the ones that I tried) was that they had an artificiality that I found bothersome and that I did not experience with the behind-the-ear models. I learned from the audiologists I spoke with that my reaction likely results from the fact that the behind-the-ear devices leave the ear canal open, allowing a combination of amplified sound and natural (unamplified) sound blending together, while with the CIC versions, the sound largely comes through the CIC hearing aid. The audiologists I talked to told me that for people with moderate hearing loss either style will work, but many individuals prefer the behind-the-ear version, likely for the reasons I expressed. For people with more severe hearing loss, I am informed that the CIC style generally works better. Please note that these are anecdotal generalizations and that you should make your decision as to the hearing aid style you prefer based on the recommendations of your audiologist after an examination of your particular hearing issues. As a rule, expect that the CIC versions will cost more than the behind-the-ear versions.

Some hearing aids have Bluetooth technology built into them, either through the use of a separate intermediate device, or, with some of the newer models, directly into the hearing aids themselves (a situation I prefer). Bluetooth technology allows you to stream music from your Bluetooth equipped computers, tablets, telephones, or music players and to answer telephone calls through the hearing aids.

I had the opportunity to test some high-quality non-prescription amplifiers and hearing aids in conjunction with this article. I do not represent my study as exhaustive. There are many other models and manufacturers whose products I did not experience and have no ability to comment about. One of the things that I did learn, however, is that different people have different reactions to the devices and different preferences. Most providers of prescription hearing aids have programs through which you can try out devices for a period of time and return them if you do not find them satisfactory. I did not find any similar program for the non-prescription amplifiers, but they do represent a substantially smaller investment. If you have a slight hearing loss, you might just want to get a non-prescription amplifier, such as those I will discuss below. If you have a more significant loss, you may find yourself happier with the more powerful and flexible prescription hearing aids. Under any circumstance, you should consult an audiologist for advice if you suspect that you have any hearing loss.

The non-prescription sound amplification devices I looked at in connection with this article both came from Able Planet and cost just under $500 per unit. The in-ear version (PS2500AMPT) costs $499.99 each. Please note that the Able Planet In-Ear Amplifier has a fairly open sound that I found very comparable to the behind-the-ear version. It is not like the CIC hearing aids that fit in and fill the ear canal. The Behind-the-Ear Amplifier (PS1600BTET) costs $474.50 each. A comparison of the two models can be found on Able Planet’s website, http://hearinghealth.ableplanet.com.

In most situations, I found that the amplification from the Able Planet devices improved my listening experience and made it easier for me to hear than without any assistive devices. I found both of the devices easy to insert in my ear and comfortable to wear. Each of them has four built-in programs that you can manually switch to reflect different listening environments. The behind-the-ear model has a manual switch, and the in-ear model requires you to cup the ear and tap twice to change the program. Although it takes a little effort to figure out how to make it work, once you figure it out, it works fine. Both use the same sized hearing aid battery and get approximately the same duration of use from the batteries. I could not detect any significant difference in the sound between the two models. As a result, I concluded that both can prove very helpful. Both appear to be well made and neither produced any distortion of the sound that I noticed.

I also had the opportunity to try out the recently released GN ReSound LiNX behind-the-ear hearing aid. The LiNX has Bluetooth capabilities built into the hearing aid so that it connects to an iPod, iPad, or iPhone, providing the ability to stream audio from the device directly to the hearing aids and giving you the ability to use the hearing aids to answer the telephone. The LiNX proved very comfortable to wear and generated a very high-quality sound. One of the nice things about the LiNX is that the hearing aid program self-adjusted the sound to the environment most of the time. ReSound describes the technology that it uses for the LiNX as “Surround Sound by ReSound,” which it reports is based on an evolution of its Binaural Directionality sound system and its Binaural Environmental Optimizer II. It also uses a special compression technology to make higher range sounds more “hearable.” Unlike the non-prescription assistive devices that simply amplify the sound, the audiologist can program the LiNX (like other prescription hearing aids) to match the user’s hearing needs and profile.

ReSound refers to the LiNX as the first “made for iPhone hearing aid.” It has an app available free from the App Store that enables you to use your iPhone to change programs, turn the hearing aids on or off, adjust their volume, and fine tune the bass and treble settings to match the environment to your personal preferences. It also allows your iPhone to memorize settings matched specifically to your personal preferences for particular locations, allowing you to geotag the setting to the location. The app also gives you an instruction manual for the LiNX in case you forget how to do something. Another nice feature included is that the app will help you find a misplaced hearing aid that you have linked to your iPhone. If you don’t have an iPhone, you are out of luck for now, as ReSound has no equivalent Android or Blackberry app.

Oh, and one final note: please keep in mind that having the amplifiers or hearing aids doesn’t help a bit unless you actually wear them.

Jeffrey M. Allen

Jeffrey M. Allen is the principal of Graves & Allen in Oakland, California. A frequent speaker and writer on technology topics, he is editor-in-chief of GPSolo magazine and GPSolo eReport, an editorial board member of the ABA Journal and Experience magazine, author of jallenlawtekblog.com, co-author of Technology Solutions for Today’s Lawyer (ABA 2013) and iPad® for Lawyers (West 2013), and a liaison to the ABA Standing Committee on Technology and Information Services. In addition to being licensed as an attorney in California, he has been admitted as a Solicitor of the Supreme Court of England and Wales. He is an associate professor at California State University of the East Bay. He also works extensively as an arbitrator and a mediator.