February 22, 2008
Below I have posted a depressingly detailed hand held close up taken by my daughter this evening. It was intended to show the mounting for my bone conduction hearing aid, when it is fitted in a couple of months time. In the original photo, the ear hairs are more noticeable and I somehow seem to remember the days when my hair was much thicker and blacker than it now appears. Ah well, we will quickly move on from the effects of the ageing process and get back to the matter in hand. I should note at this point though that the surgeon in charge did apologise as they were cleaning the area before the operation. It appears that the staff are well trained in surgical procedures, but not hair dressing. I also admit that I don’t comb or brush that particular area very vigorously at the moment.
It looks much more tender than it really is. I honestly have had no pain or discomfort at all from the procedure. The last bits of dressing were removed a week ago and I am now pretty much back to normal. I shower and wash my hair as usual and the area has to be left undressed. The only concession I make now is wearing a ’silly’ hat with ear flaps while out in cold winds. This to protect the graft more than anything else. I use a multi-purpose ointment prescribed to prevent infection, and to promote healing in the area generally. To begin with I had to use a pair of shaving mirrors to apply this, but I’m pretty good now at hitting the right area first time. In the early days I applied an awful lot of the medication to the back of my ear. (You try it, two mirrors are most confusing!)
I don’t suppose that could be real the reason for the hairy ear? 
February 22, 2008
I’m not sure just how well qualified I am to blog on this subject now as I’m not really a mainstream user these days, in that I’m retired and out of the more demanding working environment. However, if readers will bear in mind that this is my personal view and experience only – here goes. It may well also have to be spread over more than one post, it’s a very involved subject when you get into it.
The two main things that people consider when thinking about a hearing aid are; What does it look like? and How effective is it (for me)? The relative importance of these two is strictly a personal matter. Regular readers will already know my own views. Actually the two are not unrelated and the other possible decision, private or NHS, tends to creep in here as well.
One point for thought before going further is the question of what exactly do we want an aid to do? Is that a silly question? After 40 odd years of significant hearing loss, if someone restored my hearing to normal tomorrow the result would probably be devastating. I certainly wouldn’t be able to tell what people were saying immediately and, at my age, I would probably never completely learn to adjust to the new range and volume of sounds. People considering an aid obviously have a hearing loss, will probably have had it for some time, and their brain will have already started to make adjustment. If this person is now provided with an aid that restores their hearing to normal, this “adjustment” has to be undone and the person has to re-learn to hear normally again. One of the difficulties I’m sure audiologists find when trying to prescribe aid settings for a patient, is to balance technical reality against what the patient has already become adjusted to.
One thing I would stress amongst this confusion is that a hearing aid never actually restores normal hearing . Whatever that is – we all have our own illusions of reality. (Quite deep that, I must have read it somewhere) They are merely a tool to help us mitigate the loss. As with all tools, skills are needed to use them effectively, and these skills involve both conscious and unconscious learning processes. If you are going to have to learn these skills, it is better to start earlier rather than later.
If we now overlook the previous two paragraphs and take the sound engineer’s view of hearing instruments. What we would want to do is to look at a patient’s audiogram and provide them with an instrument that exactly corrected the loss at each frequency. It would also have automatic adjustment to cope with very loud or quiet sounds, and a means of tuning in to concentrate on selected groups of frequencies when needed. All of this has been possible for some time of course – it’s called a recording studio!! We are back again to balancing size & looks against technical specification & power.
The basic “behind the ear” analogue instrument had a three position switch and a volume control. A little manual dexterity is required to manipulate these accurately in situ, especially with ageing fingers and, particularly, the non dominant hand. The instrument however is normally large enough to accommodate controls big enough for most users after a little practise. The tinier instruments have very little room for controls other than on/off, and in these circumstances the wearer perhaps would not want to draw attention to them by making running adjustments anyway. However, people very often do prefer to make their own adjustments, and versions are even available with radio remote control of settings for this reason, operated from a pocket or handbag if needs be.
In addition to the “user controls” the technician usually had three small adjustment screws (potentiometers) concealed in the instrument body, with which they could roughly “tune” the aid to the patients requirements.
Just about everyone now knows that the latest development in hearing instruments is “digital processing”. With this technology the amplified sound signal fed to the patient is controlled as a computer program, rather than with a “collection of knobs and switches”. The technician actually connects the instrument to a computer to program it to the patient’s prescription. The the aid can be considered to be a mini computer in its own right, but is relatively limited as to the amount of memory, power and processing capability that can be fitted into the body. The technician must decide how to allocate these resources to the best advantage, considering the individual patient’s circumstances. With such a complex system, the other consideration for the designer and/or technician is;- just how much running adjustment can the patient be allowed to make for him/herself? Restricted adjustment is probably the source of most adverse comments I have heard about “digitals”, though their superior performance in many other areas is readily acknowledged.
February 15, 2008
Until I started on this blog I could never work out a really good way of answering this question. The true answer would be considered rather rude, so I tend to fudge it. I don’t think people would like to be told bluntly “Yes, but most people have no idea what that actually means”. The better answer, that has just come to me, would be “Everyone does! I rely on it a lot more than normal, but not as much as some.” It really boils down to how you think of lip reading – as some kind of special academic skill, or a day to day means of communication. Most people ‘read’ or react sub-consciously to body language, and everyone recognises facial expressions such as sadness, laughter, surprise etc. It’s only one very small, involuntary, step further into reading lips.
In the days before audiometry was widely available (producing the charts shown earlier from controlled electronic sound signals), specialists were skilled in assessing the patient’s situation from their own test routines. I haven’t had one in recent years but they may still do them. The specialist would say single words or phrases at varying loudness and distance, from various parts of the room, face on / profile and even back turned. In many respects it was a test of total speech recognition rather than purely a hearing test. I only realised this during one of the lengthier assessments. I repeated the number the specialist had said, but felt compelled to add, helpfully “but only because I’m reading you”. We actually got on very well, considering that some specialists could be very ‘haughty’ in those days. His answer was a mixture of amusement and resignation “And just what do you think I’m testing?”
During a couple of infections, when I thought that my hearing was deteriorating very fast, I asked specialists if I should try formal lip reading classes. On both occasions the answer was basically “You won’t learn anything, you already read pretty well, easily as well as you need to.” It’s that last phrase that is important.
The following appeared in an article in the Telegraph 23/11/2006 (Hitler Home Movies Telegraph Link ) “The technology that has allowed the dialogue to be reconstructed is called ALR — automated lip reading — and has been developed by Frank Huber, a speech recognition expert. The computer recognises shapes that lips make, turns them into sounds and matches these to a dictionary.” (NB The “dictionary” must have been phonetic, not the ordinary kind) It’s a pretty good definition of lip reading. You can appreciate how one could program a computer to do it, particularly on a film of a limited number of individuals that could be run over and over again, with unlimited time allowance. Humans in normal conversation have to attempt the same process in a much shorter time scale with very limited resources. So basically we cut corners. If we can simply hear, that is the preferred path. In areas of difficulty we will get extra clues from reading. If we know the speaker well we may use a restricted dictionary of their favourite words or phrases.. Similarly the topic or even the mood of the conversation allows other short cuts to the right kind of words. At conversational speed you don’t have the luxury of working everything out from first principles. You either see/hear the phrase first time or you don’t. Practise is everything, it can be tremendously difficult and tiring and people naturally only learn to do it as well as they need to.
You will appreciate the difficulty in the question now. If I turn my hearing aids off I will probably read a bit better than a person with regular hearing, but nowhere near well enough to carry out a normal conversation. I have never been forced to learn to that level of skill. On the other hand if I wore my aids but with a blindfold my “hearing” of speech would deteriorate considerably. Like the old (but very valid) chestnut “Wait till I put my glasses on, I’ll hear you better”!!
I did actually go to a series of reading classes at the age of about 40. Essentially the specialists were right, of course, and I learned very little of practical value. What I did learn was the basic theory behind what I had been doing instinctively since the age of three. In a way I had been learning to see/hear for most of my life. The others on the course benefited much more, and had been forced onto what might be called an accelerated learning curve by circumstances. A minority of various ages had been rendered deaf suddenly. The majority were, say, early sixties upwards and starting to struggle with age related deafness, after a lifetime of perfectly good hearing. In such cases some sort of formal schooling and practice in reading is well worth considering, rather than just “picking it up as you go along”. Classes are usually provided free, or at very low cost, by local authorities.
After my last blog about ‘Hearing Strategy’ and possibly trying to conceal a hearing loss, one might be forgiven for thinking that lip reading was a fairly secretive way of dealing with things. It is however very difficult, and I have seen it reported that even good readers can only be positive of about 35% of what they see. The rest is guesswork. So, again, reading is just one tool to be used in conjunction with other techniques to get as many clues as possible for the crossword.
One thing I didn’t realise until I got a little more involved in body language and psychology etc (ie basic sales training ) was just how antagonistic and uncomfortable intensive lipreading can be for the subject being read. I will cover this later but, again, there is a very strong case for letting the subject know exactly what you are doing and, perhaps more importantly, why.
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