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What Is A Monaural Hearing Aid

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Hearing Aids 3 Advantages

From a monaural to a binaural fitting session with Connexx 9 | Signia Hearing Aids

When you have two hearing aids, you can take better advantage of the way the brain processes sound through whats known as binaural hearing. With normal hearing, sound signals from both ears are comparable in strength. The brain can pick out the important signals, like voices, when theyre louder than the background noise. But if youre wearing just one hearing aid and someone talks into your unaided ear in a noisy room, the voice may sound softer than the background noise. As a result, its harder for your brain to give it preferential status.

It may also be harder for the brain to identify the location of particular sounds if youre wearing a single hearing aid. The brain normally does this by comparing the qualities of the sound signals that come through each eartheir relative loudness, their frequencies, and the time it takes them to travel through the ears. But the brain cant locate a sound as well if sound signals are always louder through one ear.

Wearing wireless hearing aids in both ears enhances the binaural hearing process because the hearing aids communicate with each other and transfer data back and forth, rather than working independently to process sound. This means they are able to maintain localization cues better than hearing aids working independently of each other.

Should I Get Fitted For A Hearing Aid

Research from 2013 studied why a group of individuals chose not to wear hearing aids, and along with other reasons, some people chose to opt out of wearing their aids due to an uncomfortable fit.

To avoid this, make sure the ones you choose fit correctly and feel comfortable in your ears, even after all-day wear.

Why Should I Wear Two Hearing Aids Instead Of Just One

Studies have shown that in most cases, when age-related hearing loss has occurred, both ears are generally affected. This does not include instances where hearing loss is the result of trauma, as in those cases, only one ear may be affected. Although the amount of loss may not be equal for both ears, it is safe to assume that both ears are experiencing at least some noticeable loss. As a result, a common question asked when a person is struggling with hearing loss is:

“Is a monaural or binaural hearing aid fitting the best for me?”

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What Are Some Features For Hearing Aids

Hearing aids have optional features that can be built in to assist in different communication situations. For example:

The more complicated features may allow the hearing aids to best meet your particular pattern of hearing loss. They may improve their performance in specific listening situations; however, these sophisticated electronics may significantly add to the cost of the hearing aid as well.

Bilateral Fittings Increase Ability To Recognize Speech In The Presence Of Other Speech

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The traditional speech tests like the HINT use speech-shaped noise as the interference.; That is quite different than the speech interference that we encounter in real life.; This research was a collaboration with the University of Manchester.; We simply measured speech recognition performance in a situation where subjects had to listen to female speech in the presence of other female talkers for a unilateral hearing aid fitting compared to bilateral hearing aid fitting.; This was an extremely well-controlled experiment with controls to rule out better-ear effects and those kinds of things. ;There was a tremendous amount of attention to detail, and it was a very clear demonstration that there was a significant benefit of for bilateral fittings over unilateral fittings.; This may not seem like a lot in dB, but it equates to 10 to 15 percentage points on the percent-correct score for speech understanding.;

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Setup For Speech Audiometry And Eeg Recordings

Experimental setup is described in detail in Balkenhol et al. . Speech comprehension tests and EEG recordings were performed in a dimly lit sound booth shielded against electromagnetic interference . Participants sat in a comfortable armchair and were observed via glass window and camera.

Speech stimuli were presented in soundfield from a loudspeaker 1 meter in front of the participant . Noise came from the same loudspeaker or from one of the two loudspeakers at ±90° azimuth. Sound pressure level was always calibrated before testing and with ±0.5 dB accuracy .

Speech Audiometry

Speech audiometry was performed as in Balkenhol et al. . An overview on tests and listening conditions is given in Table 2. Tests were performed for the following monaural and binaural listening conditions: CI alone , HA alone , CI and HA in combination . For all monCI, the HA was removed and the ear was masked with white noise at 65 dB SPL through an insert earphone . For monaural listening with the HA, the CI was removed. In NH the contralateral ear was masked in both monaural listening conditions in the same way as for monCI.

Table 2. Experimental conditions.

Ear Dominance and Bimodal Benefit

The binaural benefits HS, SU, and SQ were calculated from OlSa results according to Schleich et al. . HS was calculated as follows:

HSmonCI = S0NCImonCI S0NHAmonCI.;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;

SUQ = S0bin S0monCI,;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;

SUN = S0N0bin S0N0monCI.;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;

SQ = S0NHAbin S0NHAmonCI.;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;

SRMmonCI = S0N0monCI S0NHAmonCI;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;

and for binaural listening:

One Hearing Aid Or Two

If youre like most people with hearing loss, youll probably find that it takes time to accept the idea that you need a hearing aid, and you may be unhappy when your audiologist recommends that you get not one, but two. Chances are that your first question will be, Is it normal to get two hearing aids? And then, Do I really need two?

If you have hearing loss in only one ear and normal or nearly normal hearing in the other, then one hearing aid is all you need. But most people have hearing loss in both ears, especially if the loss is age-related. In that case, research and experience suggest that youll ultimately be more satisfied with two hearing aids.

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Why Choose Binaural Hearing Aids

A comparison can be drawn between hearing aids and vision-correcting lenses. After all, with two bad eyes youd much rather wear a pair of glasses than a monocle, or two monocles together so why not apply the same logic to your hearing?

Many people take their chances with their two-sided hearing loss, correcting only their bad ear. For some people, this is perfectly serviceable, but these individuals are almost certainly missing out on the aforementioned benefits to speech intelligibility, sound localization, and their enjoyment of a full-spectrum soundscape.

Additionally, modern hearing aids have other handy design features that old-style amplifier aids lack. Notably, advances in tiny battery-powered tech allow smart microphones inside the hearing aid to swivel to face and receive sound sources.

Older aids are tuned to mainly pick up sound in the direction in which the wearer is looking, which can sometimes leave a friend struggling to get their attention from behind. A new-model monaural aid can pivot its microphone towards the relevant source of a sound, of course, but this ability is far more useful when its two-sided with the right set of binaural aids, one aid can pivot to listen behind as required while another keeps its attention faced front and center.

Binaural hearing aids can be a really useful tool to restore not just your hearing, but the less-noticeable benefits of two-sided hearing most people take for granted.;

Why Is Binaural Hearing Important

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Humans naturally possess binaural hearing. The same way music nearly always sounds better in stereo rather than mono, hearing is far more useful when your two sound-receivers are both in working order.

Particularly important is the fact that binaural hearing provides for 360-degree hearing in a way we often take for granted, allowing us to hear sounds clearly from every direction without turning our heads.

As far as we know, our hearing pinpoints sound in a similar way to that in which GPS satellites pinpoint users, byusing the relative time delay between received signals. For example, a sound off at a right angle to the head can reach your nearest ear 0.6 milliseconds before it reaches the ear on the other side. Equally usefully, the sound arriving at each ear can be of slightly different volumes due to what audiologists call head shadow.

We dont just hear with our ears, but with our brains too. The ears transmit all this data to the brain, which uses some complicated processes honed over our lifetimes and humanitys far longer evolutionary career to tell us as best as it can what a sound is and where its coming from.

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Why Two Vs One

For populations with bilateral hearing loss, why is the true value of binaural hearing still an issue for us?; One reason is that in much of the world the fit rate for bilateral hearing aids is quite low .; The bilateral fit rate is fairly high in the United States and Australia.; However, in much of the world including Europe, which is fairly wealthy, bilateral fit rates can be quite low.; It seems most of the world still needs to be convinced of the benefits or binaural fittings.

While the research literature extensively shows that bilateral fittings are beneficial compared to unilateral fittings for most patients, there have been some cautionary findings, some of which have been quite influential.; A study from Walden and Walden tested the SNR loss in bilateral fittings.; The SNR loss tells the SNR that listeners require to understand at least 50% of the spoken material compared to normal hearing listeners; the lower the SNR loss, the better.; The hearing impaired listeners do not need an SNR that is that much lower than normal hearing listeners to achieve the same performance.; With bilateral fits, the SNR loss can be quite considerable for some of these patients.; In Walden and Waldens study , the SNR loss for understanding speech in noise was often worse with bilateral hearing aids than with a single hearing aid.; I will explain this later in the presentation.; However, this kind of data gives us pause when recommending two hearing aids versus one hearing aid for patients.

Binaural Processing Starts In The Brain

All of this processing starts in the midbrain.; The cochlea detects sound and transmits that information to the rest of the brain.; Binaural processing, almost by definition, has to happen somewhere centrally in the brain.; The information from the two ears has to come together in some way.; That happens in the lateral superior olive, which is in the midbrain.; The details of it are not critically important; the important thing is to recognize that binaural processing is a benefit we get from the central nervous system.;

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Why You Need Two Hearing Aids

We almost always recommend two hearing aids;if you have hearing loss in both years, because you will hear far better with two hearing aids instead of one. You have bilateral hearing but only one brain. In other words, your ears detect noise, but it’s your brain that;processes;random noise into recognizable;sound. It’s far easier if your brain is receiving signals from both ears.

Your hearing care provider or audiologist will program each hearing aid separately, to match the precise levels of amplification you need in each ear .

This is a well-known recommendation. For decades, research in the field of hearing science has supported the commonsense idea of wearing two hearing aids . Here are a few convincing reasons to equip yourself with a pair of devices instead of just one:

Binaural Benefits Are Underappreciated

BTE Monaural OtoClip Blue

The benefits of spatial hearing and bilateral hearing aid fits are underappreciated in the hearing aid research literature, as well as in the clinical world.; If the benefits of bilateral fits and binaural hearing are underappreciated, then the cost-benefit trade-off of having two hearing aids versus one hearing aid becomes less apparent to patients, and that can drive some of the conversation that a clinician might have with their patients about the value of the second hearing aid.; We have been quite concerned with how to show the benefits of binaural and spatial hearing in our research.;

The outcome measures for assessing hearing technologies do not tap into any of these higher-order brain functions, including binaural hearing.; As a result, we are not assessing the benefit of bilateral fits compared to unilateral fits in settings where binaural function is especially beneficial.; That is part of the reason why the benefits of binaural hearing are underappreciated.;;There is a need for generating outcome measures that engage these higher-order brain functions.

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Monaural Vs Binaural Comparisons

NH Group

NH listeners gained the largest binaural benefits, therefore results from this group are presented first, and results of the CI group are compared to them. Many NH performed the FBE with a ceiling effect , and the difference between listening conditions failed the Bonferroni-corrected significance limen of p< 0.025. In contrast, recognition in the OlSa S0 test was significantly better for sentences presented binaurally . A 3 × 2 repeated-measures ANOVA revealed a significant main effect for noise direction and listening condition , with a significant interaction between these factors . Post hoc tests focused on listening condition and revealed significantly better results for binaural listening when noise was presented at the side of the monaurally active ear . The difference between monaural and binaural presentation remained insignificant for noise from the same source , or for noise presented from the side of the monaurally inactive ear .

CI Group

Bilateral Hearing Aids Fully Stimulate Your Brain

Wearing two hearing aids is far betterfor you than one hearing aid.

You probably know one of the best ways to keep your body healthy and in good working order is to use itthat means getting regular exercise, taking the stairs instead of the elevator and getting your steps in for the day. Conversely, when we don’t move and use our muscles, they tend to weaken and can even atrophy over time.

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Correlations Between Audiometric Measures

Correlations were tested on an exploratory basis for NH and the T4 assessment and not corrected for multiple comparisons. Bivariate comparisons between the different binaural/bimodal effects, and between these effects and PTA-4 as well as with PTA-4 asymmetry were calculated. Only significant correlations are reported. Several significant positive as well as negative correlations were found . Mostly, these were present for either the NH or the CI group, but not for both. The only exception was the significant inverse correlation between SUQ and PTA-4 asymmetry, which in CI listeners represented the aided PTA-4 of the CI and HA ears. For both groups, the correlation had the same direction and magnitude. This indicated that, on one hand addition of a better HA ear produces a larger SUQ, and that on the other hand, lower asymmetry between ears is associated with a larger SUQ if the CI ear is an equal or the better ear.

Table 5. Correlation matrix between Binaural Benefits in the bimodal group at T4 and in NH controls.

Hearing Independent Of Your Line Of Sight

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The direction of the microphone normally corresponds with the hearing aid wearers line of sight. But if you are sitting at your personal computer and concentrating on the screen, and still want to converse with a person behind you, the older hearing systems will not be of much use. Modern binaural hearing aids, on the other hand, are able to rotate the microphones in the direction from which the speech signal originates, allowing you to have conversations without having to make eye contact. Effortless hearing is now possible with the latest and advanced hearing devices.

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Monaural Hearing Aid Fitting Considerations For Patients With Unilateral Hearing Loss

Jun 24, 2014 | Hearing Loss |

Who should receive unilateral fittings, and how should you fit them?

Fitting Tips: Unilateral Hearing Loss | Hearing Review July 2014

Unilateral hearing loss is common, and without intervention it can lead to academic, speech-language, and social-emotional difficulties. But there is only limited literature about hearing aid fitting for these patients. Here is a brief review and some considerations when fitting patients with UHL.

It used to be that monaural hearing aid fitting was the standard of practice . About 78.2% of hearing aid fittings were monaural in 1984. In the ensuing years, as the benefits of binaural hearing aid fittings became apparent, the proportion of monaural-to-binaural fittings did a dramatic flip-flop. As of 2008, only 25.7% of total hearing aid fittings were monaural in the United States. For people with bilateral hearing loss, only 10.2% are fitted monaurally.1 Some of these include individuals who have an unaidable ear.

This indicates that the majority of people today who are fit monaurally with hearing aids are those with unilateral hearing loss .; UHL is defined as a loss in one ear of any degree regardless of the type of hearing loss. Permanent conductive, sensorineural, and mixed losses are all included in the definition. The incidence of UHL is estimated to be 0.8 to 2.7 per 1000 in newborns, 30 to 56 per 1000 in school-aged children, and 7.9% in adults. UHL accounts for half of adults with hearing loss.2,3

What Is Binaural Hearing Loss

Binaural hearing loss is a hearing loss that affects both ears. By contrast, monaural hearing loss affects just one.

Binaural hearing has a wide range of benefits as detailed above, which we often dont realize until its too late. Unfortunately, even mild hearing loss in both ears can have outsized negative effects, as the information the brain receives from the ears becomes hard to process; garbled, confused or just not quite right.

The severity, onset, and specific effects of binaural hearing loss vary from person to person. Some people are quite severely hearing-impaired in both ears, others only mildly. Some people have one bad ear and another good one. Hearing loss, of course, can arrive suddenly or gradually.

Either way, binaural hearing loss can often result in a marked reduction in our ability to localize sounds, to hear everything thats going on in our surroundings, and is oftenaccompanied by tinnitus.

Hearing speech clearly is often particularly tricky for those with binaural hearing loss. As referenced above, its thought that the interplay between the two halves of the brain after receiving signals from both ears aids both hearing and comprehension. Without this, many hard-of-hearing people have to concentrate hard to clearly hear a single speaker in a noisy room.

Perfectly understandably, this can sometimes lead to tiredness, frustration, and a feeling of exclusion.

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