The answer to this question will depend on a number of variables. Hearing aids should function well for at least four to five years. Although they may still work after this period, technological advancements as well as a change of hearing may mean that once this timeframe approaches you may benefit from new hearing aids to improve listening ability. In addition, you need to consider what type of hearing aids are being used. Factors such as illness, general health, an alteration in hearing ability or a change in lifestyle may result in needing to change your hearing aids. For example arthritis may result in deteriorating dexterity and you may no longer be able to manage controls or smaller batteries. In this situation, the option of hearing aids that have a remote control with large buttons and devices with larger hearing aid batteries may be the solution. Taking up a new sport, starting a fitness regime or changing jobs to a more dusty or humid environment may also mean you require more robust aids that tolerate moisture and dirty air. Hearing aids like many other electronic devices are exposed to the wear and tear of daily use including humidity and perspiration. These factors may require the devices to be sent away for repair or service. The service and repair fees may differ from one hearing aid manufacturer to another however a minor check of hearing aid function and cleaning the aid can cost approximately $70 and a major repair may exceed $300. Sometimes repairing old hearing aids out of warranty may be less cost effective in the long term for the user than purchasing a new set of hearing aids. Cleaning your hearing aids often and scheduling routine appointments with your audiologist will help ensure optimal performance over the lifespan of your audiological equipment. 

For many individuals, the prospect of being fitted with two hearing aids may be daunting. Often new hearing aid users may feel that the process of adjustment with a single aid may be easier than two, more cosmetically appealing or in some cases it may be financially difficult to purchase two hearing aids. If a hearing loss is present in both ears, it would be recommended that you wear a hearing aid in each as the expected benefit of wearing two hearing aids exceeds that of wearing one. To totally understand the benefit of wearing two hearing aids we need to recognise that the process of hearing is not limited to only our ears but also involves the brain. Much of our brain's ability to make sense of sound is based on the information it receives from both ears working together. A few reasons why two hearing aids are recommended over wearing one:

1. Better hearing in noise - Hearing speech in noise can be improved if the sound reaching each ear arrives at slightly different moment in time - this time difference helps the brain process a signal more efficiently.

2. An improved ability to tell what direction sound is coming from (sound localisation) - the brain uses the sound entering each ear to determine the direction of the sound.

3. Wearing two hearing aids gives you a more natural balance of sound.

4. Less listening effort is required to be able to understand speech in noise.
5. Individuals fitted with two hearing aids are more satisfied than those fitted with one.

Second Answer: Two hearing aids (binaural) is usually best for a patients ability to hear well. There are a few exceptions. I recommend only one hearing aid (monaural) for patients in these situations: 1) One ear has normal hearing. This ear would not need an aid. 2) One ear is completely deaf and cannot be helped with an aid. 3) The patient absolutely cannot afford a second aid. One is better than none but two would be best. I like to give this handout to patients that question me when I recommend two hearing aids for them and they insist that they only need one. Do I need one hearing aid or two? If you have hearing loss in both ears it is best to have two hearing aids. Here are the reasons why:

1.) Better reception of sounds and soft spoken words. To approximate the performance of two aids, a single aid may have to be worn with the volume at a higher volume than it would if two aids were worn. The higher volume setting puts the patient closer to the point beyond which an increase in sound level becomes uncomfortable or painfully loud. The addition of the second aid can have the effect of increasing the range of sound pressure than the patient can comfortably wear.

2.) Better understanding of speech in background noise. Even a person who has one normal ear and one non- functioning ear has trouble with understanding speech in the presence of noise. In order for the central nervous system to "sort out" speech from noise, input from both sides of the head is required.

3.) Reception of sound from both sides of the head. The addition of a second aid reduces the need of rotating the head around to face the speaker, making communication easier and more comfortable.

4.) Localization of the sound source. The ability to localize the origin of a sound allows a person to react more appropriately to his/her environment. It also helps with acoustic balance.

Two hearing aids are not recommended for all patients evaluated. When the recommendation is made, it is because the hearing health-care provider feels that the communicative abilities of the patient will be significantly improved by wearing two hearing aids instead of one. Typically I find that I can prove to the patient that their ability to understand speech is better with both ears than one ear alone on their word discrimination test. 

Meningitis is a serious infection of the fluids and linings surrounding the brain and spinal cord. It can be caused by a range of viruses or bacteria. Although the incidence of meningitis following cochlear implantation has been very low, there was an increased concern of the risk of meningitis by implantees, their families and doctors following a report in the US (Sept 2003) of a cluster of bacterial meningitis cases in cochlear implant recipients. The report investigated 118 meningitis cases in implant recipients. Both adults and children recipients were affected with the age range of 13 months to 81 years. The onset of the infection ranged from less than 24 hours following implant surgery to more than 6 years after. The most common infection was due to a particular organism called Streptococcus pneumonia. Although these cases suggested that meningitis was more prevalent in implantees these cases had occurred over a period of 20 years during which around 60,000 implant surgeries had been performed.

In the paediatric population the incidence of implant-associated meningitis was higher than non-implanted children indicating that cochlear implant surgery was an added risk factor for meningitis. Subsequent investigations, both clinical and laboratory based, suggested that there were multiple factors involved in the meningitis cases leading to an ‘at risk’ profile of implant cases where particular actions are taken around the time of surgery to prevent meningitis. These risk factors included the presence of inner ear malformations, CSF leak2 during or after implantation, history of VP shunt2 (used for treating hydrocephalus) and recurrent otitis media (middle ear infection). There was also a particularly high incidence of post-implant meningitis with an electrode designed with a positioner (a small wedge designed to place the electrode closer to the auditory nerve endings), which has since been withdrawn from the market and subsequent electrode designs modified to minimise this risk. Several strategies have been developed to minimise the risk of post-implantation meningitis. Not all strategies have been universally accepted, with the adoption of a range of strategies being left up to the protocols in various implant clinics, individual surgeons, implant recipients and their families.

Antibiotics are universally administered during implant surgery and continued for several days after. Similarly, measures to reduce the incidence of recurrent acute otitis media in infection-prone children by insertion of a grommet in both the implanted and non-implanted ears, is also commonly practiced. Emphasis has been placed on immunisation against a range of bacteria for implant recipients, particularly children, but also adults, those with inner ear malformations, CSF leak at the time of implantation or with VP shunts to optimise their immunisation status. In Australia the national immunisation program ensures that children and adults have access to a range of bacterial vaccines to minimise the chances of infection, particularly Streptococcus pneumonia, Haemophilus influenzae type B (HIB) and menigococcus, from a young age. Immunisation against Streptococcus pneumonia, the most common bacterium involved in post-implant meningitis is strongly recommend for implantees of all ages by most surgeons. The immunisation schedule is widely practiced, and changes made as new knowledge concerning the prevalence of infections in the community and more effective vaccines become available. Hopefully these measures will see a further reduction in the already low incidence of bacterial meningitis in cochlear implant recipients over time. 

If a cochlear implant recipient is using Autotelecoil they may find that the telecoil activates when they enter a looped area. This can sometimes be surprising if the looped area is not obvious e.g. a train station, tram, exhibition at a museum etc. Also if the telecoil is enabled the wearer may be more susceptible to interference from the environment. 

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