When the telecoil is enabled you may hear a buzzing sound. This is to let you know the processor is now ready and waiting for a telecoil connection to happen (telephone or looped room). Sometimes you may also find that speech does not sound right, which means that the telecoil and microphone are mixed to enable you to hear people next to you while you also hearing what is being transmitted through the loop. Apart from the straight telecoil setting there is also a new setting called Auto-Telecoil. It enables someone who works in an office to pick up the phone and the telecoil will activate automatically. However, because the telecoil is constantly looking for a connection, it may mistake emissions from a microwave oven, fluorescent lights, computer or other electronic devices for a telecoil, resulting in buzzing that is stronger near certain devices and speech that does not sound quite right. Use the remote assistant to look at the se ttings when you experience something unusual. If you see the Telecoil or the Auto-telecoil symbol in the display window, deactivate them with a short button press for each setting. To help you notice that you are on the telecoil setting accidentally you can adjust the telecoil to eliminate the microphone input on the remote assistant. 

Cochlear implant surgery is best and most safely performed under a combination of general anaesthetic with assistance from local anaesthesia injected into the skin behind the ear to make the recovery after the surgery almost painless. The surgery involves drilling hard bone in the skull to enter the cochlea, while negotiating several sensitive structures including the facial nerve and nerve of taste. The ear drum, lining of the brain as well as the carotid artery and jugular vein are only a few millimetres away. The opening into the cochlea (cochleostomy) is around 1 millimetre in diameter (less than a dressmaker’s pin head) and the cochlear implant electrode around 0.6mm in diameter (like a bristle on your toothbrush). The surgery is performed under a microscope which magnifies these structures many times to make them clearly visible to the operating surgeons and generally takes around an hour and a half to perform. As you can imagine, trying to lie perfectly still for that period of time while the surgery is being performed is uncomfortable. The slightest movement (not to mention more vigorous movements such as deep breathing, a cough, sneeze or even swallowing) appears like a mini earthquake under the microscope. The sensation of the drilling would also be unpleasant, and lastly when the electrode is finally inserted into the cochlea extreme dizziness (vertigo) might occur. For all these reasons it best that implant surgery is performed while the patient is pleasantly asleep. We are fortunate today to have excellent new general anaesthetic agents which are safe, act quickly and have very few side effects which were commonly a problem with the older agents. All patients are carefully evaluated before surgery and any health factors which might interfere with the anaesthetic or surgery can be identified and corrected, if possible, or controlled beforehand. I have performed ear and mastoid surgery in hundreds of patients including over 200 CI surgeries, many of them elderly patients (the oldest 92!) – rarely has their fitness for a general anaesthetic been a reason to prevent the surgery for occurring. 

A personal amplifier contains a microphone that picks up sound and an amplifier to make the sound louder. It usually consists of a box slightly larger than a matchbox with the components enclosed. A general rule of thumb is the larger the box, the more powerful the device. The box is usually connected to ear-bud headphones through which the amplified sound is heard. They can be useful for people who have difficulty wearing or managing conventional hearing aids or who are unable to tolerate anything inside the ear canal. They are also a good option when the device is managed by another person as the controls are large and headphones are easy to place over the ears. Usually a personal amplifier will have a volume control that can be adjusted by the wearer – but unlike hearing aids they are not set up to match the individual’s specific hearing loss. Often personal amplifiers can be plugged directly into other devices such as the television. They can be a good solution if a simple, easy to manage device is required. They are usually fitted instead of hearing aids but can also be used with hearing aids via the telecoil.

There are lots of factors to take into consideration when choosing a style of hearing aid. The range of devices available is very broad from tiny devices that are completely in the ear canal to implantable devices with external and internal components like the cochlear implant. The style of devices depends on the type of hearing loss, the degree of loss, the shape of the ear, personal preference and ear health factors among others.

In general, the smaller the hearing aid, the lower the power, so people who use these tend to have low to moderate hearing loss and so may appear to be doing better because they don’t need so much help!

There are exceptions to the bigger = powerful rule as the completely in-the-canal devices can be pushed a long way down the ear canal, thereby increasing the sound pressure level at the eardrum. This means that it takes less power for these devices to get more volume. They are still not suitable for profound hearing losses. Also, some people’s ear canals are simply not large enough to accommodate this style of hearing aid or are an unusual shape which makes it hard for the device to fit in the ear - you could have a sharp bend or a very narrow canal which could make wearing an in-the-ear device difficult. Depending on the loss, aids that sit behind-the- ear can be fitted with very narrow tubing and a simple dome that sits in the ear avoiding issues with ear canal shape and size. These also allow fresh air and natural sound into the ear canal. For some people, the sensation of wearing the hearing aid in-the-ear and the subsequent effect of hollowness or loudness of their own voice is unpleasant and so prefer an open style of device. Smaller aids can also mean less functionality such as less hearing programs or no telecoil. However in these hi-tech days of remote controls, streamers and remote microphone technology, even very small devices have more and more options. The most important thing is to ensure that you discuss your individual wishes and concerns with your own audiologist to make sure that you choose something that is right for you. The audiologist can guide you and provide expert advice on clinical aspects of the fitting. Some people are happy to sacrifice a little on the functionality or sound quality to obtain the style of the hearing aid they want and that is a choice that only the hearing user themselves can make.

Second Answer: Different styles of hearing aids suit different people. The main reason why people choose the behind the ear style aid with an earmould which sits in the ear is that they are much more powerful. With the in-the-ear style, even though they can now accommodate much greater losses than in the past, you are still limited by the physical size of the aid and the way it sits in the ear canal and concha. Sometimes components such as a telecoil have to be left out of the in- the-ear aids to save space and this can reduce the functionality of the device for the user. The other reason why a behind the ear aid could be preferable is because the earmould can be made very open in what we call a skeleton style with a big air vent which lets lots of fresh air and natural sound into the ear. These are often better for people with tinnitus, good low pitch hearing or ear health issues. More recently we have seen very open devices where there is no earmould but simply a tube carrying sound from the aid to the ear and a dome to hold the tube in place. It is important to discuss all the aspects of your device decision with the Audiologist so you can make an informed decision for this important choice. 


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