Successful Hearing Aid Use, part 9: What if your hearing is very poor?

Most hard-of-hearing people derive substantial benefit from wearing hearing aids. Unfortunately, there are a few hard-of-hearing people who have such severe hearing loss that they cannot use hearing aids successfully. This article is written for these folks.

However, before deciding that your hearing is so “bad” that hearing aids can’t help you, be sure you have consulted with at least two different, experienced audiologists who agree with this assessment. I have seen many patients who, after owning one or two pairs of poorly fitted hearing aids, concluded that their hearing was “beyond hope.” Yet, often they were able to benefit from appropriately fitted instruments.

When in doubt, get a good pair of hearing aids from an experienced audiologist on “trial.”



The following information is for people who really do have “very poor” hearing—so poor that hearing aids are not the solution—at least not a total solution.

There are many resources available to such people. The following is a brief summary of some of them. I discussed this topic at greater length in my June 1999 Nuts & Bolts article in The Hearing Journal, entitled “What to tell your patient when hearing aids are not enough.”


  1. FM systems: An FM system is a type of communication device often used in school classrooms for hard-of-hearing children. The teacher wears a microphone and a transmitter. The student wears a “receiver” unit that is attached to his/her hearing aid. The FM system delivers the speaker’s voice directly, clearly into the hearing aid wearer’s ears. The room noise is not transmitted to the student, only the teacher’s voice. This is an excellent system not only for students, but also for anyone else who needs to hear and communicate with one person, e.g., a spouse. FM is not so good when you need to hear and communicate with several different people, e.g., friends at a party.
  2. Bluetooth technology: The traditional FM system—discussed in the preceding paragraph—has a microphone and a transmitter, and a receiver attached to hearing Recently, systems have became available that use Bluetooth technology rather than FM transmission. The result is the same, i.e., excellent delivery of one person’s voice. This new transmission system costs much less than traditional FM if you purchase the transmitter when you purchase a new set of hearing aids.
  3. Closed-captioned telephone: Most people know about closed captioning for television—a technology that shows the printed words of the audio signal on the TV screen. There is also a wonderful new technology that provides captions for telephones, just as captioning provides the words for the TV. These phones use high-speed Internet and the services of a translator. When I use one of these phones and someone calls me, I see the words printed in large type on the screen of my special telephone. This is especially helpful when someone is giving you lengthy, hard-to-hear instructions, e.g., “Be at Dorothy’s house at 8793 Willington Street at 3:30 next Saturday.”
  4. Assistive devices: Many products, such as smoke alarms, doorbells, and alarm clocks, have been modified for use by people with severe or profound hearing loss. The sound has been amplified, and, in some cases, flashing lights and vibrators have been attached to the primary unit. There are many such devices available and a Google search will uncover a long list of products and providers.
  5. Group support: There are several groups that offer support for people with severe hearing loss. Probably the best known is the Hearing Loss Association of America (formerly Self Help for Hard of Hearing People or SHHH). This national organization has more than 200 state and local chapters around the country.
  6. Cochlear implants: These surgically implanted units bypass the eardrum, middle ear, and inner-ear hair cells and directly stimulate the hearing nerve with mild electrical signals. This type of equipment is designed for people with severe-to-profound hearing loss. Cochlear implants are not generally recommended for people who benefit from hearing aid use. Before you decide to have a cochlear implant, do some research, and talk to several people who have them. Also, make sure the surgeon who is going to do your implant has lots of experience doing the procedure. Also, you need to understand the importance of doing extensive therapy after receiving the implant. The sound has to be “tuned” for you and you have to work with your audiologist to get used to the new sound.



A final word of advice: There are many high-quality sources of information on the Internet, but also many very low-quality information sources. Many online “frauds” promise quick solutions to severe hearing problems. Before trying any “quick fix,” talk to your doctor, your hearing professional, and your family and friends about the idea. It pays to be careful.


  1. Dr. Bob may also want to inform his clients that hearing loops are now the up and coming assistive hearing system of choice for many users. All a user needs is a telecoil – the same telecoil the user needs to hear on the telephone, with FM or Infrared systems that offer neckloops, and other nifty Bluetooth non-proprietary devices such as the ClearSounds device like the Quattro: .

    A telecoil does not requiring pairing, linking, syncing, or does not drain the hearing aid battery – a telecoil gets activated simply by pushing on the button of the hearing aid. In a hearing loop the user only needs to activate this telecoil to hear the audio signal that is being broadcast over the hearing loop. Companies like Oticon are now mentioning in the telecoil section in their user’s guide (and I quote): “An increasing number of churches, theatres, and public buildings often have loop systems installed. These systems send out wireless sound to be received by the telecoil in your hearing instrument.” (Thank you Oticon!)

    Readers of this blog may want to know that thousands of people who struggle with understanding TV are now happily watching the programs in a looped TV room. A handy (grand)son (or daughter!) can loop a TV room in an hour or two and new hearing aids are not needed as long as the user has telecoils.

    I have personally listened in hearing loops in hundreds of places and love this system. I will also readily admit that I only have mild hearing loss and that this might be the reason that in some locations while using my hearing aid I can hear better than the normal hearing people ( like my husband LeRoy “Max” Maxfield or my son Lars) sitting next to me. But read what a Chelle George, a woman with severe hearing loss, wrote about her hearing loop experience recently: or read what other users have told me (unsolicited)

    Hearing loops are happening in some areas of the country (Florida, NYC, Santa Barbara, Chicago, Arizona, New Mexico and my state Wisconsin – to name a few. For more information see If we are to reach a tipping point for this easy to use and user preferred technology I encourage every hearing aid care provider to foster one or two hearing loops in their community and one in their House of Worship (if they belong to one). To find hearing loops in your state visit

  2. Even after 20 years, Dr Bob is dispensing outstanding advice; and in fact in rough order #’s 6, 5, 3 & 1 are what I recommend (with #4 being lumped into the others).

    However, #2, Bluetooth – In its current iteration of BT1.5 headset profile and BT2.1 A2DP streaming – is not quite so good, as it suffers from very high latency, up to 150 mSec, which causes all sorts of problems. When you get past 10mSec of group (propagation) delay, you get audible artifacts due to the feedforward comb filter effect, with it becoming very pronounced by 40 mSec. What’s more, at about the 40mSec mark you get a loss of synchrony with speechreading cues.

    That being said, the issue of 802.15.4 Bluetooth latency has been addressed in two ways:

    1) For the last 3 years GN ReSound has used a 2.4gHz signal similar to Bluetooth, but optimized for low latency and low power: Their very successful Unite system, in which their Mini Mic has direct-to-hearing aid capability. [Unfortuantely, they didn’t extend their wireless platform to a super power hearing aid.]

    2) Bluetooth 4.0 Low Energy (BLE) is the new industry-standard stack, which has been turbocharged by Apple’s “Made For iPhone” (MFI) program. BLE has specific accommodations for hearing aids & CI’s; and in fact some of the heavy lifting has already been done, because GNR already has the antenna & RF technology; and they even licensed it to Cochlear last September.

    Dan Schwartz,
    Editor, The Hearing Blog

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