I recently had a conversation with a hearing aid dispenser whom I highly respect, and whose opinion I often seek when I have hearing aid fitting problems. So, I was somewhat surprised when he presented me with a “difficult” case for which he had no solution and asked if I could share it with other dispensers to see if they had any thoughts to share.
The patient (HJ) is a 63-year-old male who has the hearing levels shown in the audiogram and who has been reporting hearing loss symptoms for several years. Hearing thresholds are fairly similar, showing moderate to moderately-severe hearing levels, but showing very good word recognition scores of 80% for the right ear, 90% for the left ear, and 100% at MCLs of 70 dB HTL. UCLs were 110 dB for each ear to speech. His hearing and medical status has not changed over the last twelve months.
HJ is an outside farm supplies representative who also maintains a family farm. He trialed CIC digital hearing instruments approximately three years ago, but rejected them because of his own voice (occlusion effect), physical plugged-up sensation, and their failure to address his primary related complaint – that of understanding speech in noise.
His primary reason for seeking hearing aid assistance now is to satisfy his girlfriend’s expressed frustration of having to repeat herself during their conversations. He is very conscience of cosmetics and believes that something in the ear would be best for him. Therefore, premium CICs with maximum venting were ordered for him. The trial that ensued was to determine if the aids ordered would satisfy his expressed hearing needs.
After three weeks without any success in solving his hearing problems with two CIC (completely-in-the-canal) instruments, the dispenser loaned the patient a pair of completely open-fit RIC (receiver-in-the-canal) instruments, which HJ preferred to the CICs. The occlusion effect issues were greatly reduced and listening was enhanced. However, during this entire fitting period (starting with the CIC instruments), the patient complained of sinus-type headaches following short-time hearing aid use (within 5 and no longer than 15 minutes), and showed extreme sensitivity to prescriptive amplification. To satisfy the latter concern, the instruments were fitted 8-10 dB under target (gain and output) – even for a first-time user just to be able to provide an amplified listening experience.
Now, For the Weird Part
When the hearing aids were muted,or the batteries removed, the patient did not experience the headaches. Out of curiosity, and wondering if there might be a zinc reaction, a zinc cell was taped behind his ear for 20 minutes. There was no adverse reaction (no headache). He has seen a physician about the headaches, but no explanation for cause was advanced.
Many of us might be thinking that this patient is doing and saying just about anything to not wear hearing aids. That is entirely possible. Or, might there be a reaction to the plastic of the housing? One was acrylic (CIC) and the other reported to be ABS (Acrylonitrile butadiene styrene) in the RIC instruments. But, this would not explain the absence of headaches when there was no amplification. Could it be the amplified sound? Serious measures were made to reduce the amount of amplification, but even low levels resulted in the patient headache complaint.
In spite of this, and even though he rejected the CIC instruments outright, the patient claimed to be motivated to wear the open RIC instruments, but could not tolerate the headaches. What do you think is going on?