If your hearing loss has progressed to the level that you may benefit from the use of hearing aids, a critical and important factor in their success is your understanding and acceptance of realistic expectations of their capabilities. Hearing aids regardless of type, manufacturer or even cost can never replace one's normal hearing in all listening situations. Below are some guidelines to help form more 'realistic' expectations:

1. Taking your time - As part of your rehabilitation you will need a period of time to self adjust to your hearing aid(s) and environment. Very few people have the ability to adjust to hearing aids immediately. Your brain is stimulated by so many new sounds that you may find the adjustment period tiring. You will need to start slowly, and gradually progress to wearing your hearing aids for longer periods until you are able to wear them comfortably all day.

2. Severity of loss - The extent to which your hearing can be improved depends on the severity and duration of your hearing loss along with your listening requirements. Generally the more severe your loss, then you are more likely to need a larger hearing system.

3. New sounds or long lost sounds - Everyone's hearing will decrease gradually as they get older, and we are often unaware that we have lost the ability to hear certain sounds, or the fact that we have gradually got used to hearing sounds differently (sounds that we accept as being normal, as we know no different). For instance hearing the fridge humming, floors creaking, taps running and footsteps on a hard floor are common sounds that are easily forgotten. With hearing aids in, these sounds can seem very new and in some cases quite intrusive until you become accustomed to them. This is quite a normal experience, over time, you will learn to 'tune out' the sounds that are not important and become gradually accustomed to the different types of sound.

4. Own voice - Often the first thing that any new hearing aid user will notice is the difference in the quality and loudness of their own voice. This can be off putting and distracting at first. However, if you follow your rehabilitation program you will get used to the new sound of your voice. If after a few weeks this is still a distraction then an adjustment to the hearing aid(s) by your Hearing Aid Audiologist may help.

5. Occlusion - Your hearing instrument is a physical object that occupies space in your ear canal. The sensation of having something in your ear which blocks the sound is referred to as the 'occlusion effect'. Many hearing aids and moulds have a built in vent or small groove that allows air to pass in and out of the ear. This generally combats occlusion, but again if this is still a distraction after several weeks then an adjustment to the aid may be needed. However, it is important to remember that you will never hear normally or totally naturally as the ear is not designed to have a foreign object sitting in it.

6. Feedback - This basically is a phenomenon where the amplified sound re-enters the hearing aid and is re-amplified. Typically, it sounds like a high pitched whistle, the loudness and pitch of which can vary.

Feedback is often an integral part of life with hearing aids. For instance Instruments may whistle if they are turned on whilst inserting them into the ear, putting on or removing clothing over your head, using the telephone, laying your head down or by hugging another person. So when is feedback acceptable? If you are wearing your hearing instrument and place your hand close to it, you may experience feedback. Although this can be quite alarming at first, it is normal. However, if feedback occurs after your hearing aids have been placed in your ear(s) correctly as a result of chewing, or normal head movement this would be considered to be unacceptable. This can generally be corrected by adjustment to the hearing instrument by your Hearing Aid Audiologist.

With the onset of newer technology, the likelihood of unnecessary feedback becomes less and less.

7. Wind - You may be surprised to hear the noise of the wind in your hearing aids when outside, for example when out walking, or on the golf course. This is natural, because the wind comes into contact with the microphone on the hearing aid. Different hearing aids react in different ways, this is largely dependent on microphone placement, size of the aid (smaller aids are protected more from the physical presence of the ear itself). Today's hearing aids are designed to minimize wind noise as much as possible.

8. Noise - Hearing in noise is difficult enough for someone with normal hearing, never mind someone who is hearing impaired. When you first try your hearing aids you need to be in the comfort of your own home and not in a busy restaurant. When you are ready to take your first steps in background noise, if it's within your control, try and reduce any background noise as much as possible (for instance turn the TV off or down). Since hearing aids pick up many sounds- some wanted, others unwanted you have to retrain your listening skills to focus on the words you want to hear.

9. Tiredness - Bear in mind that if you are tired or not feeling your best due to a cold etc, it may be more difficult to adjust to your hearing instruments especially in noise.

10. Can you hear that? - There is no point in comparing your hearing, with your hearing instruments in, with some one who has much better hearing than yourself, as your hearing cannot be restored to normal so you will therefore not be able to hear everything that they can hear.

11. Television - When using your instruments for the first time with the TV you need to listen to programmes where the speech is clear and distinct so that you can get used to hearing with them, for example the news or documentaries, and not soaps etc where the sounds are more complex. Once you get used to this type of listening situation then you can try other programmes. Remember, this is an artificial scenario, the person on the TV is speaking into a microphone, that signal is then transmitted through your television and is then picked up by your hearing aid, this is not the same as hearing someone one to one in the same room as you.

12. Telephone - Sometimes this can prove difficult to use, the effectiveness depends on the type of your telephone, type of hearing aid and how you hold the phone in relation to your hearing aid (more importantly the microphone). Some hearing aids are fitted with telecoils which can assist in the use of telephones. Your Hearing Aid Audiologist will advise you on the most effective use of your telephone in conjunction with your hearing instruments.

Remember hearing aids are not new ears; there may be certain sounds that you will never be able to hear again, they are designed to make the best use of your residual hearing.

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