Hearing Aid Feedback

Why do my hearing aids whistle?

Many hearing aid users wonder about that high pitched whistle sound that sometimes comes from one or both of their hearing aids. What is it and why does it happen? That high pitched sound is referred to as feedback and it can occur with any sound system that involves a microphone and a speaker, just like a hearing aid.

How does feedback occur?

In order to understand feedback, we will first look at how a hearing aid works. All hearing aids have at least one microphone which picks up sound waves from the environment and converts them to an analog signal. The analog signal is converted to a digital signal, which can be amplified and manipulated by the hearing aid to fit the user’s needs. After processing, the signal is converted back to an analog signal and sent to the receiver (speaker). The receiver converts the analog signal back to an acoustic signal and delivers it to the ear as sound. The sound travels down the ear canal and is absorbed by the ear drum.

Sometimes, excess amplified sound leaks from the receiver and gets picked up again by the microphone of the hearing aid. The microphone will re-amplify the already processed sound and the signal gets stuck in an endless loop of being delivered by the receiver and picked up again by the microphone. This creates that loud, high- pitched squeal we refer to as feedback.

How can I reduce feedback?

Feedback is possible with any sound system, and you have likely heard it occur at some point with a speaking microphone or a band setting up to play. While occasional feedback is normal, excessive feedback is not. Let’s look at some ways that feedback can be reduced.

  1. A good fit- A well fit hearing aid will minimize how much sound can leak out of the ear canal and get picked up again by the microphones. This is especially important for custom “in-the-ear” hearing aids. Behind-the-ear products have the advantage of more distance between the microphones and the receiver, which helps to reduce feedback. Keep in mind that it is normal for your hearing aids to whistle while you work to get them in your ears properly because a good seal has not yet been formed.
  2. Turn down the volume – When your hearing aids are turned up all the way, the output from the receivers is greater than it is at lower volumes. This increases the risk of the microphones picking up the excess sound. If you consistently need to turn your hearing aids up to their maximum level and this is causing excessive feedback, it may be time to speak to your audiologist regarding a more powerful hearing aid or a different fit.
  3. Clean your ears- Wax build-up in your ears can cause significant feedback because the sound is reflected by the wax instead of absorbed by the ear drum. Typically, hearing aid users will describe a situation where feedback was not present and then came on suddenly, in all situations and in only one ear. Consider having a doctor look in your ears for wax if you think this might be your problem.
  4. Clean your hearing aid – To the same point, wax build up in your hearing aid can also cause significant feedback if it blocks the sound from escaping from the receiver. Check to see if the receiver is clogged with wax and then refer to the proper way to clean that wax depending on your style of hearing aid.
  5. Feedback manager- Most hearing aids have feedback managers available in them, and many are very successful at reducing excessive squeal. Your audiologist can activate this feature on your hearing aids if it is available.


Keep in mind that in certain situations, all hearing aids will give off feedback. For example, if you take your hearing aid out of your ear and cup your hand around it, it should squeak. In fact, if you do not hear it squeak in this situation, it is possible that your hearing aid is not working correctly. As mentioned previously, it is also normal for hearing aids to feedback while being put in and adjusted to sit properly. Even after the hearing aids are in correctly, feedback can still be induced by covering your ears with your hands or putting something like a headphone over the hearing aids.

If feedback is a concern or you feel your hearing aids squeak excessively, talk to your audiologist about some ways to troubleshoot this problem without sacrificing your listening experience.

How to Interpret an Audiogram

Reading the Graph

An audiogram is a graphical representation of pure tone audiometry test results. It charts the softest sounds (threshold) that a patient can hear at each frequency tested. The frequency of the tone is displayed across the x-axis (horizontal), while the loudness of sound is displayed along the y-axis (vertical). Frequency is measured in Hertz (Hz) and intensity is measured in Decibels (dB).

There are different symbols used to differentiate between the thresholds based on the transducer used. Below is a chart of the commonly used symbols on an audiogram. Air conduction testing is performed using earphones, inserts, or speakers. Sound is sent through the middle ear to the inner ear. For bone conduction testing, a bone vibrator is placed behind the ear to deliver sounds directly to the inner ear, bypassing the middle ear.


Degree of hearing loss

Once thresholds have been plotted on an audiogram, the degree of hearing can be determined. For adults, normal hearing is considered to be thresholds 25 dB or less.

Intensity (in dB)

Degree of hearing loss

0-25 dB

Hearing is within normal limits

25-35 dB

Mild hearing loss

40-65 dB

Moderate hearing loss

70-90 dB

Severe hearing loss


Profound hearing loss

Types of hearing loss

The type of hearing loss is determined based on the difference between the air conduction and bone conduction thresholds.

Sensorineural hearing loss reveals a problem with the inner ear organ or auditory nerve pathway. If air conduction and bone conduction thresholds are within 15 dB of one another, the hearing loss is considered sensorineural.

Conductive hearing loss reveals a problem in the middle ear system. If air conduction thresholds show a hearing loss, but bone conduction thresholds are within normal limits, the hearing loss is considered conductive.

Mixed hearing loss reveals a problem with both the middle ear system and the inner ear organ.  A hearing loss evident through bone conduction testing and a greater degree of hearing loss through air conduction testing with a difference of 15 dB or more between thresholds would be considered mixed.

If you would like to have your hearing tested, or if you have any questions about your specific audiogram, please make an appointment with your JHBI healthcare provider.

Hearing Aids and Music

Will I Be Able to Listen to Music With My Hearing Aids?

A common concern among many hearing aid users is how amplification will affect their ability to appreciate or create music. Whether you are a professional musician, an avid concert attendee or you simply enjoy the occasional tune on the radio, you may notice that how you listen to music will be affected by amplification.

Many hearing aid users report an increased appreciation of music through their hearing devices. The reason for this is simple. Music is dependent on hearing a wide range of frequencies, and hearing loss can greatly limit which frequencies you have access to. Amplification can provide access to those specific frequencies, allowing for music to sound more like it was intended to sound. Also, hearing aids can increase loudness overall, which makes both the notes and the singing more audible.

However, keep in mind that hearing aids are designed to pick up speech, as that is arguably the most important thing we listen to throughout our day. Speech is very different than music in regards to which frequencies are emphasized. Vowels and consonants are higher in pitch than the sounds that are important for a melody, so those are the frequencies that hearing aids focus on amplifying. The loudness of the notes in music is also typically quite variable, which is another challenge for hearing aids.  Some features present in the hearing aids to maximize speech understanding can actually be detrimental to the ability to appreciate or produce a tune.

So what does that mean for you, as a current or potential hearing aid user? If music is an important part of your life, than that is something you should discuss with your audiologist when you are picking out a hearing aid. Most hearing aids have the ability to create special programs just for listening to music. These programs can give emphasis to lower frequencies and use different sound processing strategies to improve the quality of song through the hearing aids.

In a previous blog post, we wrote about what to expect from new amplification and the adjustment period that new users go through. Listening to music is no exception. Your favorite song will likely sound different through hearing aids but that is not always a bad thing. With a few programming changes from your audiologist and some patience and persistence on your part, you may notice that music sounds richer, fuller and overall better than before. To learn more about music appreciation in regards to your hearing loss or specific hearing device, make an appointment with your JHBI audiologist today.

Hyperacusis: Sensitivity to Sound

Hyperacusis: What is it?

Hyperacusis is defined as an unusual intolerance to ordinary environmental sounds. Individuals with hyperacusis usually have inappropriate responses to sounds that are not bothersome to a typical person.  This differs from loudness recruitment, in which a person with hearing loss cannot tolerate moderate to loud sounds. With loudness recruitment, loud sounds are too loud. With hyperacusis, all sounds are usually too loud. Many people with hyperacusis have normal hearing sensitivity. The disorder can occur in one or both ears, and is commonly accompanied by tinnitus.

Potential Causes of Hyperacusis

Studies show that in a majority of hyperacusis cases, there may not be an underlying medical condition. However, some conditions that have been linked to hyperacusis include:

Peripheral Central
Bell’s Palsy Migraines
Ramsay-Hunt Syndrome Depression
Stapedectomy Post-traumatic   stress disorder
Perilymph fistula Head injury
Meniere’s Disease Lyme Disease
Williams syndrome

One major cause of hyperacusis is exposure to very high levels of noise, either as a single intense exposure or a long-term exposure. Use of hearing protection devices is crucial in prevention of noise induced hearing loss and hyperacusis.

What Can Be Done?

A person’s first reaction to intolerance to sounds may be to wear ear plugs or other hearing protection devices to reduce the loudness of sounds. This strategy is usually not helpful, as the person may actually be worsening their poor intolerance to relatively normal sound levels. Wearing hearing protection may provide temporary relief to a bothersome sound, but when the device is removed, the individual may be even more sensitive to sounds than they were before.

Another approach that may be more successful in helping an individual deal with hyperacusis is called sound desensitization, which is administered by a professional. For this therapy, the individual with hyperacusis will listen to barely audible white or pink noise for a set amount of time each day. Over time, the individual will build a tolerance to the sounds, and find they are no longer sensitivity to every day sounds.

If you or a loved one is experiencing unusual intolerance to sounds, please visit an ear specialist for medical evaluation.

New Hearing Aids: What Should I Expect?

First time hearing aid users

Approximately 8.4 million people in America currently wear hearing aids. While some of those individuals may have been wearing hearing aids for decades, some are just starting their journey to better hearing. If you are considering hearing aids for the first time, or considering trying amplification again after a long time, you may wonder what the first few weeks of life will be like in your new ears. Understanding what to expect can help to ease some of the anxiety associated with a new fitting.

Be Patient

On average, patients wait over 10 years after their initial diagnosis to be fit with their first set of hearing aids. Most of these people will have gradual, progressive hearing loss which they have not noticed getting worse with time. This means that many first time hearing aid users have been living in a quieter world than usual for many years. They may not have heard the softer, every day sounds of life that are always present but not necessarily attended to by individuals with normal hearing. When these individuals first start using hearing aids, these sounds are suddenly audible again. New hearing aid users report being able to hear everything from the refrigerator running, to water boiling on the stove, to the turn signal in the car. All of these sounds are now novel and interesting for the brain because they have not been heard in so long. Put simply, that means that these sounds may be at the forefront of a new user’s attention more than he or she might want. Certainly no one wants to sit and listen to the air conditioner run, but it may feel like that is what you are doing during the first few weeks in hearing aids. Be patient. Your brain needs time to adjust to all the new stimulation it is receiving and decide what is and is not important to attend to. By wearing your hearing aids full-time, you will teach your brain to ignore the noises that you do not want to pay attention to, just like it used to do before your hearing loss.

You will hear many new sounds that you have not have heard in awhile with your hearing aids. Some of these sounds will be exciting, others may be bothersome. Consistent use of hearing aids allows your brain to readjust to new stimulation.

Don’t Change Your Routine

One thing that new hearing aid users are tempted to do is to avoid crowded areas or noisy situations when they first get their hearing aids. They may be afraid that these situations will be overwhelming or even painful. It is very important that you do not change how you live your life because of new hearing aids. You should feel comfortable wearing your devices all day, every day. In order to get to that point, you have to expose yourself to more difficult listening situations like background noise and crowds. In truth, these situations may be a little overwhelming at first (but never painful!), but with time, your brain will get better at filtering out noise and focusing on speech. Being in more difficult listening situations also allows you to provide feedback to your audiologist, who can make appropriate programming changes based on your lifestyle.

Go about your regular life in your hearing aids. You may feel overwhelmed with sound in more difficult listening situations, but this will improve with time and follow-up programming.

Have Realistic Expectations

Finally, it is very important to have realistic expectations about how hearing aids will work for you. Your hearing aids will not restore normal hearing and you should be skeptical of anyone that tells you otherwise. If there is a lot of background noise present, such as in a busy restaurant or a party, communication will be difficult just like it is for a normal hearing individual. You will also likely always need to use visual cues and context clues when communicating, just like you did before your hearing aids.  Your audiologist will spend time going over your hearing loss specifically and explaining why hearing aids may help in some situations, but not in others. Don’t be afraid to ask questions! Hearing aids are a financial expense and a time commitment, so it is only fair that you know their benefits and limitations.

While hearing aids hold the potential to provide a huge benefit to individuals with hearing loss, they cannot restore normal hearing. Some listening situations will always be difficult and the communication strategies you have developed will continue to serve you well, even with new hearing aids.   

Know that your experience with hearing aids will be uniquely your own. Family and friends can provide good insight into the hearing aid process but your hearing loss and fittings are different so your experience will be different as well. If you are considering amplification and would like to talk more about your options or what to expect, please make an appointment with your JHBI audiologist today to learn more!

Noise Induced Hearing Loss

Loud Noise and Hearing Loss

Roughly 10 million cases of hearing loss can be attributed to noise exposure. Noise induced hearing loss (NIHL) is characterized by a gradual, progressive loss of high frequency hearing sensitivity that usually presents as a “notch” that occurs at or around 4000 Hz.

NIHL can occur from a one-time exposure to loud noises or from extended exposure to harmful levels of sound. Sound levels are measured in decibels (dB). Normal conversations typically occur between 50-60 dB SPL, which is not loud enough to cause damage to your hearing. Exposure to sound levels 85 dB and higher over an extended period of time can cause permanent damage to your hearing. The softer the sound, the longer period of time it is safe to listen to the sound. The graphic below, created by the Dangerous Decibels public health campaign, outlines guidelines based on NIOSH and CDC recommendations for maximum time exposure allowed in various levels of sound.

Ways To Protect Your Hearing

There are many ways to prevent NIHL, such as:

  • Avoid or limit exposure to dangerously loud sounds
  • Decrease the volume of music systems
  • Move away from loud sound sources when possible
  • If you must be around loud sounds, use appropriate hearing protection.

Hearing Protection Devices

At The Hearing Center, we offer a variety of hearing protection devices. Common devices include:

  • Swim plugs are designed to prevent moisture from entering the ear canal during swimming, showering and water sports
  • Shooter’s protection is designed to protect hunters/shooters from impulse noises up to 160 dB peak SPL. These devices can be made with special acoustic filters that allow for awareness of conversation and the ability to track animals.
  • Industrial noise protection- Some work places require workers to wear custom hearing protection due to exposure to dangerous sound levels. Employees who work in industrial factories, construction sites and around aircraft equipment are likely to be required to wear hearing protection. Specialized devices can be made that can connect to radios for those who work in jobs that require radio use.
  • Musician earpieces provide hearing protection for musicians who practice and perform in a variety of settings. Depending on the source and location of the sound, different levels of attenuators can be used in the earpieces to allow for optimal hearing protection.
  • Motorcyclist’s protection is designed to help eliminate wind noise under a helmet.
  • Custom sleep plugs can be used to promote interrupted sleep.
  • Custom fit ear tips for mp3 players or other headphones are designed to have standard earphones fit into a custom fit ear tip. These earplugs help block excessive environmental noise and allow the listener to turn down the music volume.

How Much Hearing Protection Is Enough?

Custom hearing protection is rated by a system known as the Noise Reduction Rating (NRR). The NRR is used to determine the ability of hearing protection devices to decrease sound exposure within an environment. The higher the NRR number assigned to the hearing protection, the greater potential for noise reduction. It is important to remember that the NRR number is not simply subtracted from the loudness of sound. To compute how much hearing protection is provided by an earplug, take the NRR number (in dB), subtract 7, and then divide by 2. If an earplug has a NRR of 29 dB, the equation would be (29-7)/2=11. This mean if you were at a concert were the level of noise exposure was 100 dB and your hearing protection had a NRR of 29 dB, your actual noise exposure level would be 89 dB. If you are wearing hearing protection in combination, you do not add the NRR of both devices together to find the amount of protection. Instead, you would add 5 dB to the higher NRR to find the combined hearing protection. For example, if you were wearing earplugs with an NRR of 17 dB and earmuffs with a NRR of 24 dB, your combined NRR would be 29 dB.

If you believe you are at risk for noise induced hearing loss, make an appointment with your JHBI audiologist to discuss a custom hearing protection option that is suitable for your needs!

Hearing Aid Batteries

Types of Batteries

One of the most common questions new hearing aid users have about their devices is in regards to the power source: batteries. While there are a few products on the market which use rechargeable batteries, most hearing aids will be powered by disposable zinc-air batteries. Zinc-air batteries, as the name implies, are activated by being in the air. All zinc-air batteries will have some type of sticker or tab that needs to be peeled off in order for the pores on the back of the battery to be activated and start working.

Because hearing aids come in all different sizes and power levels, batteries too are designed to meet different needs.  Zinc-air batteries come in 4 common sizes: 10, 312, 13 and 675 in size order from smallest to largest. In general, larger hearing aids require larger batteries.

 Battery Life

In general, you can expect anywhere from 5 to 14 days of life from a hearing aid battery. There are many factors that come in to play when predicting where you and your hearing aids will fall in that spectrum. Also, keep in mind that a day is considered about 10-12 hours of wear time.

The first factor to effect battery life is the size of the battery itself. In general, smaller batteries get a shorter battery life than larger batteries. The size of the device will also matter. Larger, power hearing aids take a bigger battery but they draw more heavily from it, which reduces the life.  The situations you use your hearing aids in will also affect battery life. In background noise, hearing aids work harder and employ more features such as noise reduction algorithms. The more the hearing aid is doing, the more battery power it requires. Bluetooth streaming and CROS and BiCROS hearing aids (link back) also draw heavily on batteries and can reduce life to about 3-6 days per battery.

Extending Battery Life

If you are noticing that your batteries do not last very long, consider these tips and tricks to extend life:

  1. Open the battery doors on the hearing aids when they are not in your ears. The batteries will still be draining but at a significantly reduced rate.
  2. Activate a new battery by peeling off the sticker or tab approximately 3-5 minutes before you need to use it. Letting the battery charge up fully before use can result in extended battery life. Do not peel off the sticker or tab more than a few minutes before use, as the battery will start to drain once it is exposed to air.
  3.  Store your batteries in a non-humid, room temperature environment.
  4. Use a dry-kit over night to suck out moisture from both the batteries and the hearing aids.
  5. Check the expiration date on your batteries.
  6. Keep batteries away from other metal objects such as keys or change in your pocket or purse. Metal can short-circuit batteries.
  7. Consider changing battery brands or buying your batteries from a different place. Some places, such as your audiologist’s office, will go through batteries more quickly and are therefore more likely to have new, fresher batteries.


If you are still noticing a very short battery life, or your battery life has suddenly reduced significantly, it is possible that your hearing aids need to go in for repair for excessive battery drain. Consider making an appointment with a JHBI audiologist at The Hearing Center to have your hearing aids looked at, or stop in any time to purchase batteries at our new lower prices of $25 for a box (60 batteries) or $3.50 for a card (6 batteries).



Earwax and Cleaning Your Ears

What Is Earwax?

Cerumen, more commonly known as earwax, is healthy for your ears in normal amounts. Glands in the ear canal produce earwax, which helps trap dust and dirt particles from making its way to the eardrum. It serves as a self-cleaning agent that can protect and lubricate the ear canal. Without earwax, the ear canal may be dry and itchy. While everyone produces earwax, the amount can vary greatly. For most people, earwax naturally works its way out of the ear. It is transported by jaw motion from the ear canal to the outer ear where it dries and falls out.

Should I Use Q-Tips To Clean My Earwax?

Earwax is formed in the outer 1/3 of the ear canal. When cerumen impaction occurs deep in the ear canal at the eardrum, it is often the result of the individual pushing the wax deeper with things such as q-tips or bobby pins. You should never probe into your ear canal to remove wax. Injury to your eardrum can occur as a result of probing in the ear canal. Some medications, stress and exercise can cause the body to process excessive earwax. Symptoms of earwax impaction can include decreased hearing, ear pain, plugged or fullness sensation, tinnitus, itching or dizziness.


How Should I Keep My Ears Clean?

If you notice earwax buildup in your ears, there are safe, at home ways to soften the wax. Patients can place a few drops of mineral oil, commercial cerumen softening drops or a mixture of hydrogen peroxide and water drops in the ear over the course of a few days. If deep impaction has occurred, softening the wax alone will most likely not remove all of the wax. A person who has an eardrum perforation should not use eardrops to soften their earwax.

Many licensed medical providers have the ability to manually remove earwax. Different methods include suction, water irrigation, or curette removal. The method used varies from person to person depending on the condition of their ear. Consult a physician if you are unsure if you have cerumen impaction. Ear candles are not a safe option to remove earwax. The U.S. Food and Drug Administration (FDA) do not approve use of these products.

There is no way to prevent excessive earwax. Individuals who are prone to cerumen impaction should see a doctor at regular intervals to have routine ear cleanings. If you believe you may have cerumen impaction in either ear, contact Jacksonville Hearing and Balance Institute to set up an appointment for removal by our physician or physician’s assistant.

Unilateral Hearing Loss: CROS and BiCROS Hearing Aids

CROS and BiCROS Hearing Aids

In a previous blog entry, we spoke about the benefits of two hearing aids for users with bilateral hearing loss. However, you might wonder what some options are for a person with hearing loss in only one ear or hearing loss that is worse in one ear than the other.

One option for consideration is referred to as a CROS or BiCROS system. CROS systems are for users with normal hearing in one ear and deafness in the other ear. BiCROS systems are for individuals with hearing loss in one ear and deafness in the other ear. In both systems, the user will need to wear a hearing aid device in both ears; however the style of the device can be flexible depending on the manufacturer and the user’s individual hearing loss. A microphone will be used on the poorer hearing ear to pick up sounds and transmit them wirelessly to a receiving device worn on the opposite ear. With a CROS device, no amplification is present in the signal. It is simply sent from one side of the head to the other. With a BiCROS device, the transmitted signal is amplified to fit the hearing loss in the better hearing ear for optimized listening.


CROS (left) BiCROS (right)


BiCROS and CROS hearing aids are designed for users who receive no benefit from traditional amplification on their poorer hearing side. In that situation, these systems can give individuals back their awareness to sounds coming from their poorer hearing side. This is an important benefit for safety, communication and quality of life. If you currently have single sided deafness or asymmetrical hearing loss and you think a BiCROS or CROS system might be right for you, please consider making an appointment with one of our audiologists for a hearing aid consult to discuss your options further.