1. If a button cell is swallowed, call the 24-hour National Button Battery Ingestion Hotline at 202-625-3333 immediately.
2. If available, provide the battery identification number from the package or from a matching battery.
3. An X-ray must be obtained immediately to be sure that the battery has gone through the esophagus into the stomach. Do not wait for symptoms to develop before getting an X-ray. If the battery remains in the esophagus, it must be removed immediately. Batteries lodged in the esophagus can cause serious burns in just 2 hours. Battery removal is done with an endoscope; surgery is rarely indicated. Do NOT give ipecac.
4. If a battery has moved beyond the esophagus, it can be expected to pass by itself. Passage may take days, or even months. Removal is NOT indicated if the battery has passed beyond the esophagus and the patient is asymptomatic. Once you are sure the battery is not in the esophagus, the patient can be sent home to wait for the battery to pass. Watch for fever, abdominal pain, vomiting or blood in the stools.
5. Send passed battery to: National Capital Poison Center, 3201 New Mexico Ave, Suite 310, Washington DC 20016.

RIC with wax

RIC or slim tube aid

A slim tube aid has a hollow slim tubing that runs from the hearing aid and into the ear canal. It is often held in the ear canal with a small dome, but can also be connected to a mold made from your actual ear canal.

RIC stands for “receiver in the canal”, meaning that the actual receiver (loudspeaker) sits in your ear canal. The tube that runs from the hearing aid and into the ear canal has a wire in it, and on the end of that wire is the loudspeaker. The loudspeaker is held in the ear canal with a small dome, or a mold of your ear.

Since this receiver does not have to be housed in the hearing aid now, the hearing aid can be smaller. And since the receiver is much closer to your eardrum, the aid does not have to work has hard to amplify sound. So the RIC aid is more efficient than the slim tube aid.

However, earwax is the number one enemy of hearing aids. With the slim tube aid, the wearer can remove the tube, push the wax out of the tube with a monofilament, and continue using the aid.

With the RIC aid there is a filter covering the receiver, but the receiver will eventually get wax in it. You will then either have to have the receiver replaced by your audiologist or have the aid repaired at the factory.

That is why I generally choose slim tube aids over RIC aids.

Our hearing is so sensitive that it can detect a minus-6 decibel sound that causes the tympanic membrane to vibrate less than the diameter of a hydrogen molecule. Yet it can also analyze a 90 decibel sound that is over a million times stronger.

The ear contains the 3 smallest bones in the body. The smallest of these bones, the stapes, is strengthened by its arch-like shape. The arched shape makes it look like a stirrup and allows a reduction in mass that would otherwise reduce high frequency sensitivity. Connected to the stapes is the smallest muscle in the body, the stapedius.

The vestibular part of the inner ear contains gyroscopic structures that are sensitive to head movement in any direction and that help control eye movement. Rotate your head quickly and it is the ear, via the vestibulocular reflex, that tells the eyes exactly how far the head has rotated so that vision can quickly be focused.

The hearing part of the inner ear, the cochlea, and is about the size of a large garden pea. Like the eye, the cochlea has 2 types of sensory cells. The inner hair cells number about 3000 per ear and the outer hair cells number about 15000 per ear. These hair cells are innervated by both afferent nerve fibers (carrying information from the ear to the brain) and, uniquely, efferent nerve fibers (carrying information from the brain to the ear).

The outer hair cells are a sensory cell but they also have a mechanical motility: they move under their own power! No other sensory cell does this. This motility tunes the inner ear and enhances its sensitivity.

Not only does the cochlea receive sound, it makes sounds called otoacoustic emissions. Otoacoustic emissions are are probably a by-product of the outer hair cell motility. These cochlear emissions can be detected by a microphone placed in the ear canal.

The hearing nerve is the only cranial nerve that twists around itself like the threads of a screw. This is probably due to the unique shape of the cochlea, which is coiled in a way that conserves precious space.

The ear is a unique organ that is often taken for granted until something in it does not function as it should.

However, it can also push the cerumen deeper in the ear and can over-clean the skin of the car. Over-cleaning the ear canal makes it prone to itching and infection.

Cerumen protects your ear by repelling moisture, bacteria, and fungi.

So how do you clean your ears? Cover your finger with a handkerchief or washcloth and wipe what you can get with your finger. Do not worry about cleaning down inside the ear canal. In most people, it is self-cleaning.

Do not worry about cerumen that is deeper than the ear canal entrance: it is supposed to be there and is not a sign of poor hygiene.

A few words about ear candling: it does not work. Do not do it.

-Talk directly to the person. If you are facing them they not only get a better speech signal, they can make use of the visual cues of speech. About 30% of speech sounds are visible on the face and most people, even normal hearing people, can make use of at least some of these visual cues.

-Talk at a normal, or slightly above normal, loudness. Shouted speech is difficult to understand and soft speech may still be difficult for some hearing-aided individuals.

-Do not talk too fast, but not too slow either. No hearing aid in the world will slow down fast speech. Slow, exaggerated speech is also difficult to understand.

-If the person does not understand you or asks for a repeat, it may not help to raise your voice. When you raise your voice, your articulation often suffers, but you also raise mostly the vowel sounds of speech (predominantly low frequency) and not the consonants (predominantly high frequency). Most hearing impaired people need just some of the frequencies of speech raised and the hearing aid is probably already doing that. So, if you are asked for a repeat, remember that even some normal hearing individuals need a repeat sometimes. Try rewording what you said. For example, you might say, “It is supposed to rain today.” When you have to repeat you might consider saying, “The weather report this morning said that we are supposed to get some rain.”

-If you are the hearing impaired person, it is helpful to tell the talker what part of their conversation you understood and what part you did not. When all else fails, ask them to spell a key work.

-Speak clearly. You don’t need to exaggerate, but there is a difference between clearly spoken speech and mumbled speech.

We replaced the aid and this time she knew to store the aid where the puppy couldn’t get it when the aid was not in use (at night when she went to bed). However, she was rough-housing with the dog one day and the aid got knocked out of her ear and the dog bit the brand new hearing aid.

So, you are forewarned. Your dog really, really wants to bite your hearing aid. Sometimes cats do too.

If this is you, trouble understanding speech is almost always a hearing loss. Because hearing loss is frequency specific, many hearing impaired people hear lots of sounds very well, or even normally.

However, there are lots of sounds or parts of sounds that they do not hear. Because the loss of hearing if often very gradual to develop, they do not notice that they are missing some sounds and they don’t notice that music is muffled. They notice that they have difficulty understanding speech.

If you have trouble understanding speech, get a comprehensive ear and hearing evaluation. This is not a screening test, and this is not a free test.

Clean the wax and skin debris from the shell of the hearing aid by wiping it with a cloth, tissue or handkerchief that has been moistened with a solution made for hearing aids, or with vinegar.

All hearing aids that fit in your ear have a receiver port. The receiver port is a hole that is located at the end of the canal portion of the aid. There are often 2 holes here, the receiver port and the vent.

Turn the hearing aid upside down over a toothbrush, as shown above, and run the receiver port back and forth in the bristles of the brush. Much of the dried wax will dislodge and fall away from the hearing aid in this manner.

Clean the receiver port in the morning after the aid has been out of your ear all night. This allows the wax to dry. If you clean the aid when the wax is moist it may smear and not crumble away from the hearing aid.

Do not put anything on the toothbrush, it should be dry. And do not use your spouse’s toothbrush, he or she will eventually notice a funny taste.

Size 13 battery

Size 10 battery

Batteries of this size could power your watch a year or so, but hearing aids use a lot more power than watches. Hearing aid batteries are not like watch batteries in materials or voltage, and they are less expensive than watch batteries.

How quickly the battery is used depends on a number of factors, including the size of the battery. The largest battery, the 675, might, MIGHT, last 2 or more weeks. The smallest battery will generally last between 2 and 6 days. Other factors that affect battery life include how much electrical current your hearing draws and how fresh the battery is. If you wear your hearing aid 24 hours a day (not recommended), your battery will not last as many days as someone with the same hearing aid but who wears the hearing aid 10 hours a day.

Modern hearing aid batteries are zinc-air and have a voltage of 1.35 to 1.4 volts. Batteries of years past were mercury and silver oxide and had a much smaller capacity (they didn’t last as long) than current batteries. Most hearing aid batteries stop working when the battery voltage drops below 1.2 volts. Making a digital amplifier of a hearing aid work on these small voltages was one of the hearing aid industry’s shining moments.

Hearing aid batteries are called zinc-air because air is an active ingredient in making the battery work. The colored tab, or sticker, on the battery is designed to keep air out of the hearing aid. This tab prevents air from entering the cell and activating it before it is ready to be used. Removing the tab activates the battery and makes it ready to use in your hearing aid.

Size 10 batteries have a yellow sticker; 312 a brown tab; 13 an orange tab; and 675 a blue tab. Do not take the sticker off until you are ready to use the battery. The tab (sticker) extends the shelf-life of the battery.

Changing the battery is not a big deal, but there are hearing aids designed to be placed and worn in your ear for months before having the aid removed and replaced. In other words, the battery in these extended wear hearing aids lasts several months, and the aids (and batteries) are not designed to be removed by the wearer. There is a trade-off between this convenience of not having to change the battery, but having to keep the hearing aid in your ear 24 hours a day.

Many hearing aids can use rechargeable batteries. Rechargeable batteries have been around for over 30 years and have improved over the years in ease of use and hours of use per charge. However, rechargeable batteries have not become as commonly used as standard zinc-air batteries.

If you want a rechargeable battery, keep in mind that you still need to have a few conventional zinc-air batteries around in case you don’t get your rechargeable batteries charged for some reason, for example if the electricity goes out over night. Rechargeable batteries also need to be replaced occasionally, sometimes every year.

2. If you hear ok, but just have trouble understanding speech, that is still almost always a hearing loss.

3. Make an appointment for evaluation with someone who knows both hearing and ears. Get your hearing aids from someone who knows both hearing and hearing aids, and how to couple one to the other.

4. If possible, get your hearing aid locally, just as you would your dentures or glasses.

5. A person with one ear (one hearing aid) does not hear as well as someone with two ears (hearing aids for both ears).

6. The state of the science in fitting hearing aids is with real-ear, probe-microphone measures, where a microphone is placed close to your eardrum so that the sound at your eardrum from the hearing aid can be compared back to the results of Step #1 (complete hearing evaluation).

7. Hearing everything, or hearing more than what you heard without hearing aids, can take some getting used to. It takes some people six weeks, or longer, to acclimate to this.

8. Your voice will sound different to you.

9. Don’t get hung up of the manufacturer or model of hearing aid. Get hung-up on who is fitting you with hearing aids. There are lots of details to the process of fitting a hearing aid.