Although we often think of hearing loss as a plight of the elderly, children are also susceptible to the condition. In fact, the World Health Organization (WHO) estimates that some 32 million children around the globe suffer from some form of hearing loss – a staggering number.
That being said, the WHO also estimates that about 60% of these children have hearing loss that could have been prevented. While some children are born without the ability to hear and others have unavoidable conditions that lead to hearing loss, for that 60% of children who can avoid hearing loss, preventative interventions by parents and caregivers are critical.
Parents and caregivers want the best for their children, so the thought that your child could develop preventable hearing loss is a scary one, indeed. Luckily, there are steps you can take to help your child maintain good hearing health throughout their life. Here’s what you can do:
- Stress the importance of hearing health. Many children – and adults for that matter – don’t realize how important their hearing actually is nor do they recognize the dangerous situations we often put our hearing in when we expose ourselves to loud noises. It’s easy to overlook the importance of something that we take for granted, so teaching children to respect the value of their own hearing can help them start to take personal responsibility for their own hearing health.
- Set a maximum volume on electronic devices. Many modern smartphones and computers have parental control settings that can limit the maximum volume of music or videos that children can listen to. This can be a good way to protect a child’s hearing, especially if they’re not old enough or mature enough to understand the importance of their own hearing abilities. For older children and teenagers who are more likely to see this action as a sign of parental interference in their independence, a conversation about the importance of these volume limits could be helpful.
- Choose quality headphones. There are so many different headphones on sale today that it can be really difficult to choose a pair that is less likely to cause hearing damage. Although playing music too loudly on any set of headphones can hurt your ears, there are some headphone choices that are better than others in this regard. For the most part, earbuds are best avoided because they allow too much background noise to get to your ears, encouraging people to turn up the volume too much higher levels than they actually should. Over the ear and noise-canceling headphones can help alleviate some of that problem.
- Use hearing protection. Especially if you take children to sporting events, concerts, or other noisy venues, you might want to consider investing in some hearing protection. Ear protection can include anything from custom molded earplugs to protective ear muffs, so it’s important to find a pair that works well for your children. It’s also worth considering the use of ear protection when a child practices playing an instrument indoors and at home as repeated exposure to loud instruments, including percussion and brass instruments, can have a negative impact on one’s hearing health.
At the end of the day, there’s a lot we can do to help protect a child from preventable hearing loss. Many of these steps are simple and don’t require a huge time or financial commitment but they could protect your child’s hearing, so they’re well worth the investment.
The loss of the ability to hear has a profound impact on a child’s language and behavioral development. Estimates suggest that children with a hearing problem are more prone to behavioral problems than their normal-hearing peers. The challenges of early childhood communication lead to maladaptive interaction with others resulting in behavioral disorders. Why are children with hearing problems more prone to behavioral issues and what are the solutions to the challenge?
High Rates Of Aggression
Hearing loss treatment for children is better than it has ever been before. Technological improvements along with institutional changes are giving these kids more options for their hearing loss. Despite these advancements, children with hearing loss exhibit more aggression than their peers with normal hearing. Deaf children, in general, have higher rates of aggression, noncompliance, and inattention. Depression and other mental health problems are also high in children with a hearing loss.
Current Research Into The Problem
Research suggests that problems with language and communication skills are at the root of behavioral issues. Control of language is essential for life management. Those children without this control show an increase in difficulty with impulse control, planning, and regulating behavior. In studies with deaf children who have practical communication skills, the results show improvement in organizing behavior, attention, and impulse control. Furthermore, deaf children who have deaf parents or those with cochlear implants who have developed their language skills show improvement on par with children with normal hearing.
Most children who are deaf have parents with normal hearing. These children often present with language barriers early on because the healthy hearing parents are not skilled at visual communication making it difficult for the child to benefit from an accessible form of communication. Many deaf children have parents who report much stress in their daily lives and often make poor decisions. Deaf children develop an understanding of social interaction later than other kids. Most deaf children now receive education in mainstream schools. However, studies indicate that deaf children may experience neglect by their peers which limits the opportunity for social interaction.
There is positive news to report. Studies indicate that intervention with these children can be useful. Programs can teach these children impulse control and social skills to improve social interaction and behavioral control. These interventions must be a part of the regular school curriculum for these children with language and communication skills being the primary focus. Academic programs where deaf and hearing children learn together are beneficial in promoting inclusion into mainstream educational programs. Interventions that support communication in the family are also critical to the child’s development and behavior.
If your child has a hearing loss and behavioral problems do not fret. Interventions can help. Your child can learn methods for controlling their behavioral impulses as well as improve their social interaction skills. If you are not sure if your child has a hearing loss, please schedule a hearing evaluation with a hearing healthcare professional today or check out the Hearing Loss Association of America website for more information and possible assistance.
“It’s important to make your social life and your friends and family – make that a priority.” Samantha Barks
Whether you have always maintained a bustling social life with a packed calendar and lots of time with friends and family or prefer a quieter and more relaxed social life with family and a few close friends, hearing loss can make an impact on your plans. It’s hard to deny how we communicate and stay engaged changes after diagnosis, even with hearing aids. Hearing loss can become a barrier to socializing… but only if we let it.
Social side effects of hearing loss
According to the National Institutes of Health, approximately 15% of Americans report some difficulty with hearing. While recent research points to several potential side effects of hearing loss from an increased risk of injuries to an increased risk of dementia, one may be subtle enough to go unnoticed by many until it’s too late. That is social isolation.
Experts believe that as hearing loss changes how we communicate and interact, it can affect our desire to socialize. Many report increased levels of anxiety or stress over social interactions. For some, difficulty communicating due to hearing loss may lead to a withdrawal from activities and the people they once enjoyed. Social isolation and even depression then become concerns.
Maintaining your social life
Social connections and healthy relationships play an important role in health and longevity. If you have a hearing impairment, be proactive about maintaining your social life using strategies like these:
- Schedule a hearing evaluation. If you haven’t already the most important step you can take to supporting a healthy social life is getting a hearing evaluation. Whether you suspect you may be missing part of what’s going on around you or others have brought up their concern that you may have hearing loss, a hearing healthcare professional can diagnose and offer treatment options.
- Talk to your hearing healthcare provider about hearing aids. Treating hearing loss is essential to keep communication strong and help you feel more confident in social situations. In fact, a survey by the National Council on Aging found that those with hearing loss who did not use hearing aids were more likely to be socially isolated and report feelings of sadness than those who did wear hearing aids. Working closely with your hearing healthcare professional can help you find the best choice for you and your lifestyle and shorten the learning curve as you start using them. Enhanced programming capabilities and added features can make hearing in social environments easier and more natural than ever.
- Be open and honest. Millions of Americans now have hearing loss. Chances are one or more people you know have hearing loss. If you’ve been diagnosed, be open and honest with family, friends and colleagues about your hearing loss. This can help to reduce any anxiety you feel, cue others into your need for more effective communication, and put everyone more at ease.
- Adjust plans, but don’t cancel. While you may find yourself suggesting quieter restaurants or events that offer options for the hearing impaired, don’t cancel your plans. It can be easy to give into anxiety or fear of embarrassment, but it’s a slippery slope that can quickly lead to no plans or social interactions at all. Invest in your health and well-being by spending time with the people you care about.
Social isolation can be more harmful to our health than we realize. Don’t let hearing loss hurt your relationships and social life. Take steps like these to continue doing the things you love even with hearing loss.
If you have questions or would like to schedule a hearing evaluation, call our office today.
There is no cure for tinnitus. The typical treatment options for tinnitus address the emotional and cognitive effects associated with tinnitus but do not repair the underlying origins of tinnitus. A new research study finds that 83 percent of patients with tinnitus feel like their office visits with hearing healthcare professionals are ineffective. Patients with tinnitus have expectations for their care, and the new study looks at what healthcare professionals can do for them.
What Tinnitus Patients Expect
The research survey includes 230 patients seeking treatment to either eliminate tinnitus or decrease the loudness associated with tinnitus. 29% of the patients were expecting medication, 25% came with expectations for hearing aids, and 17% felt sound therapy would be the answer. A big surprise was that 37% went with no expectations of treatment of any type.
Hearing Healthcare Professionals Definition Of Success
Sixty-eight hearing healthcare professionals took part in the research survey and defined how they measure tinnitus treatment success. 77% believe a decrease in a person’s awareness of their tinnitus was a success. 63% saw improvement in thoughts and emotions as an accurate measurement. Finally, 63% feel that increasing public knowledge about tinnitus is the key to success.
The researchers note that only 60% of the healthcare professionals involved in the study took the time to use questionnaires or outcome assessments on their patients. Although the majority of patients receive the necessary information about tinnitus, they rarely receive any specialized counseling for the condition nor have their concerns about tinnitus addressed. Disturbingly, more than half of the patients do not feel that they receive an answer to their questions about the situation. 70% of the healthcare professionals in the survey do not think that specialized counseling for tinnitus is an essential part of treatment.
The universal agreement seems to be that most people with tinnitus want a quick fix for their problem. The difficulty is that there is no magic cure for tinnitus. There are however ways to lessen the symptoms of tinnitus and manage the disease more effectively. The researchers have faith that the time has come for healthcare providers to expand their services to include teaching patients about tinnitus management. They also encourage specialized counseling, hearing aids, and sound therapy for tinnitus patients.
Treatment For Tinnitus
If you receive a diagnosis of tinnitus, remember that treatment focuses on treating your symptoms. Possible remedies for tinnitus include:
- Noise suppression. Relief may come by tuning out annoying Devices include hearing aids, white noise machines, and masking devices.
- Yes, a drug can’t cure tinnitus, but a few may help to ease the symptoms. Effective drugs include anti-depressants and anti-anxiety medications.
- Coping and support. Coping with tinnitus is an integral part of treatment. Counseling, support groups, and patient education are useful coping tools.
- Alternative medicine. Some alternative therapy is useful for tinnitus including acupuncture, hypnosis, ginkgo biloba, melatonin, zinc supplements, and vitamin B.
Effective management of tinnitus depends upon providing patients with tools for the effective management of their condition and encouraging healthcare providers to educate them regarding tinnitus.
Have you ever wondered about what you hear at night? If so, you’re not alone. The topic of whether or not our hearing stays on even when our other senses have turned off during sleep has been one of considerable debate.
New research may now be showing that we do, in fact, process auditory information in our sleep. These findings could prove valuable in the future for those who use hearing technology for hearing loss.
Research from Vanderbilt University recently released preliminary results from an EEG study that offered surprising insight into hearing and sleep. In the study, the team worked with a group of preschool-age children at the university’s preschool. The children were placed in a quiet and isolated room for naptime, and while they were asleep, researchers played a group of three nonsense words over a short period. The preschoolers’ brainwaves were tested using an EEG machine.
Following the nap, the team showed the kids a variety of nonsense words, including those played during naptime.
According to the results, the children showed signs of recognition for the naptime nonsense words, confirming the hypothesis that they were still hearing and processing sounds while asleep.
Researchers dig into hearing during sleep
This isn’t the first study to take a closer look at whether or not we process auditory information during sleep, how it happens and how it affects us. It has been a question that has intrigued scientists for years:
- In a 2016 study, a team from the École Normale Supérieure in Paris used EEG to monitor the brains of volunteers listening to recordings of spoken words. Participants were asked to classify these words as either objects or animals. The results showed varying degrees of information processing depending on the depth of sleep (light non-REM, non-REM or REM).
- Earlier findings from Johns Hopkins also took a look at how the brain processes sound during sleep and why some sounds seem to wake us while others don’t. In this study, an undergraduate student uncovered where in the frontal cortex this process might take place. “We found that during waking, only areas around primary auditory cortex are activated by the tones,” Serena J. Gondek, study lead and author said. “Then, during light and deep sleep, you find not only primary auditory activation, but the frontal lobe also responds.”
- Another study published in Current Biology in 2014 found that sleeping participants were able make decisions (“task relevant responses”) in response to spoken words. The study reiterated previous findings that the brain does not completely shut down and disconnect during sleep as we once thought.
As researchers continue to explore how and what we hear while sleeping, experts believe this valuable information not only helps us to understand better how hearing works but may also one day translate into better hearing technology and treatment options for those with hearing loss.
If you have questions about your hearing or believe you have hearing loss, contact our office to schedule an appointment for a hearing evaluation.
As we age, a decline in our health condition comes as a natural consequence of our bodies living longer. But some conditions seem to go hand in hand. And, with hearing loss, it’s no different. The risk of psychological and medical conditions such as dementia and depression heighten as a result of untreated hearing loss in older populations. This fact is especially concerning given the high rate of hearing loss that goes untreated.
To investigate this issue further, researchers at Johns Hopkins Bloomberg School of Public Health led a 10-year longitudinal study in conjunction with AARP, University of California San Francisco and OptumLabs. Two groups were studied: individuals with untreated hearing loss, and those without hearing loss. Over a two-year period, individuals with untreated hearing loss incurred 26 percent more in health care costs compared to those without hearing loss, a gap that expanded to 46 percent by 10 years.
Growing Aging Population
This statistic is concerning given expectations for the aging population to grow to nearly 76 million in the United States by 2060. Two-thirds of adults 70 years and older have significant hearing loss, many of whom go untreated.
To investigate further, researchers data mined anonymized healthcare patient data from OptumLabs Data Warehouse to identify what specific characteristics stood out between patients with untreated hearing loss and patients who did not experience hearing loss.
They found that in a 10 year period, patients with untreated hearing loss experienced 50 percent more hospital stays, a 44 percent higher rate of hospital readmission within one month, were 17% more likely of revisiting the emergency department, and had 52 more outpatient visits on a whole than those without hearing loss. Individuals with treated hearing loss were not included in the study.
Links Between Medical Costs And Hearing Loss
Interestingly enough, only $600 of the total $22,434 of extra costs for medical care were spent solely on hearing loss related services. While the study did not determine exactly why costs are so much higher for those with untreated hearing loss, researchers offered some ideas that presented avenues for further investigation.
One idea follows the logical assumption regarding what kind of psychological fallout occurs as a result of untreated hearing loss. Higher incidences of depression and dementia occur within this population. Medical consequences of higher rates of depression, dementia, and similar conditions result in the form of more emergency room visits, hospital readmittance, and medical conditions related to falls.
Even though intuition would tell us that the high incidence of dementia, depression, hospital visits, and falls are due to untreated hearing loss, not enough scientific studies have been performed to establish this link. Another theory behind higher medical costs is the degraded communication ability between patient and provider. Those who have a difficult time hearing may misinterpret information provided to them by medical professionals.
However, recent changes in federal law have made the sale of over the counter assistive listening devices such as hearing aids permissible. This and increasing supply of assistive listening devices in doctors offices will help people with hearing loss communicate better and improve their quality of life.
Experts believe that tinnitus, or ringing in the ears, is one of the most common health conditions in the United States. Estimates put the number affected at roughly 45 million! This often frustrating symptom can be caused by a number of things including:
- Exposure to loud noises
- Age-related hearing loss
- Head trauma
- Underlying medical conditions such as high blood pressure and anemia
While a physician or hearing health care provider can help uncover the cause of tinnitus, research is showing that many put off tinnitus treatment.
Barriers to tinnitus treatment
A recent review of the existing research, published in The Hearing Journal, uncovered many reasons why people put off tinnitus treatment. Experts now hope to use this information to better serve the millions affected by tinnitus. According to the findings, here are some of the most common reasons people do not seek tinnitus treatment:
Sure we’re all busy, but it’s the amount of time that many have to wait to see a specialist (often weeks!) and the short amount of time they usually get to spend with specialists. According to the findings, patients often spent 10 minutes or less with hearing healthcare providers. The conclusion was “As both ENT specialists and audiologists provide specialized care for otological problems, counseling for 10 minutes or less may not be sufficient for some patients with tinnitus.” This in addition to the many weeks patients often have to wait even to see a specialist seems to add up to too large a barrier for many to overcome.
Lack of services
Tinnitus is complicated and varies from person to person due to its more psychological aspect. Research is showing that effective treatment may be equally involved and varied. Unfortunately, many hearing healthcare providers lack the option to refer patients to psychologists who may offer the support they need. In recent years, research has shown how effective techniques such as mindfulness, Cognitive Behavioral Therapy (to help patients identify and reframe negative thoughts about a specific situation), and Relaxation Therapy to reduce the stress of living with tinnitus can be in managing the condition. According to the recent findings, “audiologists reported that open access to audiology clinics for patients and long-term support services for chronic tinnitus were essential. However, these services are not always locally available to patients. Audiologists in the same study reported difficulty accessing rehabilitation, surgery, and psychiatric care for their patients.”
This barrier seems to go hand-in-hand with many other obstacles identified in the literature review. For many seeking tinnitus relief, the combination of minimal time with practitioners plus the lack of knowledge, resources and services sets patients up for ineffective treatment. Researchers across studies found that overall, practitioners were dissatisfied with medications prescribed for acute and chronic tinnitus and that estimated treatment success rates, in general, were low. The highlight was that approximately “60 percent of patients had minor to major relief of tinnitus from hearing aids”. For many, this lack of relief may pose a significant barrier for further treatment.
The bottom line is that it’s time for healthcare to take a closer look at reducing the barriers to tinnitus treatment. Untreated tinnitus can pose a significant health risk by increasing the risk of anxiety, decreased social interaction, irritability, and even depression.
If you are experiencing ringing in the ears, don’t put off treatment. Advocate for your health by speaking to a hearing healthcare provider today about options such as hearing aids, sound therapy, mindfulness, Cognitive Behavioral Therapy, Relaxation Therapy and alternative therapies for relief.
Normal gestation time for a human fetus is 40 weeks and any child born before 37 weeks of gestation is considered premature. Being born premature presents a whole host of complications for a newborn and puts them at risk for health problems that can have life-long implications.
Premature babies – affectionately known as preemies – can suffer from a variety of health issues, like apnea, intraventricular hemorrhage, and respiratory distress syndrome, which can keep them in the hospital for weeks or months after they are born. But did you know that preemies are also at risk for hearing loss?
According to researchers, nearly 2-4% of premature infants are at risk of sensorineural hearing loss compared to 0.1-0.3% of their full-term counterparts. Since premature birth can be coupled with immediately life-threatening conditions, the risk of hearing loss is often overlooked or unappreciated during initial care. That being said, hearing loss in preemies can have lifelong consequences so special attention to its causes and treatments is of the utmost importance.
The Cause Of Hearing Loss
When we think of the causes of hearing loss in preemies, many of us might assume that it is often due to underdevelopment of the sensitive – yet important – organs and structures within the ear. Contrary to popular belief, however, the overwhelming consensus amongst neonatal hearing experts is that hearing loss in preemies is due to the antibiotics so frequently used to help the infants fight off infections.
It turns out that 1 in 500 people inherit a gene variation from their mothers that increases the risk of severe and irreversible hearing loss in infants after they are exposed to the commonly used antibiotic gentamicin.
While the solution to this issue may seem simple (just stop administering this antibiotic), gentamicin is incredibly effective at treating a whole host of bacterial infections, such as pneumonia, sepsis, and endocarditis, so it can be critical in saving a newborn preemie’s life. Thus, the answer may lie not in avoiding gentamicin completely, but in knowing when the antibiotic many eventually cause irreversible hearing loss.
Preventing Preemie Hearing Loss
Luckily, many researchers have already dedicated themselves to this important task. A team at the Manchester Centre for Genomic Medicine at the University of Manchester have been searching for a way to screen newborns for the genetic variation that increases this risk for hearing loss and have been making significant progress toward their goal. So far, the team believes that they have developed a genetic test for the gene variant that does not adversely affect the newborn.
Using a simple cheek swab, the team believes that they can generate a genetic test result in 30 minutes or less that can inform physicians as to whether or not they can administer gentamicin to a preemie, all within the recommended first hour after admission.
Another group of researchers is focusing on the antibiotics themselves. At Stanford University, a research team led by Tony Ricci, Ph.D., are looking to create a new generation of aminoglycosides – a type of broad-range antibiotic, which includes gentamicin among their ranks. Although these antibiotics save lives, they have a nasty side-effect: they cause hearing loss in about 20% of patients, particularly in newborns and people who take repeated doses.
To combat this issue, the Stanford researchers have created three new aminoglycoside antibiotics, all of which have molecules that are simply too large to enter the ion channels of the inner ear. Thus, these new antibiotics can significantly lower the risk of hearing loss, especially in preemies.
While the research is still in its early stages, the work of countless research teams will likely have a lasting impact on the prevalence of hearing loss in premature infants. As our understanding of premature infant hearing loss expands and new technologies are developed, we can work toward a world where premature babies can grow up to live long, healthy lives free from hearing loss.
The excitement of the holiday season is here, and children everywhere are thrilled. The kiddos are counting the days until Santa brings lots of fun things. One problem with all this fun is the noise these toys may bring with them! Excessive noise is harmful to a child’s hearing. The American Academy of Otolaryngology believes that three million children under the age of 18 may have a problem hearing. So as the holidays arrive, take the time to help protect your child’s hearing.
The Impact Of Noise
A noise-induced hearing loss doesn’t just affect one’s ability to hear. For children, it also affects a child’s speech, language, cognitive, social, and emotional behavior. The viral video and computer games on the market today can reach sound levels of 135 decibels. For comparison, this sound level is equal to that of a jackhammer. Music players are no better. When a child listens to their favorite music through earbuds, they may be enduring 110 decibels. Prolonged listening to music at this level will likely produce a hearing loss of some degree.
A significant problem with all of the noisy toys that are available this holiday season is that manufacturers do not warn parents of the potential dangers these toys pose to their children’s hearing. Thankfully, groups are working to change this policy. The Sight & Hearing Association (SHA) tests toys and alerts parents to potential dangers associated with the noisemakers. This organization tests toys at distances that children typically play with them, unlike the intervals that manufacturers use. For this holiday season, the group is offering the following tips to help protect your child’s hearing:
- Always check the sound level of a toy before you purchase it.
- If a toy is earsplitting report it to the Consumer Product Safety Commision or the Sight & Hearing Association.
- Try applying masking or packing tape over the speaker of a toy to reduce the volume.
- Only purchase toys that have volume controls.
Toys With Less Noise
For the sake of your child’s hearing, it is vital that you as a parent provide an atmosphere for your child that is quiet. Try to minimize the noise and provide time for reading, talking, and listening. There are great gifts that don’t damage hearing. Here are a few to help you get started:
- Books. Books are not only quiet, but they also help children develop reading skills.
- Educational toys. Shop for computer games with educational themes.
- These gifts are quiet and fun for the whole family.
- Construction sets. Building blocks are quiet and develop diverse skills in your child.
- Card games. These noiseless games are not only fun but help your child with math and language skills.
Make this holiday special this year by reducing the noise that is cumulative and detrimental to your child’s hearing. The damage is irreversible, so it is wise to protect children early. Keep an eye on their activities, listen to their toys volume, and spend good times with your child doing quiet activities. Happy holidays!
Using headphones with hearing aids can sometimes be a difficult task for many hearing aid wearers. That’s because the fit of the hearing aid can interfere with the placement of the headphones. Other problems can entail the microphone of the hearing aid sitting too close to the headphone speakers causing audio feedback.
These problems create a frustrating aspect of wearing hearing aids for many users who are accustomed to enjoying music on a long car ride, plane ride, or during their typical exercise routine. But, in actuality, most audiologists would argue that there is a headphone selection available for most everyone living with hearing aids. The challenge is identifying the one that’s most compatible with your hearing aid type and placement.
Good News For Headphone Wearing
Wearing headphones with hearing aids poses no additional risk to your hearing as long as you’re responsibly using them at normal volume levels. The most challenging hearing aids to work with when it comes to headphone selections are those that sit behind the ear. Behind The Ear (BTE) and Receiver In The Canal (RIC) hearing aids both have at least some part that lies behind the ear. The best kind of headphones for these style hearing aids are those that fit over the ear instead of on top or in the ear. This configuration will keep the hearing aid microphone properly positioned an adequate distance from the headphone speaker to avoid audio feedback.
Noise Canceling Headphones
Noise canceling headphones may also be a good option for hearing aid wearers because they help block out ambient sound so that the user can focus more on the music. These kinds of headphones do put out a soft hissing sound, so it’s best to try these before you buy these to make sure your hearing aid doesn’t pick up on that.
In The Canal (ITC) hearing aid wearers are fortunate because their microphones are placed further away from the ear exterior. This fact opens up options for the kinds of headphones they can wear. Both on the ear and over the ear headphones are appropriate for this hearing aid.
Completely In The Canal (CIC), hearing aid wearers will experience the most luck with headphones. These users should be able to use over the ear, on the ear, or even in the ear headphones with little problem. As always, the best bet is to try these headphones before you buy them. Ask your friends and family if you can try on their existing headphones to get a better feel for what works and what doesn’t. Chances are you know someone with all three types of headphones.
While expense is not necessarily a good indicator of quality, there are some makers of headphones that are better than others. Noise canceling headphones may be a good option, but if you are better off with standard headphones go with a pair that has a good reputation and are comfortable on your head. Comfort is especially important if you wear BTE or RIC phones.