Overview of Hearing Aids

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Even a mild hearing loss can interfere with your ability to understand speech, use the telephone, and interact comfortably in your world. Your hearing loss might benefit from hearing technology. If so, it’s time to explore the many options.

This is a good time in hearing history (hear-story) with an incredible variety of technological tools and toys to optimize your hearing experience. With guidance from your doctor, audiologist, hearing aid dispenser, plus your own trial and error experimentation, you’ll find the right instruments to fit your specific hearing loss needs.

Positive Changes Ahead

Hearing research and technology are evolving rapidly, along with the knowledge of how we hear, what happens when things go wrong, and what methods of hearing augmentation, rehabilitation and/or restoration might prove to be most beneficial. It is also an important time to educate yourself about the current medical and technological options from multiple reliable sources and not just from a single individual, website, company or other resource. The good news is that the growing visibility and an aging public’s interest in hearing loss have driven researchers and manufacturers to come up with truly remarkable technology to help you manage your hearing loss.

Tip: As with other points in this guide, expect this information to change with advances and products right around the corner.

STYLES OF HEARING AIDS

All hearing aids are custom made and programmed to fit your specific hearing loss needs. The settings can be adjusted by your audiologist and sometimes by yourself through special apps and devices. It’s always a good idea to continue to have your aid adjusted until you are comfortable, whenever there is a change in your hearing experience, or you wish to have more connectivity and/or flexibility with your instrument. Often, the cost of adjustments is included in the price of your aid.

Behind the Ear (BTE) Aids

As the name implies, BTE hearing aids house most if not all of the device behind the ear. Sound is sent from the hearing aid into the ear either by a tube connected to a custom earmold or by a thin wire connected to a tiny speaker in the ear canal. The style that includes the speaker in the ear canal is also known as receiver-in-canal (RIC) or receiver-in-the-ear (RITE). The tiny speaker can be in a custom earmold or in standard sizes. Given the range of options, BTE hearing aids can be fit to people with mild to severe to profound hearing losses. BTE hearing aids tend to have more options (such as rechargeable batteries, directional microphones and wireless connectivity).

Tip: If your aid needs repair, it’s easier to get a loaner with a BTE aid. You simply attach your earmold to the replacement aid and you’re good to go. Another, often overlooked advantage, is that the size of the hearing aids makes adjusting external controls and replacing the batteries much easier for people with vision problems, arthritis, or fine motor control issues.

In the Ear (ITE) Aids

The entire hearing aid fits inside the outer ear. Although there are a few powerful models, most are for moderate rather than severe to profound losses. These must be custom made to fit into the ear.

In the Canal (ITC) Aids

These hearing aids fit completely inside the ear canal and are mainly for mild to moderate losses. They must be custom-made to fit into the ear.

Completely in the Canal (CIC) Aids

These tiny aids fit deep in the ear canal and are removed with a stem of wire. They must be custom-made to fit into the ear.

CROS (Contralateral Routing of Signal) Hearing Aids

These are for people who have no hearing in one ear and good hearing in the other. The components look like two behind the ear aids, but the one draped over the poorer functioning ear has no earmold, and instead contains a wireless microphone and transmitter, while the unit draped over the “better” ear contains a corresponding receiver and speaker. This allows sound from someone’s “bad” side to be transmitted wirelessly to their “better” ear.

BiCROS Hearing Aids

Similar to CROS hearing aids, these are for people who have no hearing in one ear and also hearing loss in the other. The microphone is worn in the poorer functioning ear and the receiver is built into an actual hearing aid worn in the better ear.

Bone-Anchored Hearing Aids (BAHA)

This type of aid operates by bypassing the outer and middle ear and transmitting sound directly to the cochlea using what is referred to as an osseointegrated (bone-anchored) implant. A titanium post is implanted behind the ear in a minor surgical procedure. The sound processor then snaps onto this post. Sounds picked up by the processor’s microphone cause the post and the connected bones to vibrate, generating a response in the cochlea. The processor can also be held onto the skull using a surgically implanted magnet. Even without surgery, a BAHA can be used when held onto the skull using a headband.

Tip: This type of hearing aid is useful for those with chronic conductive hearing loss (such as chronic ear infections, a congenital hearing loss due to malformation or absence of the outer ear or middle ear known as atresia), or for unilateral — single-sided deafness.

Eyeglass Aids

The temples of these glasses incorporate the hearing aids. These models were quite popular from the 1950s through the ’70s. A newer variant, which includes multiple directional microphones in the sides of the frame, has been developed by Varibel, a Dutch company.

Disadvantage The obvious drawback here is that you may still want to hear when you take off your glasses, which is impossible when using this type of aid.

HEARING AID FEATURES

Analog vs. Digital Hearing Aids

Before there were commercially viable digital devices starting in the 1990s, hearing aids were analog. These aids did not have the ability to be precisely adjusted to meet not only the individual’s hearing needs, but also to accommodate the variances in different acoustic environments. Digital hearing aids overwhelmingly dominate the market today. They allow for precise matching of the amplified signal to those frequency bands most affected by the user’s hearing loss. They match the amount of amplification needed to the amount of sound in the environment which makes listening much more comfortable. They also improve the signal to noise ratio using:

• integrated noise reduction (allows you to block out some of the sounds that you don’t want to hear and focus on those that you do)
• directional microphone circuitry (allows you to “aim” your hearing somewhat, with the same purpose).

Digital hearing aids also have situation-specific programs that can be activated automatically or by the user, and advanced algorithms to minimize feedback — the whistling sometimes heard when a hearing aid amplifies its own sound.

Hearing aids have changed dramatically.

Hearing aid features that are commonplace today would have seemed like science fiction only ten or twenty years ago. If you read this guide two months from now — never mind two years — there will most probably be something new and revolutionary afoot that you won’t find mentioned here because it either doesn’t exist or hasn’t been publicized yet.

THE TELECOIL Hearing Aids

Telecoil (aka T-Switch or T-Coil) is a small spool or coil of wire that lets the hearing aid pick up electromagnetic energy from a sound source such as a hearing aid-compatible telephone receiver or assistive listening device and converts it back to amplified sound. Since 1989, every corded telephone sold in this country has been required to be hearing aid (telecoil) compatible, a compatibility which has since extended to many models of wireless phones as well.

Telecoils may vary greatly in effectiveness between manufacturers and models. You should have a way to manually activate the telecoil when needed, whether by a program selector switch on the aid, an external control, or via a smartphone app if that is your preference and if it is available for the hearing aid you are considering.

Automatic Telecoil Activation

Here’s another option, one that can be somewhat challenging at times as it may turn on when you don’t want it to and not turn on when you do want it to.

Positioning is important.

When using the Telecoil, the external telecoil (the one in the telephone handset, for example) should be in close proximity to the internal telecoil of the hearing aid. If not, you may not get a signal, or a very weak one. For best results, they should be in physical contact or as close as possible to one another.

Background Noise

The telecoil setting helps eliminate some or all of the background noise at your location. Some hearing aids and cochlear implants offer adjustable T switch to microphone pickup ratios, allowing you to decide how much you want to hear from the telecoil and how much you want to hear from the hearing aid’s or cochlear implant’s microphone.

Bluetooth

If you are a smartphone owner, enjoy listening to the television but are afraid of annoying your partner by turning the volume up, or enjoy listening to music, consider Bluetooth. Bluetooth is a wireless connectivity protocol that allows two devices to link together in a process called “pairing,” a kind of virtual handshake to establish a private connection between your hearing aid and a smartphone, or a TV “streamer” connected to your TV or audio components.

It is becoming almost ubiquitous and allows for small remote microphones, smartphones, or Bluetooth “streamers” that can be connected to telephones and television sets to send sound information directly from the sound source to the listener’s hearing aids or cochlear implants if the latter are equipped with Bluetooth functionality. If they are not, a Bluetooth receiver/neck loop can be used to the same effect.

The beauty of Bluetooth is that it:
• is an open and universal standard already built into many communication and entertainment devices
• does not require a wired connection
• allows you to hear in total privacy since the sound is being streamed directly into your hearing aids or cochlear implants
• can also be streamed into small portable receivers that are linked to your hearing devices (if they predate integrated Bluetooth functionality), and
• can be employed via a small, clip-on “remote” microphones that streams sound directly to your hearing devices, which can enhance speech comprehension in noisy backgrounds.

Feature Overload

Some people with or without hearing loss are not comfortable with technology beyond a basic level of features. Buying an advanced hearing aid that requires a familiarity with other forms of unrelated technology such as a smartphone is often counterproductive and unnecessarily expensive. In some cases, having no technology is almost better than having technology that does not work for you, so keep that in mind before buying the latest hearing aid or gadget for yourself or someone who still remembers and misses their rotary telephone.

PURCHASING HEARING AIDS

Currently, the standard recommendation is to purchase your hearing aid from an audiologist or hearing aid dispenser you choose to work with. Hearing aid companies do not sell direct to consumers but through their channels to the audiologist and other dispensers.

While the times and regulations are changing, you can’t go to a hearing aid “store” to get a cheaper aid like you might do when you’re trying to decide which TV to buy. You can go online and find a hearing aid for less, but what kind of hearing aid do you choose, and does the cost provide any servicing? Who will do the testing, and the fitting and adjustments? You will want all that knowledge and service behind your purchase. You cannot get that online.

You can also buy hearing aids at retail at a big box store like Costco. Buying hearing aids at big box retailers can also result in lower prices since they have enormous purchasing power. Sub lines of hearing aids and less expensive options are often sold from reputable hearing aid manufacturers with many years or decades of experience in business. However, it would be wise to investigate the qualifications of the dispensing staff at the retailers you’re considering — are they certified medical professionals who can answer questions you might have about hearing loss or the fitting process?

Tip: You may experience a difference in the quality of services and products available at a big box store vs. working with an HCP — Hearing Care Professional like an audiologist or board-certified dispenser.

Tip: The most important advantage of working with an audiologist/hearing aid dispenser is that you will work with someone who knows you, understands your hearing health history, and is intimately familiar with the hearing aid being considered. Normally, your adjustments won’t cost anything.

How much does a hearing aid cost?

Hearing aids are expensive. First, find out if your insurance company will pay for all or part of your hearing aid(s). Find out if there are any health company or community grants (veterans, etc.) or other programs available to you to help defray the cost such as flexible spending accounts (FSA) or health savings accounts (HSA). Cost depends on your needs but aids will run from $75–$3,000 or more, per hearing aid — with a great variation up and down. Usually, all of the service (selection of the device before purchase, adjustments and troubleshooting after purchase) is bundled into the price of the hearing aid. Sometimes hearing aids can be purchased separate from the service, which requires the audiologist or dispenser to charge a fee for their service. 

Tip: The best companies make great hearing aids. But the reality is that the costs without insurance can be prohibitive. Most companies also have a “B” line of products — less expensive but with little fall off in quality. Ask your audiologist about the “B” line of products available, but be sure you aren’t sacrificing important features in the process. The process is somewhat similar to buying a lower trim model of a car you might be considering if you don’t need/want all the fancy features — just be very certain that you’re not giving up an option that you’re later going to wish you had included.

Insurance Coverage

In Massachusetts, hearing aids for children are covered by health insurance. There is, at time of writing, no such mandatory coverage for adults with existing health insurance policies that exclude pre-existing conditions. Even when available, coverages may vary widely, as will deductibles.

Over-the-Counter Hearing Aids and Personal Sound Amplifier Products (PSAPs)

The issue of costs especially has brought us to the era of the over-the-counter hearing aid. Over-the-counter personal sound amplifier products (PSAPs) are already available and sold in a variety of places (such as online, at pharmacies, etc.). By law they may not be called hearing aids for good reason — they are not considered to be such under the Food and Drug Administration (FDA) regulations. They vary in their features. Some are simple amplification devices made to look like hearing aids, and others have the same features as hearing aids and Bluetooth in-ear headphones. Regardless of their features, they are not permitted to be marketed or sold as products to help hearing loss.

In 2017, Congress passed, and the president signed into law, the Over-the-Counter Hearing Aid Act of 2017. This brings new and emerging technology (at least in the realm of mild to moderate hearing losses, which these aids are designed to accommodate) and the potential modification of costs onto the landscape. As a result, it is more important than ever to have a full audiological evaluation and become an informed and knowledgeable consumer of hearing aids and assistive technology before you buy any product at any price point.

Tip: If you’ve already had hearing aids before, or have them now and are simply trying to buy a replacement hearing aid, you may be able to do this online as well as through your audiologist or hearing aid dispenser. Since your hearing aids will likely require individualized adjustment, make sure that your audiologist or hearing healthcare provider will adjust hearing aids that they did not sell to you. You may be charged a fee for that service.

In the days of analog hearing aids, this was a much more straightforward process since many aids could be adjusted by their owners by virtue of changing physical controls on the hearing aid itself to match those of their previous aids. Today, sophisticated computerized equipment may be needed for fine-tuning some devices, which makes professional assistance mandatory. Still others can be adjusted via smartphone apps or remote controls.

Tip: If you have a very mild hearing loss, PSAPs may work for you. Just be aware that they are not hearing aids. That said, your audiologist can do a hearing test and may be able to verify fit as well as advise on adjustments. You may also need a smartphone or other device to get the best functionality out of them by adjusting listening parameters via dedicated apps.

Tip: Legitimate hearing aids sold over-the-counter are not yet available at time of writing, although legislation has passed allowing for this to happen. While the OTC sale of hearing aids may potentially reduce the cost of hearing aids and thereby increase availability, the danger is in the fact that hearing loss is not always a symptom in and of itself, as has been mentioned extensively throughout earlier chapters. It can be a sign that something systemic and more serious is going on in someone’s body. If the symptom is treated without the underlying cause being discovered, there could be significant health repercussions. Also, improperly fitted hearing aids can injure the ear or make hearing loss worse.

On the Flip Side of This Argument

Hearing aids are prohibitively expensive, so much so that many people simply cannot afford them and end up not buying them meanwhile 43 suffering from the repercussions of untreated hearing loss and the isolation it creates. While dispensers may point out that the cost of a hearing aid often includes adjustment visits and sometimes free batteries, filters and other equipment, not everyone requires frequent adjustments, and batteries and other supplies can be purchased fairly inexpensively by consumers themselves through direct retail.

Tip: Caveat Emptor. (Buyer beware.) One side of this technological boom is that for every breakthrough and innovation, there are claims made which are simply not accurate and which can be downright misleading. Many of these misleading claims play on the understandable desire of someone with an acquired hearing loss to be able to hear and function just as easily as they previously did in their familial, social and workplace environment. Unfortunately, this may not always be possible, regardless of how much money one spends.

Tip: Search the web and look for more tips on how to save money on hearing aids.

Return Period

By law, you have a 30-day trial period within which you can return an as-new hearing aid for a full refund, minus the service fees up to 20% of the purchase price.

Tip: MCDHH encourages consumers to demand written extensions of these 30-day policies in cases where a hearing aid has to be readjusted after two or three weeks from the initial fitting date. Note that this leaves a consumer with only a single week to decide whether the second adjustment was adequate to make the hearing aid work for them. Make sure any such agreement is written into the sales contract and that you keep a copy of all the paperwork and sales slips and adjustment dates.

Be an educated consumer.

Buying a hearing aid is a major purchase — like buying a car — and you will have to live with your purchase for many years. Get it right from the beginning with the right hearing aid dispenser and never stop asking questions or requesting adjustments when needed. You’ll be glad you did.

Do your homework.

Go to the websites of hearing aid companies and find out what they offer. Google any questions you have that are not answered in your initial search. Each company now has multiple hearing aids with multiple feature sets, accessories, and apps that can further enhance your hearing experience.

HEARING AID COMPANIES

Here is a short list of some popular hearing aid manufacturers. It is not intended to be a complete list; rather, it is intended as a starting point for further research.

Oticon
Phonak
Resound
Signia
Starkey
Widex

Tip: Each of these companies produce other brands or sub-brands that may be less expensive than their top of the line product.

Here’s a website that reviews hearing aids top to bottom: https://www.hearingtracker.com/blog/hearing-aid-brands-in-2017

CARING FOR YOUR HEARING AID

Perspiration is likely going to be a factor with your hearing aid. In fact, moisture is the biggest enemy of any electronic device, including hearing aids. Get help and training in how to effectively dry and clean your hearing aid and/or ear mold/receiver. Ear wax and other detritus accumulates and can make any hearing device less effective or, at worse, unusable. Impact damage and high heat can also render a hearing aid inoperable, so it is a good idea to not drop hearing aids or keep them in the glove box of a car in scorching sunlight. Conversely, bring them inside rather than leaving them outside overnight in sub-zero temperatures.

Hearing Aid Dryer Options

Many hearing aid users have no knowledge of commercially available, renewable hearing aid drying kits that contain silica gel desiccants for overnight moisture removal. These inexpensive solutions can greatly extend the serviceable life of a hearing aid. There are also specialized electric dryers with both drying and ultraviolet light capability to kill bacteria as well as eliminate moisture.

Tip: Never use a hair dryer set to high or a microwave to dry hearing aids out, even if they’ve been exposed to water. If no high-tech solutions are available, place them, with batteries removed and battery compartments opened, in a sealed Ziploc bag containing uncooked rice overnight. The rice will act as a natural desiccant until you can bring the aid to your dispenser for further follow-up.

WEARING A HEARING AID

Wearing a hearing aid is not like putting on a pair of glasses, even those worn for the first time. There are many more adjustments to be made, not just technically, but physically, psychologically, and emotionally as well before you enjoy the quality of life and comfort that a hearing aid can provide. That said, there are some helpful rules of the road that any experienced hearing aid user knows well.

Physical and Lifestyle Considerations for Hearing Aid Users

What is your overall physical condition?
Will you be able to independently insert a potentially tiny hearing aid into your ear by yourself, or change a filter or battery? What about a year or two from now? Do you have a very sedate or active lifestyle? For many individuals in supported living residences in Massachusetts, hearing aids are uselessly kept in drawers because their owners cannot put them on independently any longer, and staff may not be trained to help them to do so, or are afraid to do so. This is often the same scenario for many elders with diminishing physical capabilities who are still living in their own homes.

Smaller hearing aids take tiny batteries, which may be difficult to change even with self-dispensing battery packs, doubly so when arthritis, vision loss, and diminishing physical dexterity come into play.

Rechargeable Hearing Aids

If that is an issue, you might want to consider rechargeable hearing aids, but those also have to be placed on a charger correctly in order to recharge. There really is no easy way of getting around a frank assessment of your ability to actually use the hearing aid you are considering purchasing. A larger hearing aid, while more obvious, might actually be easier in everyday use simply because everything about it, from the controls to the batteries will be larger, and consequently, easier to see and adjust. This becomes less of an issue with hearing aids that feature remote controls.

Every hearing loss is different.

Some of us are teachers, social workers or musicians; others, computer technicians, engineers, mechanics or architects. Hearing loss will affect everyone differently depending on their general health, socioeconomic status, jobs and vocations, personality, their psychological and emotional makeup, and the level of support — or lack thereof — they receive from people in their immediate environment.

Even a slight hearing loss can have a great negative impact depending on the importance that hearing acuity has in the individual’s life. There are some areas where hearing as well as is humanly possible is not just convenient but necessary, and for people in those situations, even a slight hearing loss may have a much greater negative impact than a more severe hearing loss might have on someone for whom perfect hearing may not be as critical to everyday functioning.

Have realistic expectations.

It’s easy to have unrealistic expectations of hearing aids — “Life will go back to normal;” “I’ll be able to hear everyone again,” “I can get back to watching TV or listening to my favorite music again,” etc. There are expectations formed from marketing campaigns that make it sound as if hearing aids work as effortlessly and perfectly as eyeglasses do. Neither is true. Imagine your disappointment when you put on your new hearing aid expecting an instant reversal of your hearing loss, only to find that while there may be significant improvement in some areas, your communicative abilities in other environments may actually appear to have become worse at first.

Best Case Scenario

While sweeping generalizations cannot easily be made, it is fair to say that for most people with hearing loss, talking face-to-face with a familiar person who is enunciating clearly, in a well-lit environment free of any other sound source, is much easier than trying to pick out one voice among many in a loud, dark restaurant or at a party full of strangers.

Hearing aids reconnect you to your world.

People don’t buy hearing aids to help them sit alone, at home, in a quiet environment, talking to only one or two people at a time. They buy them because they want to be social and interact with other people in most everyday environments, and those environments are often unpredictable. There can be overlapping speakers, ambient noise, poor acoustics, less than ideal lighting, and many other factors that can make picking up one particular voice out of many a real challenge. There are no guarantees. It is important to realize that current hearing aids will not function to everyone’s satisfaction, all the time, in every situation. Once that is accepted, you can start to enjoy the settings, programs, and functionalities offered by hearing aids.

Adjustments can be made to help optimize their effectiveness across different listening settings and circumstances over time, once you’ve adjusted to the basics.

Take it slow.

The best result for you will come from gradually adjusting to and getting comfortable with your hearing aid. Don’t put on a brand-new hearing aid and immediately seek out a conversation in a challenging environment. In fact, that is a primary reason why many hearing aids end up in the drawer, never to be used again. New hearing aid users can easily become disappointed, disillusioned and frustrated, particularly because hearing aid marketing makes the process look so easy and effortless.

That will change if you take it slow and if you do, you’ll discover new things each day that will enhance your hearing experience. If you’re still having trouble adjusting after two or three weeks, get back to your audiologist ASAP and work together to make your aid work for you optimally. Take your time to understand what your hearing aids can do, how the different programs work, and get used to hearing things differently than you did before. When you’ve reached that point, you can start seeking out more complex environments and hearing challenges — and expect that you’ll be making more adjustments then too. That’s the lay of the land.