Hearing FAQ
Audiology / FAQ: Hearing
Check out our Find a Professional page for audiologists in public and private practice. You will find names and contact information for private practitioners and information about areas of expertise.
An Ear, Nose and Throat specialist (ENT) or otolaryngologist is a medical doctor who treats and diagnoses diseases of the ear, nose and throat. ENTs will typically complete a four-year university undergraduate degree, followed by a four-year medical degree and a four or five year specialty residency program. In Canada, ENTs do not dispense or prescribe hearing aids, although they may recommend them.
Audiologists are healthcare professionals who are trained in communication disorders, including the physiology of speech and hearing organs, physics of sound, hearing loss, hearing loss prevention, aural rehabilitation, and treatment of hearing loss. Audiologists will typically complete a four-year university undergraduate degree, followed by a two- or three-year master’s (graduate) degree. ‘Dispensing’ audiologists will have further specialized training in fitting and dispensing hearing aids.
Hearing instrument specialists (also called hearing aid dispensers, practitioners or dealers) have training in hearing testing, hearing aid fitting and servicing. The training required to be a hearing aid dispenser is two years post secondary training, usually done online, and then passing a licensing test. Only those individuals licensed with the College of Health and Care Professionals of BC are legally allowed to dispense hearing aids in the province of British Columbia. In order to obtain licensing, individuals must pass a comprehensive oral and written examination, as well as complete a set number of supervised hours under the training of a licensed dispenser. To check the status of any license, or to lodge a complaint, you may contact the College of Health and Care Professionals of BC. The proper fitting of hearing aids requires careful evaluation and testing, followed by post-fitting care and adjustments. Purchasing hearing aids by mail or over-the-counter bypasses all of these important processes and is certain to lead to an unsatisfactory solution to your hearing problem.
For more information on the difference between an audiologist and hearing instrument practitioner, visit SAC.
As rates for services vary, please check the bill rates and billing process with the audiologist before booking an appointment.
It is important to find out exactly what you will be asked to pay for. Take the time to ask for specific costs so there are no surprises once services are started.
Please note that in order to practice in BC all registrants have to meet the standards of the College of Health and Care Professionals of BC. There are documentation standards that are required of the audiologist.
Please check our funding page for more information.
We will not recommend a specific audiologist; however, our online Find a Professional tool can help you find private clinics in your area.
In order to practice in BC, an audiologist has to be a registrant with the College of Health and Care Professionals of BC. Check the registry to insure that the individual is listed.
For your protection, we recommend that you contact the College if an unqualified person is posing as an audiologist.
Speech and Hearing BC is a member-driven association; we do not respond to concerns or complaints from consumers. If you have a concern, the College of Health and Care Professionals of BC protects the public and will listen to your concerns.
Please contact them at:
College of Health and Care Professionals of BC
900 – 200 Granville Street, Vancouver, BC V5Z 1K5
Fax: 1-604-608-9863
Audiologists will list their university degree, typically MSc (Master of Science) or MA (Master of Arts) depending on the University program. If the professional has a doctorate in Audiology, they will list Au.D. In most cases, professionals only list their highest degree.
RAUD (Registered Audiologist) means that the person is registered with College of Health and Care Professionals of BC and is licensed to practice in BC. The audiologist may have completed additional professional training to become certified in certain specialty areas. They will note this at the end of their title, for example “Certified in Cochlear Implant Management”.
Aud(C) or Certified in Audiology by SAC means that the professional is a certified member of our national association, Speech-Language and Audiology Canada.
CCC-Aud means that the professional is a certified member of the American Speech-Language-Hearing Association (ASHA), the national credentialing association in the United States, and has met the requirements for certification in Audiology.
RHIP means Registered Hearing Instrument Practitioner. This person has met the requirements for registration with the College of Speech and Hearing Health Professionals of BC.
Audiology / FAQ: Hearing Tests
Hearing assessments are not all created equal. A complete hearing test, also referred to as a ‘diagnostic hearing test’ or a ‘hearing evaluation’ includes a full assessment of your hearing ability, your speech understanding ability, and an assessment of your outer ear, middle ear, and inner ear. This type of test can take anywhere from 30 minutes to 1 hour or more, depending on the degree and type of your hearing loss, and is typically performed by an audiologist.
A hearing screening is an abbreviated version of a standard hearing test. It is a test only of your ability to hear different tones for each ear. The screening will only indicate if a hearing loss is present or not. A hearing screening typically takes less than 15 minutes. This type of test can be performed by any number of individuals, including public health or school nurses, Speech-Language Pathologists, ENT medical office assistants, hearing aid dispensers or dealers, audiometric technicians and audiologists.
The Medical Services Plan (MSP) of British Columbia does not cover the cost of hearing screenings or tests unless performed at a hospital (under the direction of an ENT). Hearing tests performed in public health units are typically free of charge to the public. All other tests are subject to a charge, at the discretion of the audiologist or dealer.
A full diagnostic evaluation is much more thorough than a hearing screening. If you have experienced any of the following symptoms, you should obtain a full diagnostic assessment:
- Sudden hearing loss with or without vertigo (dizziness)
- Significant hearing difference (asymmetry) between your ears (i.e. you have one ear that is significantly better than the other)
- History of ear infections, surgery, or draining ear(s)
- Noticeable difficulty following conversational speech either in quiet or noisy situations.
You may also want to obtain a full diagnostic assessment if you have concerns about your hearing or ears, are considering purchasing hearing aids for the first time, or it is your first time having a hearing test. If you are simply curious about your level of hearing, wonder whether you are a hearing aid candidate, or you have had your hearing tested before and you would simply like to know whether your hearing has changed, a hearing screening will often suffice. An appointment for a hearing screening typically does not allow sufficient time for discussing hearing aids and options in depth, but only whether or not you are a candidate based on your hearing levels. It is important to understand that a screening does not provide information regarding the cause(s) of your hearing loss. Certain screening results do necessitate referral for a full diagnostic assessment.
The following is a list of suggestions for your first visit with an audiologist for a hearing aid consultation:
- Bring any previous test results with you. This can help the audiologist to determine whether your hearing has changed or whether it has remained stable.
- Bring a friend or family member with you to take notes when you go to the hearing clinic for a consultation. There is an awful lot of information presented during a hearing aid consultation, and four ears are better than two!
- Before you purchase hearing aids, list all of the situations where you have difficulty hearing and understanding conversation. Ask your audiologist in which of these situations you can reasonably expect improvement in your hearing. For example, will your ability to hear conversations at the dinner table improve? What about at a nightclub or restaurant?
- Ask for information about various kinds of hearing aids, how they will help you, what their limitations are, and the pros and cons of the different makes and models. You should come away from a hearing aid consultation appointment understanding the advantages and disadvantages of different styles and hearing aid technologies.
- Ask for a copy of your audiogram. This is helpful for the audiologist so that she/he is able to determine whether there has been a significant change in your hearing
Audiology / FAQ: Selecting and purchasing a hearing aid
Hearing aids can indeed be very confusing. There are a large number of hearing aids from which to choose. Luckily, you don’t have to make a decision on your own. Your audiologist can narrow down your choices and can guide you in the right direction based on your audiological needs and your budget. The two main decisions that you will need to make in regards to your hearing aid(s) are style (size) and level of technology.
STYLE
The style of hearing aid refers to how it appears in your ear. There are several different styles of hearing aids:
- Behind-the-ear hearing aids (BTE) have two parts: The hearing aid fits behind your ear and is attached to a custom-made earmold, which directs the sound to your ear.
- Custom hearing aids refer to hearing aids that have only one part that fits in your ear. There are several different sizes of custom hearing aids:
- In-the-ear (full-shell ITE) hearing aids fill up the entire ‘bowl’ of your ear.
- Half-shell (HS) hearing aids fill up approximately half of the ‘bowl’ of your ear
- In-the-canal (ITC) hearing aids fill up the canal of your ear.
- Mini-canal (MC) hearing aids also fill up the canal of your ear, but are more recessed into your ear.
- Completely-in-the-canal (CIC) hearing aids fit very deeply into your ear canal and are the least visible of the hearing aids. A pull-string is added to the hearing aid to allow you to pull it out more easily.
The style of hearing aid that is recommended will depend on degree, configuration and the nature of your hearing loss, among other factors. You and your audiologist will discuss these factors to determine the most appropriate and effective hearing aids for your hearing needs and lifestyle. Generally speaking, the smaller the hearing aid, the more expensive it is.
TECHNOLOGY
Technology of a hearing aid refers to the type of processing it uses and the number of features that it has. There are three levels of technology: Basic, Mid-range and Advanced. Basic and mid-range technology can come in digital or analog hearing aids. Advanced technology hearing aids are digital; however, the reverse is not true. Not all digital hearing aids are advanced! Generally speaking, the more technologically advanced the hearing aid is, the better it is at reducing background noise, the more ‘automatic’ it is, and the more features that it has. If you lead a very active life, and you have difficulty hearing in background noise, more technologically advanced hearing aids may be more appropriate for you. If, on the other hand, you lead a fairly quiet life and need hearing aids only to hear your spouse at home, a basic hearing aid may be sufficient. The more technologically advanced the hearing aid is, the more expensive it is.
A hearing screening is an abbreviated version of a standard hearing test. It is a test only of your ability to hear different tones for each ear. The screening will only indicate if a hearing loss is present or not. A hearing screening typically takes less than 15 minutes. This type of test can be performed by any number of individuals, including public health or school nurses, Speech-Language Pathologists, ENT medical office assistants, hearing aid dispensers or dealers, audiometric technicians and audiologists.
The Medical Services Plan (MSP) of British Columbia does not cover the cost of hearing screenings or tests unless performed at a hospital (under the direction of an ENT). Hearing tests performed in public health units are typically free of charge to the public. All other tests are subject to a charge, at the discretion of the audiologist or dealer.
Analog hearing aids convert sound to an electrical signal and amplify it. Analog hearing aids come in basic and advanced technology. Advanced analog hearing aids can have multiple programs for different listening environments as well as directional microphones for improved hearing in noise. Advanced analog hearing aids can perform as well, or, in some cases, better than digital hearing aids.
The digital hearing aid market has changed significantly over the past year or two. Digital hearing aids now account for approximately 50% of hearing aids sold in Canada. In British Columbia, this percentage is much higher. Hearing aid manufacturers are attempting to phase out analog hearing aids from the market, and, instead, offer different levels of digital hearing aid technology.
Basic-level digital hearing aids cost the same, or less than basic analog hearing aids. Digital hearing aids contain a computer chip in them, like a computer, that converts sound into a special code before amplifying it. Digital hearing aids are not all created equally. They range from basic digital hearing aids that perform similarly to basic analog hearing aids, to advanced digital hearing aids whose potential capabilities are seemingly endless. Digital hearing aids have the capability to not only amplify sound, but to analyze and manipulate it as well. The most advanced digital hearing aids can, for instance, determine if the sound is speech or noise, and if it is noise, determine what direction it is coming from, and then attempt to reduce it. They can also enhance speech. This is digital sound processing (DSP), and it is designed to improve speech understanding in noisy situations. Digital hearing aids may have additional features, such as a low-battery indicator or beep, feedback reduction capabilities, directional microphones, and multiple programs for different listening environments. If your hearing loss is very unusual, or you are very sensitive to loud sounds, a digital hearing aid can also offer improved comfort for loud sounds while maintaining audibility for soft sounds. Most hearing aids, regardless of technology, perform well in quiet situations. The main advantage of mid-range and advanced hearing aid technology is better hearing in noisy situations.
The best hearing aids for you depend largely on your expectations (i.e. Do you want hearing aids to reduce background noise?), your lifestyle (i.e. Are you active? Do you attend meetings, work, lectures or have frequent social gatherings?), your experience (i.e. Do you currently have hearing aids, and if so, are you happy with them?), your hearing loss (i.e. Do you have an unusual hearing loss configuration and/or are you very sensitive to loud sounds?) and your budget (i.e. Can you afford advanced hearing aids?).
Omnidirectional microphones are standard on all hearing aids. They pick-up sounds all around you equally, and provide ‘surround sound’. Directional (dual) microphones are an option in most mid-range and advanced hearing aids. They consist of two microphones: a front and a rear microphone. The microphones work together to reduce sounds coming from behind you. This results in a reduction of background noise. Directional microphones can significantly improve speech understanding in noise. While they reduce the effect of background noise to a greater extent, there is still no technology that can eliminate background noise completely.
A cochlear implant is an electronic device for children or adults who have severe or profound hearing loss to help them hear when amplification with hearing aids is not enough. The cochlear implant bypasses the damaged hair cells in the cochlea and transmits sounds directly to the brain through the auditory nerve. One part is inserted surgically under general anesthetic. This includes an electrode array into the inner ear (cochlea) and a connecting receiver embedded under the skin behind the ear. The second part is outside the ear. This includes a microphone to pick up sounds, a speech processor to analyze the sounds, and a headpiece to send sound to the implant.
In the past, some professionals recommended only one hearing aid, even in the case of bilateral hearing loss. With the backing of countless research studies, however, the recommendation now is that people with hearing loss in both ears should wear two hearing aids. The advantages that two hearing aids offer are:
- Better understanding of speech.
- Better understanding of speech in noisy situations.
- Better ability to tell the direction of sounds.
- Better sound quality and ‘stereo’ hearing.
- Smoother tone quality and less distortion because less volume is required when you wear two hearing aids. Less battery drain for the same reason.
- Wider hearing range. A person can hear sounds from a further distance with two hearing aids.
- Better sound identification. With just one hearing aid, many noise and words sound alike. With two hearing aids, as with two ears, sounds are more easily distinguishable.
- Having two hearing aids keeps both ears active. Research has shown that with only one hearing aid, the unaided ear tends to lose its ability to hear and understand speech. This is called auditory deprivation.
- Hearing is less tiring and listening is more pleasant.
- Greater comfort with loud sounds.
- Reduced feedback and whistling because of lower volume control.
- Improvement in tinnitus, or ringing in the ears. Approximately 50% of people with ringing in their ears report improvement when wearing two hearing aids.
- No need to worry about having people sit on your ‘aided’ side.
- Hearing aid satisfaction. Research with more than 4000 hearing-impaired people demonstrated that people wearing two hearing aids are more satisfied with their hearing aids than those wearing only one hearing aid.
Of course, there are exceptions to this rule. If one of your ears is ‘unaidable’ (i.e. the hearing loss is either too severe or not severe enough, or your speech understanding ability is too poor in that ear to benefit from a hearing aid), then two hearing aids may not be recommended. Another situation where only one hearing aid may be recommended is in the case of a person with severe dementia or confusion, or with very poor dexterity, who has no source of help and would be unable to handle two hearing aids. Finally, if, for financial reasons, someone is unable to afford two hearing aids, then one hearing aid is recommended (with the realization that one hearing aid is better than none!)
Myth: Behind-the-ear hearing aids are ‘old-fashioned’. The smaller the hearing aid, the more technologically advanced it must be.
Fact: The size of the hearing aid has nothing to do with how technologically advanced it is. In fact, if anything, the larger hearing aids have the capability to be more technologically advanced, because the hearing aid manufacturers have more room to fit components and features into the hearing aid.
Myth: Hearing aids are so advanced now that you can buy ‘invisible’ hearing aids.
Fact: Cosmetic appearance and visibility can vary significantly and depend largely on ear canal size and degree of hearing loss. In general, men have larger ear canals and therefore have a higher chance of obtaining a less visible hearing aid. Even the smallest hearing aids however, can still usually be seen if someone is looking directly into your ear canal.
Myth: You can now get hearing aids that eliminate background noise.
Fact: There is currently no hearing aid on the market that can eliminate background noise. Some hearing aids are able to reduce background noise, but none are able to eliminate it. Unfortunately, hearing aids are not ‘smart’ enough to know what you consider to be background noise.
Myth: Digital hearing aids are the ‘best’.
Fact: Countless research studies to date have failed to prove that digital hearing aids are ‘significantly’ better than analog hearing aids in terms of sound quality, background noise reduction, and hearing aid satisfaction, among other things. Only directional microphone technology, which is available in both analog and digital hearing aids, has been proven to reduce background noise. Advanced digital hearing aids do have additional features that may be beneficial, but caution should be applied when choosing hearing aids solely on the claim that they are ‘digital’ and therefore superior.
The life expectancy of a hearing aid depends on the condition of your ear and the care you give your hearing aid. Hearing aids should last, on average five years; however, some may only last a few years, while others several more years. Behind-the-ear hearing aids and larger custom hearing aids typically last longer than smaller custom hearing aids. Your aid(s) will require ongoing service. Consumers typically replace hearing aids because of hearing changes, technologic advances, or repairs that are too frequent or too costly.
Having realistic expectations from your hearing aids is very important. Support from family and friends is equally important. The Canadian Hard of Hearing Association is a non-profit organization that provides information and support to hard of hearing individuals. There are local branches in many BC cities and across Canada. Contact www.chha.ca for more information.
Speech-reading classes offered through various organizations, including the Western Institute for the Deaf and Hard of Hearing in Vancouver, can also greatly improve your chances of success with hearing aids as can Assistive Listening Devices (ALDs).
- A hearing aid practitioner/dealer or audiologist has the discretion to set their own prices.
- Prices for hearing aids are per hearing aid.
- Prices will depend on the hearing aid style, e.g behind-the-ear or in-the-canal and whether the technology is basic, mid-range or advanced.
- The consumer is encouraged to ask for the total price of the hearing aid and what that price includes (i.e. hearing test, follow-up servicing, warranty).
- There are no taxes on hearing aids, as they are considered a ‘medical device’.
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If you have been given a quote on hearing aids and it is beyond your price budget, ask whether there are any less expensive alternatives. For example, a hearing aid will be less expensive if you choose a larger size or if you don’t need advanced technology for reducing background noise. Make sure you understand what features you may be losing by going with a less expensive hearing aid. If you are not given any other alternatives, you may want to get a second opinion.
Audiology / FAQ: Maintaining and repairing hearing aids
Depending on how familiar you are with your hearing aid, you may be able to do some basic trouble-shooting to get your hearing aid working again.
- Step 1 The first step is to ensure that you have the correct battery size and that you have correctly inserted it into the hearing aid. Then, try a new battery in the hearing aid. Even if you have recently replaced the hearing aid battery, some batteries are defective and do not last very long. It is not necessary to try more than one fresh battery. If the hearing aid is still not working, go to Step 2.
- Step 2 Visually inspect the hearing aid. If you see wax on the hearing aid, clean it. You should have received a small brush and a wire loop with your hearing aid. Focus on the area at the tip of the hearing aid where the sound comes out. Brush the microphone gently to remove any debris or dust. If you have a wax prevention system on your hearing aid and you have been shown how to replace it, try to put a fresh wax guard in the hearing aid. If you have a behind-the-ear style hearing aid, inspect the earmold and tubing for cracks or wax. You may want to pull the earmold off the hearing aid and clean it in a mild soap and water solution. Make sure it is completely dry (including the tubing) before reattaching it to the hearing aid.
- Step 3 If the hearing aid is still not working, contact your hearing aid clinic. In many cases, a hearing aid can be repaired in the hearing aid clinic. Some clinics do not charge for in-house repairs, as they are considered to be a part of the original cost of the hearing aid. Others may charge a service fee for in-house repairs. If a hearing aid cannot be repaired in the clinic, it may need to be sent out for repair. Most hearing aid manufacturers in Canada are located in Ontario, and therefore it may take 2 to 3 weeks to get the hearing aid back from repair. Repair costs vary depending on two factors:
- The age of the hearing aid. If a hearing aid is less than five years old, it is normally repairable (and worth repairing). If a hearing aid is more than five years old, it is normally recommended that a repair estimate be obtained. In some cases, the hearing aid is considered ‘obsolete’ and the parts are no longer available. In other cases, the cost to repair the hearing aid may approach the cost to obtain a new hearing aid, and therefore may not be worth repairing.
- The extent of damage to the hearing aid. In many cases, a hearing aid malfunctions simply because it is plugged with wax or there is a loose connection in the internal components. If the problem is relatively simple, the repair cost will be lower. If, however, the hearing aid has been damaged significantly (either physically or with excess moisture/corrosion), the repair may be more costly.
If you are experiencing fit or feedback problems with your custom hearing aid, a ‘recase’ may be necessary. Most custom aids come with a recase warranty of one to two years; therefore, if you are anticipating feedback or fit problems, it is a good idea to have the hearing aid recased within this warranty period.
When you are fitted with hearing aids, you should be informed about the refund policy or exchange privilege. This is commonly referred to as a ‘trial period’ or a period of at least 30 days that is provided by the manufacturer, allowing you to obtain a refund or exchange if you are not satisfied with the hearing aid(s). Following this period, you may not be able to obtain a refund. If the aid(s) are lost or damaged during the trial period, your return privilege may also be canceled. If you return the hearing aid(s) for a refund, some clinics may charge a fee for the clinician’s time spent testing and evaluating the hearing aids. There is no reason for hearing aids to be in the drawer and not in your ear. If you are not happy with your hearing aids, return to your clinic and discuss your options with your audiologist or dispenser. Never keep a hearing aid with which you are not fully satisfied. If you are unhappy with the service you are receiving and you wish to make a complaint, you should contact the College of Speech and Hearing Health Professions of BC at 604.568.1568. Be aware that fitting hearing aids may take several weeks and may require several visits to the clinic before you are satisfied. Do not ‘give up’ on hearing aids if you are not satisfied with them immediately. Make sure you understand the details of the return or exchange policy and discuss any fees that you may be responsible for if you do decide to return the hearing aid(s).
All hearing aids should come with a repair and service warranty. Hearing aids should have a minimum of a one year repair warranty on them. Many hearing aids have two year repair warranties. You may also have the option to purchase an extended warranty. After the repair warranty has expired, you may be responsible for the cost of hearing aid repairs. Some hearing aids come with a loss or damage warranty. There is usually a one-time replacement limit and a deductible applies.
The amount of benefit a hearing aid will provide can vary significantly from person to person and for different listening situations.
You can reasonably expect the following:
- In both quiet and noisy situations, you should hear better with hearing aids than without hearing aids.
- Your hearing aids should be comfortable in your ears.
- You should be able to hear speech comfortably. Loud sounds should sound loud, but not uncomfortable.
- The sound of your voice may at first be unusual; however, you should be able to tolerate the sound of your own voice.
- You should not have feedback (whistling) at the volume you need to use the hearing aid.
Things you can not reasonably expect:
- You will not hear as well in noise as you will in quiet. You may still have significant difficulty hearing in noisy situations. The degree of difficulty can depend on your degree of loss and word recognition abilities.
- Hearing aids will not make your hearing as good as you remember it to be. They are not a cure for hearing loss; they are a treatment.
Be patient. It likely took many years for your hearing loss to happen. Your brain has adapted to not hearing well. It may take some time for you to adapt to hearing many sounds that you haven’t heard for a long time. The more you wear your hearing aids, the better your brain will become at hearing the new sounds.
Audiology / FAQ: Other Devices
Assistive listening devices (ALDs) are devices that can help hearing and are used in conjunction or in addition to hearing aids. They include, but are not limited to, FM systems, Infrared systems for television and radio, amplified telephones, and alerting/signalling devices. They can significantly improve your hearing and your success with hearing aids. For a complete listing of ALDs, go to Western Institute for the Deaf and Hard of Hearing, or Assistive Listening Device Systems. Your local hearing aid clinic and audiologist are also likely able to provide you with information and products.
FM means frequency modulated. FM systems help people understand speech in noisy situations. An FM system wirelessly transmits sounds from a speaker to the person with a hearing loss. There are two parts: a microphone that is worn by the speaker and a receiver to transmit sounds to the hearing aid if the person has a hearing loss or directly into the ear through earphones for someone with problems with auditory processing.