I’ve been told that I need hearing aids. It is all so confusing! Where do I begin?

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.

What is the difference between digital hearing aids and analog hearing aids? How do I know what is best for me?

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?).

What is the difference between ‘directional’ and ‘omnidirectional’ microphones?

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.

What is a cochlear implant?

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.

I have a hearing loss in both ears. Should I buy one hearing aid or two?

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!)

What are some common myths regarding hearing aids?

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.

How long do hearing aids last?

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.

What can I do to improve my chances of success and satisfaction with my hearing aids?

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).

How much do hearing aids cost?

• 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’.

I have been given a quote on hearing aids and I feel it is too high. Do I really need to pay that much?

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.