- What is a hearing aid?
- How can hearing aids help?
- How can I find out if I need a hearing aid?
- Are there different styles of hearing aids?
- Do all hearing aids work the same way?
- Which hearing aid will work best for me?
- What questions should I ask before buying a hearing aid?
- How can I adjust to my hearing aid?
- How can I care for my hearing aid?
- Are new types of aids available?
- Can I obtain financial assistance for a hearing aid?
- What research is being done on hearing aids?
What is a hearing aid?
A hearing aid is a small electronic device that you wear in or behind your ear. It makes some sounds louder so that a person with hearing loss can listen, communicate, and participate more fully in daily activities. A hearing aid can help people hear better in both quiet and noisy situations and hear sounds they have been missing.
A hearing aid has three basic parts: a microphone, amplifier, and speaker. The hearing aid receives sound through a microphone, which converts the sound waves to electrical signals and sends them to an amplifier. The amplifier increases the power of the signals and then sends them to the ear through a speaker. The vast majority of modern hearing aids contain digital technology. Please see “Do all hearing aids work the same way?” for a discussion on digital versus analog aids.
How can hearing aids help?
Hearing aids are primarily useful in improving the hearing and speech comprehension of people who have hearing loss. This loss results from damage to the inner ear, particularly small hair cells which amplify and receive the signal sent to the auditory nerve. This is called a sensorineural hearing loss and can occur as a result of disease, aging, or injury from noise or certain medicines.
A hearing aid magnifies sound vibrations entering the ear. Surviving hair cells detect the larger vibrations and send them to the brain via the auditory nerve as neural signals. The greater the damage to a person’s inner ear, the more severe the hearing loss, and the greater the amplification needed to make up the difference. However, there are practical limits to the amount of amplification a hearing aid can provide, and if the inner ear is too damaged even large vibrations will not be converted into neural signals. In this situation, hearing aid benefit may be limited and appropriate assistive devices may be necessary.
Some individuals with conductive hearing loss, (a loss occurring from the middle ear) may also benefit from hearing aids. Patient with conductive losses who opt not to have surgery often do very well with hearing aids.
How can I find out if I need a hearing aid?
If you think you might have hearing loss and could benefit from a hearing aid, visit an audiologist or hearing instrument specialist. These are hearing health professionals who performs a hearing test to assess the type and degree of loss and works with their patient to manage that loss. At the appointment your hearing health professional will review your hearing test with you to help you understand what type of hearing loss is present and what the options for remediation include. If the identified hearing loss can be treated medically, an appropriate referral will be made to either a primary care physician or an otolaryngologist. An otolaryngologist is a physician who specializes in ear, nose, and throat disorders and surgeries and will investigate the cause of the hearing loss.
Are there different styles of hearing aids?
There are several basic styles of hearing aids. The styles differ by size, their placement on or inside the ear, and the degree to which they amplify sound (see figure on page 1).
- Behind-the-ear (BTE) hearing aids consist of a hard plastic case containing the electronics worn behind the ear which is connected to an earmold that fits inside the bowl of the ear and ear canal. Sound travels from the hearing aid through the earmold and into the ear. BTE aids are used by people of all ages for mild to profound hearing loss. The earmold may be custom made to the ear or non-custom depending on the degree of hearing loss. All levels of technology can fit into this style.
- Receiver-in-Canal (RIC), also referred to as receiver-in–the–ear (RITE), hearing aids are small devices which sit behind the ear with a narrow tube or wire leading to a small dome inserted into the ear canal, usually enabling the canal to remain unblocked. In addition, some people may prefer the open–fit hearing aid because their perception of their voice does not sound “plugged up” and sounds more natural. All levels of technology can fit into this style including directional microphones.
- In-the-ear (ITE) hearing aids are custom made to fit completely into the outer ear and are used for mild to severe hearing loss. The case holding the electronic components is made of hard plastic.
- In-the-canal (ITC) hearing aids are also custom made and fit into the bowl of the ear to manage mild to moderately severe hearing loss.
- Completely–in–canal (CIC) and Invisible-in-the-canal (IIC) hearing aids are nearly hidden in the ear canal, with IICs fitting so deep into the ear canal that they cannot be seen at all. These are used for mild to moderately severe hearing loss. Because they are small, CIC and IIC aids may be difficult for a person to adjust and remove. In addition, they have less space available for batteries and other features that can help in difficult listening situations. They usually are not recommended for people with severe to profound hearing loss because their reduced size limits their power and volume.
- Some hearing aids may have certain added features installed, such as a telecoil. A telecoil is a small magnetic coil that allows users to receive sound through the circuitry of the hearing aid, rather than through its microphone. This makes it easier to hear conversations over the telephone. A telecoil also helps people hear in public facilities that have installed special sound systems, called induction loop systems. Induction loop systems can be found in many churches, schools, airports, and auditoriums. Custom hearing aids are usually not worn by young children because the casings need to be replaced often as the ear grows.
Do all hearing aids work the same way?
Hearing aids work differently depending on the electronics used. The two main types of electronics are analog and digital.
Digital aids convert sound waves into numerical codes, similar to the binary code of a computer, before amplifying them. Because the code also includes information about a sound’s pitch or loudness, the aid can be specially programmed to amplify some frequencies more than others. Digital circuitry gives a hearing professional more flexibility in adjusting the aid to a user’s needs and for certain listening environments. Digital circuitry gives the patient more flexibility by being able to choose from multiple adjusted settings. These aids also can be programmed to focus on sounds coming from a specific direction and to process and reduce background noise. This makes noisy environments more comfortable for the wearer and make it easier to hear speech. Digital circuitry can be used in all types of hearing aids.
Analog aids convert sound waves into electrical signals, which are amplified. Analog/adjustable hearing aids are custom built to meet the needs of each user. The aid is programmed by the manufacturer according to the specifications recommended by your hearing specialist. Analog/programmable hearing aids have more than one program or setting. A hearing specialist can program the aid using a computer, and the user can change the program for different listening environments–from a small, quiet room to a crowded restaurant to large, open areas, such as a theater or stadium. Analog/programmable circuitry can be used in all styles of hearing aids but many manufacturers are phasing out this product choice.
Which hearing aid will work best for me?
You and your hearing instrument specialist should select a hearing aid that best suits your needs and lifestyle. The hearing aid that will work best for you depends on the type and severity of your hearing loss. If you have a hearing loss in both of your ears, two hearing aids are generally recommended to provide a more natural signal to the brain. Hearing in both ears also will help your brain to tell the difference between speech and background noise and also locate where the sound is coming from. Price is also a key consideration because hearing aids range from hundreds to several thousand dollars. However, don’t use price alone to determine the best hearing aid for you. Just because one hearing aid is more expensive than another does not necessarily mean that it will better suit your needs.
Though they will help you hear many sounds and speech that you would otherwise miss, a hearing aid will not restore your normal hearing. With practice, however, a hearing aid will increase your awareness of sounds and their sources and you will learn to tune out sounds that you do not want to focus on. You will want to wear your hearing aid regularly, so select one that is convenient and easy for you to use. Other features to consider include parts or services covered by the warranty, estimated schedule and costs for maintenance and repair, and the hearing aid company’s reputation for quality and customer service.
What questions should I ask before buying a hearing aid?
Before you buy a hearing aid, ask your hearing instrument specialist these important questions:
- What features would be most useful to me?
- What is the total cost of the hearing aid? Do the benefits of newer technologies outweigh the higher costs?
- Is there a trial period to test the hearing aids? (Most manufacturers allow a 30- to 60-day trial period during which aids can be returned for a refund.) What fees are nonrefundable if the aids are returned after the trial period?
- How long is the warranty? Can it be extended? Does the warranty cover future maintenance and repairs?
- Can the hearing instrument specialist make adjustments and provide servicing and minor repairs? Will loaner aids be provided when repairs are needed?
- What instruction does the hearing professional provide?
How can I adjust to my hearing aid?
Hearing aids take time and patience to use successfully. Wearing your aids regularly will help you adjust to them.
Become familiar with your hearing aid’s features. With your hearing instrument specialist present, practice putting in and taking out the aid, cleaning it, identifying right and left aids, and replacing the batteries. Ask how to test it in listening environments where you have problems with hearing. Learn to adjust the aid’s volume and to program it for sounds that are too loud or too soft. Work with your hearing instrument specialist until you are comfortable and satisfied. You may experience some of the following issues as you adjust to wearing your new aid.
- My hearing aid feels uncomfortable: Some individuals may find a hearing aid to be slightly uncomfortable at first. Many people when getting new hearing aids will wear the aid in increasing amounts of time for the first few days. The goal is to be able to wear your aids 8 to 12 or more hours a day. If the aid/mold is uncomfortable, then in office modifications can typically be performed.
- My voice sounds too loud: The “plugged-up” sensation that causes a hearing aid user’s voice to sound louder inside the head is called the occlusion effect, and it is very common for new hearing aid users. Additionally, there is a slight time delay between how the wearer is used to hearing their voice and how they are now hearing it through the hearing aid. Most individuals get used to this effect over time but a programming adjustment may need to be done.
- I get feedback from my hearing aid: A whistling sound can be caused by a hearing aid that does not fit or work well or is clogged by earwax or fluid. Many digital hearing instruments have feedback managers that can be utilized to minimize feedback.
- I hear background noise: A hearing aid does not completely separate the sounds you want to hear from the ones you do not want to hear. Sometimes, however, the hearing aid may need to be adjusted. Many hearing aids have different strengths of noise suppression systems that can easily be adjusted on the computer by the hearing professional.
- I hear a buzzing sound when I use my cell phone: Some people who wear hearing aids or have implanted hearing devices experience problems with the radio frequency interference caused by digital cell phones. Both hearing aids and cell phones are improving so these problems are occurring less often. When you are being fitted for a new hearing aid, take your cell phone with you to see if it will work well with the aid. Some hearing aids with manual override capability can have a special phone program placed in to the device for talking on the telephone. New digital technology hearing instruments are usually compatible with Bluetooth wireless technology. This is accomplished by wearing an ancillary product around your neck that a Bluetooth cell phone pairs with wirelessly. This in turn will allow for hands free hearing through both hearing aids.
How can I care for my hearing aid?
Proper maintenance and care will extend the life of your hearing aid. Make it a habit to:
- Keep hearing aids away from heat and moisture.
- Clean hearing aids as instructed. Earwax and ear drainage can damage a hearing aid.
- Avoid using hairspray or other hair care products while wearing hearing aids.
- Turn off hearing aids when they are not in use.
- Replace dead batteries immediately.
- Keep replacement batteries and small aids away from children and pets.
- Use drying systems as needed to keep moisture build at a minimum.
Are new types of aids available?
- Receiver-in-the-ear aids are currently the most widespread style of hearing aids. They allow for a nice small unit to be placed behind the ear with a small wire tip being placed in the ear canal. For many individuals these aids meet aesthetic expectations while also meeting functionality needs. These aids tend to give a more natural sound quality to the users voice.
- Bluetooth compatible hearing aids. Hearing aids at all price ranges can work with hands free Bluetooth devices that are worn around the neck, with some being able to connect directly to certain smartphones. These assist in hearing the cell phone and television better.
- Middle ear implants, (MEI), work differently than the hearing aids described above. A middle ear implant is a small device attached to one of the bones of the middle ear. Rather than amplifying the sound traveling to the eardrum, an MEI moves these bones directly. This results in strengthening sound vibrations entering the inner ear so that they can be detected. A thorough consultation with a physician is required, followed by surgical implantation by an otolaryngologist.
- A bone-anchored hearing aid (BAHA) is a small device that attaches to the bone behind the ear. The device transmits sound vibrations directly to the inner ear through the skull, bypassing the middle ear. BAHAs are generally used by individuals with middle ear problems or deafness in one ear. Surgery and a consultation with an otolaryngologist is required to implant this device.
Can I obtain financial assistance for a hearing aid?
Hearing aids are generally not covered by health insurance companies, although some do. Financing is usually available.
Mario Hearing and Tinnitus Clinics contracts with numerous insurance companies. Please check with us and we would be happy to verify your benefits. If no benefits are offered we offer our patients payment plans including some interest free and extended pay options.
What research is being done on hearing aids?
Researchers are looking at ways to apply new signal processing strategies to the design of hearing aids. Signal processing is the method used to modify normal sound waves into amplified sound that best suits the hearing aid user. NIDCD-funded researchers also are studying how hearing aids can enhance speech signals to improve understanding.
In addition, researchers are investigating the use of computer-aided technology to design and manufacture better hearing aids. Researchers also are seeking ways to improve sound transmission and to reduce noise interference, feedback, and the occlusion effect. Additional studies focus on the best ways to select and fit hearing aids in children and other groups whose hearing ability is hard to test.
Another promising research focus is to use lessons learned from animal models to design better microphones for hearing aids. For example, NIDCD-supported scientists are studying the tiny fly Ormia ochracea because its ear structure allows the fly to determine the source of a sound easily. Scientists are using the fly’s ear structure as a model for designing miniature directional microphones for hearing aids. These microphones amplify the sound coming from a particular direction (usually the direction a person is facing), but not the sounds that arrive from other directions. Directional microphones hold great promise for making it easier for people to hear a single conversation, even when surrounded by other noises and voices.