Some time back I heard an interesting NPR Report on hearing loss (with sound examples) that can give you a good foundation of understanding what it is like to be hearing impaired or be around someone who is. Hearing loss isn’t linear or across the board. I hear low tones pretty well but as the frequency climbs and the pitch rises, I hear less and less of it. That’s typical nerve damage-related hearing loss. Working around loud machinery, too much loud rock and roll through headphones, and similar noisy environments can do real damage. Usually, the greater loss comes in the higher portion of the hearing spectrum. People begin to have difficulty hearing consonants more than vowels.
Analog: boosts the volume of sound coming into your ear – like tiny loudspeakers. Boosts the level of everything with limited filtering, some targeted help. Lesser cost (which in hearing aids is a hugely relative term. You can spend $7,000 or more for a pair of high-end digital hearing aids). To be honest, this may now be a historical category. I don’t know if they are still made.
Digital – the latest in very expensive, very tiny sound processing equipment using digital sound processing technology to make things sound clearer, less distorted and LOUDER, while trying to filter out background noises. Offers noise reduction and almost no feedback. If you’ve never had hearing aids, feedback is like a kid with a loud whistle hiding inside your ear. It’s usually caused by poor fit. It is guaranteed to make you wince and grab madly for your ear in public. Newer technologies can take sounds at a certain spectrum of frequencies and short them to a slightly different part of the spectrum. If you hear very poorly in one section of the hearing spectrum, those sounds get shifted to another part of the spectrum where you hear a bit better.
Analog programmable – a hybrid of the two with some programming capabilities.
Note: The technology in hearing aids changes almost as often as does other modern technology, like laptops and phones. This is up to date as of when I wrote it and thus, completely out of date.
Types: (Note that size and price are not linearly related to each other. If anything, they’re inversely related.)
Barely visible at all – fits inside the ear canal (and called ITC – in the canal) and has a nearly invisible flexible stalk with a little ball on the end you use to grab it and remove it. Least noticeable of all hearing aids and appealing to your vanity. They offer cosmetic advantages (harder to see by others) but their small size limits the amount of technology inside them. Uses the smallest batteries and thus has the smallest battery life.
In the ear – called ITE. Capable of handling digitally programmable technology that allows for several advantages. The audiologist can set break points in the audio boost to better tailor what gets amplified to match your actual hearing loss patterns. Can have both a volume switch and a tiny push switch you trigger with a fingertip to change the audio boost for certain types of environments (such as in a noisy restaurant with hard walls and ceilings which echo like crazy, or a concert/tv setting). Custom environment settings can make a difference between understanding the conversation at your table and impossibly trying to pick sounds out of the whole restaurant to hear and understand.
Behind the ear – (called BTE, you seeing the pattern?). These come in tiny versions (which can be thought of as training wheels for hearing aids) which can provide a nice boost to hearing for people who don’t yet need a significant jump in decibels. The smallest BTE aids can be perfect for small children and adults new to hearing aids with lower levels of hearing loss. They have a small clear tube that runs from the hearing aid to the (usually) flexible earpiece. They can be hard to notice if you aren’t looking for them.
When you think of the hearing aid your grandfather or great-grandfather wore, this is what you think of. These days, with technology, the huge ones like grandpa had are dinosaurs. The modern ones are much smaller (a quarter the size) and much more powerful. They can be unobtrusive. Bigger size can also mean more room for high-tech gadgetry including directional microphones to help you hear what the person in front of you is saying. (Hearing aids make everything a little louder, so you can hear things being said at restaurant tables two and three tables away almost as easily as hearing your dinner partner.) Keeping your hearing focused where you want it can be a trial to learn. This type of hearing aid usually has a larger clear plastic tube that runs from the hearing aid, over the top of the ear and into the ear. The less technology-savvy versions of the BTEs can be in the $500 each range, which is great if they work for you. You don’t want to know the top end.
The earpiece itself frequently has an open fitting which is a central dome inside an open, vented tip. This open type lets air get in your ears and reduces sweating that would take place if the ear was completely filled with a hearing aid. Hearing aids that fill your ear can make you feel as if your ears are plugged (Surprise! They are.) They have holes that run from the outside of the hearing aid through to the inside, called vents, that help. Vented tips don’t feel as intrusive and can be more comfortable.
There’s also a kind of BTE that actually has a small speaker on the tip that fits in your ears. Somewhat akin to magic. Some BTE’s come with remotes. Why would you want a remote? In a word, bluetooth. The remote can link your hearing aids and your smartphone together so that when you get a call you tap the remote and the call is fed right to your ears through the hearing aid. This is serious magic.
Remember when I mentioned the little buttons that you use to change the settings when you go in that trendy restaurant with the brick walls and tin ceiling? Well, the buttons are on the outside of your hearing aid where you can easily tap them. When you stick your smartphone up to your hearing aid it can hit those same little buttons. As the button changes a setting, it tells you with a set of beeps or a voice that things just changed. You’re having a conversation (or trying to) and suddenly you hear the conversion punctuated with beep, beep, beep or a voice saying Three, One, Two as you accidentally tap the buttons with your phone. The person on the other end won’t know it is happening. They’ll keep talking even though you can’t keep up.
Also, have you see those commercials for those headphones that can make the TV sound louder? the remote can work the same way. Set it in front of the TV and turn it on and the TV is piped straight into your ears.
Other things to know:
Hearing aids don’t fix your hearing problems. The most common damage is from nerve damage. Those nerves won’t heal. You will still have difficulty figuring out what the sounds are and what words those sounds are creating. (That NPR clip is an excellent example.) Most hearing loss is from nerve damage caused by exposure to loud noises. If you have a good degree of nerve damage, people will mumble louder once you have hearing aids. Mental sound processing will still be required, particularly if you are really hearing impaired. Nerve damage-based hearing loss is the most common and that loss makes it harder to hear consonants in spoken words. Write a sentence down on a white board and then erase the consonants. If you hadn’t written it down yourself, would you be able to figure out what it used to say? Begin to see the problems.
You have two ears. Had you noticed? Your mind processes the sound input from both ears to generate how you understand what you hear. If you need hearing aids, unless you had only one ear suffering from hearing loss somehow, you will also probably need two hearing aids. It’s a binaural world out there.
Using them with phones
Features you want to have in a hearing aid: Telecoil – means the hearing aid can sense that you have a phone next to your ear and it turns the hearing aid off. You want this because having something up against your ear usually creates feedback. Feedback hurts and prevents you from paying attention to anything else in the world at that moment. If you have a house phone or a standard office phone at work, this can be important.
If you have a VOIP (internet-based phone) at work or home that plugs into a USB port, you need a headset that has a cushion to keep the ear pieces off your ears. The earpieces provide space – not too much so the telecoils work as they should, but not so close that the headphones trigger any mode-changing buttons on your hearing aids. If you like to listen to music on your phone or iPod, you’ll probably need a similar type of earphone with them. One that stands off your ears and lets you switch from music playing to answering the phone will be difficult to find, but not impossible.
Cellphones are available that work with hearing aids. They are specifically labeled as hearing aid compatible. (HAC is the acronym you look for.) If you are not near the end of your contract, changing phones could be a cost to deal with in addition to the hearing aid costs. Remember, you’re going to have thingies in your ears. You can’t put ear buds in there too.
Most cell phone sales locations don’t display hearing aid compatibility information but the sales people can be beaten into confessing which models work. You can also search for accessibility at the vendor’s site as well. The Bluetooth gadgets you wear over one ear may not work with your hearing aids but you can use a hands-free bluetooth gadget in your car.
Other useful info
Hearing aids are expensive. They may fit in your pocket easily but you could also use that money to buy a used Mazda Miata. Add them to your homeowner’s insurance so they are covered. See if your employer’s insurance will cover some of the purchase cost. My employer at the time covered ½ the purchase price, but they would only do that once in my lifetime. I waited to use that benefit until I got the fancy digital ones and told my audiologist I wanted ones that would last me forever. They didn’t but I happened to change insurance carriers to one that covers the whole cost. By the way, if you are approaching Medicare age, have insurance coverage for hearing aids and need them, go ahead and get them. Medicare doesn’t cover the cost.
So how do you decide which hearing aid is right for you and how do you sort through the manufacturers? That’s where your audiologist comes into it. You have to find a good one that you can trust. You can ask doctors (like an ear, nose and throat specialist) for a recommendation, that works sometimes. The audiologist may be friends with the doctor (you’ll sometimes find an audiologist working in-house with an ENT practice) or there may be an undisclosed financial connection (happened to me).
Also, some audiologists are virtually a sole source vendor for one manufacturer. That sort of exclusive deal can get them special pricing but not necessarily the best product for you. This is about you, not them. Manufacturers can also compel audiologists to buy certain quantities of certain models on a regular basis, which is an incentive to prescribe what they have on hand instead of what’s going to be better for you in the long run.
You can try Angie’s List or a Google search, but word of mouth works the best. There’s probably someone you work with or know or see in church or the grocery that wears hearing aids. Ask them who they use and if they’d recommend them. I started with one recommended by a friend. I was tested and she recommended ITE hearing aids. They worked excellently but I wasn’t accustomed to them. Everything was so loud. I’d gotten used to having the world on mute and had a hard time adjusting. I returned the hearing aids within the 30 day period. I went with an audiologist recommended by an ENT physician. He fitted me with small BTE hearing aids that boosted the volume and were tiny. I became accustomed to hearing better with them on and a few years later moved back to the ITC types. I also moved back to the first audiologist. The second audiologist said some things that didn’t jibe with what I’d been told by the first one and I trusted the first one more. You have to go with trust. She eventually sold her practice to someone that treated customers poorly. Another friend then recommended my current audiologist and I’ve done business with him for a decade.