Choosing a Hearing Aid

I came to loathe the first pair of hearing aids I ever tried over five years ago. The audiologist took great delight in explaining all of the fancy electronics inside them, but I didn’t find them very impressive in the real world. The low point was one night at a restaurant, when I was able to hear pots and pans rattling in the kitchen and even the scraping of other patrons’ silverware against their plates, but could make out barely a word my dinner date was saying.

Fortunately, recent improvements in hearing aid technology have made hearing aids much more effective in real-world settings. If you have been disappointed with hearing aids in the past, as I was, now might be a good time to give them another try. To help you find a hearing aid that is right for you, here is some information to keep in mind when selecting and purchasing a hearing aid.

Hearing loss

According to the National Institutes of Health (NIH), an estimated 15% of American adults report having some form of hearing loss. Among people 75 years or older, nearly half are affected. There are a number of potential causes: For instance, some hearing loss is hereditary. Conditions such as ear infections or meningitis, head trauma, certain medicines, and long-term exposure to loud noise can also cause hearing loss. And sometimes hearing loss is a consequence of aging.

Some researchers believe that diabetes may cause hearing loss, but the issue is controversial. It is well known that diabetes can damage tiny blood vessels throughout the body, a condition called diabetic microangiopathy. According to some researchers, diabetic microangiopathy may affect the tiny blood vessels supplying the inner ear. And a number of studies have indicated that hearing loss may be more common in people with diabetes than in the general population.

People with hearing loss may not be completely aware that they have it. They might notice a muffled quality to speech and sounds, or they might have trouble understanding words, especially when there is background noise or the din of multiple conversations at once. But they may chalk these problems up to speakers who don’t enunciate well or to a modern world that is just too noisy. Whatever their cause, however, hearing difficulties can be frustrating and may cause people to withdraw from conversations and even avoid some social settings.

For many, hearing loss is more than just a mild annoyance – it can dampen the quality of their lives. Studies have shown that people with untreated hearing loss report being depressed at higher rates than those who wear hearing aids. Researchers believe that people with hearing loss experience greater stress and fatigue trying to adapt to situations or places, such as the workplace, where hearing is important for functioning effectively. Some studies suggest that hearing loss is related to high blood pressure, diabetes, and heart disease. Other studies indicate that hearing loss may affect memory and cognitive function as well.

In spite of how common it is and what a negative effect hearing loss can have, only one in five people who could benefit from a hearing aid actually uses one. Some people insist that they don’t have a hearing problem, some are embarrassed to wear a hearing aid, and in some cases, people have had bad experiences with hearing aids in the past, discovering that wearing one wasn’t making most conversations easier to understand. One of the most common problems is the interference of background noise that drowns out conversations. But hearing aid technology and sound selection have improved dramatically over the past decade, minimizing issues such as this and, in many cases, making the hearing aids small enough that they are virtually undetectable to the casual observer.

A study of hearing-impaired older adults conducted by the National Council on Aging showed that those who used hearing aids felt better about themselves, were more independent, had better mental health, and had better relationships with their families than those who didn’t use hearing aids. According to the Better Hearing Institute, a nonprofit organization dedicated to educating the public and medical professionals about hearing loss, the results of this study showed that treatment for hearing loss (such as hearing aids) improves earning power, communication, intimacy, warmth, emotional stability, and physical health. Treating hearing loss was also shown to reduce frustration and depression, paranoia, and anxiety.

Hearing aid choices

The basic components shared by all electronic hearing aids are a microphone, which picks up sounds and converts them to electrical or digital signals; an amplifier, which makes the sounds louder; a receiver to convert the electrical or digital signals into sound waves and transmit sound into the ear; and a battery to power the device. However, there are now several different styles and types available.

Hearing aids now come in four basic styles. In behind-the-ear devices, the microphone rests atop a hard plastic case that contains the electronic components of the hearing aid. This case, which is worn behind the ear, is attached to a piece of tubing that joins to a plastic ear mold. The mold plugs into the ear canal, where it transmits sound that has entered the microphone and been made louder by the amplifier.

A new type of behind-the-ear hearing aid is the open-fit hearing aid, which fits completely behind the ear, with only a narrow plastic tube inserted into the ear canal. This allows the ear to remain open so that the wearer’s own voice does not sound plugged up. Since only a narrow tube goes into the ear canal, these types of devices are less likely to be damaged by earwax.

Behind-the-ear hearing aids are the largest and most visible hearing aids, but nonetheless, they often escape notice by the casual observer.

In-the-ear hearing aids are custom-made to fit completely inside the outer ear. All of the electronic components are contained in a case of hard plastic. In-the-ear hearing aids are generally visible when the user is face-to-face with another person. Some in-the-ear hearing aids have an additional feature called a telecoil, which is a small magnetic coil that makes it easier to hear phone conversations while eliminating feedback from the hearing aid.

Canal hearing aids, which are custom-molded to fit into the ear canal, come in two styles. In-the-canal hearing aids fill only the bottom half of the external ear, while completely-in-canal hearing aids, the smallest and least visible style of hearing aid, are nearly hidden in the ear canal. Canal hearing aids are not recommended for young children or people with severe hearing loss.

(Click here to see the different styles of hearing aid.)

Each type of hearing aid has its own strengths and weaknesses, and not all types are suitable for everyone. Which type is best for the individual depends on the severity of hearing loss, the person’s lifestyle, where the person will typically be wearing his hearing aid, and how concerned he is about the appearance and visibility of his hearing aid.

Hearing aids also differ in terms of the electronics they employ. The principal types of electronics are analog and digital. Basic analog hearing aids amplify all sounds equally. This means, for example, that the user might need to turn down the volume on the hearing aid in particularly loud environments. Basic analog hearing aids are generally the least expensive, and not all hearing aid manufacturers make them. With programmable analog hearing aids, the audiologist can program the hearing aid to amplify sounds relative to how loud they are to begin with. Some programmable analog hearing aids have various settings that can be selected based on the hearing environment (such as a movie theater or a quiet room at home).

Digital hearing aids translate sounds, including their loudness and pitch, into numerical codes before amplifying them, so they can be programmed to amplify some frequencies more than others. Most people have more hearing loss at certain frequency ranges (for example, at high frequencies associated with consonants), and this feature allows the hearing aid specialist to amplify the frequency ranges the user is having the most difficulty hearing.

Digital hearing aids can also be programmed to focus on sounds coming from in front of the user. This is done with the assistance of a directional microphone, which picks up sounds coming from the front better than sounds coming from other directions. This can be useful for amplifying the sounds of face-to-face conversations, particularly when there is a lot of background noise. It is common for a hearing aid to have a regular microphone as well as a directional one and the option to switch between the two at will. According to some hearing aid specialists, new and better directional microphones are one of the greatest improvements in hearing aids in the last decade.

One hearing aid, or two?

In addition to considering various styles and types of hearing aid, the question of whether to use one or two hearing aids also should be addressed. For some people, such as those who have hearing loss (or hearing ability) in only one ear, getting fitted for a single hearing aid makes the most sense. The majority of people who have hearing loss, however, are affected in both ears. In this case, if a person can afford the expense, there are several benefits to wearing two hearing aids. For one thing, using two hearing aids provides stimulation to both ears, helping preserve the hearing that remains. Wearing two hearing aids also enables a person to locate the source of sounds more accurately and understand conversations more easily. This setup additionally has the advantage of allowing the user to keep the volume of the hearing aids at a lower level, decreasing the chance of feedback and minimizing the amount of noise reaching each ear. Together with your audiologist, you can decide whether one or two hearing aids would be appropriate for you.

Tips for buying a hearing aid

The first step when considering the purchase of a hearing aid should be speaking with your doctor about your hearing loss. He may want to check your hearing and look into the underlying cause of your hearing loss. He can refer you to an audiologist (a person who specializes in hearing) to get more extensive tests. The audiologist will test your hearing threshold (the minimum level at which you can hear a sound) at different frequencies.

If you have hearing loss, you can work with your audiologist to select a hearing aid that best suits your needs and your lifestyle. Here are some questions to ask about a hearing aid, as suggested by the NIH:

• What does it cost? Hearing aids are generally not covered by health insurance and range in price from hundreds of dollars to several thousand dollars. Be aware that a higher price does not necessarily mean that a hearing aid is better suited to your needs.
• Is there a trial period? Most manufacturers offer a 30-day or 60-day trial period, during which you can return the hearing aid for a full or partial refund.
• How long does the warranty last? Are maintenance and repairs covered for the future?
• Is the audiologist available to make repairs and adjustments? (Follow-up visits are extremely important in terms of making a hearing aid work optimally for you.)
• What instruction does the audiologist provide? (It is helpful to have instructions on inserting the hearing aid, removing it, cleaning it, changing the battery, and, if you have two hearing aids, distinguishing the left one from the right one.)

Breaking in your hearing aid

The breaking-in period, when you are first trying out and making adjustments to a hearing aid, can make a huge difference as to whether or not you will want to purchase the hearing aid and actually use it regularly. According to audiologists, it can take a considerable investment in time and effort to properly break in a hearing aid and make it work for you. They say, for example, that the brain may take a while to adapt to receiving new acoustic impulses and to learn to process them correctly. In some cases, people have gotten so used to their hearing loss that they have learned to tune out conversations – and it may require some effort to learn to pay attention again.

After adjusting to using the hearing aid in quiet settings, such as at home, try it out in noisy places such as crowded restaurants and airports. Try adjusting the volume and any other settings on the hearing aid to see whether some settings work better than others. Make a note of where the hearing aid works best and where it doesn’t work as well. Then find out whether your audiologist or hearing aid specialist can adjust the hearing aid’s program accordingly. Also ask friends and family members whether they notice any difference in your ability to communicate.

Be prepared for certain problems and obstacles, including the following:

• Some people find their hearing aids uncomfortable at first. Ask your audiologist how many hours a day you should wear your hearing aid. (Your hearing aid should not be worn when you sleep.)
• The sound of your own voice may sound loud, electronic, or plugged up to you. Most people eventually get used to this effect.
• Sometimes there is a whistling feedback sound, especially if the hearing aid doesn’t fit well or is clogged with earwax. Talk with your audiologist about adjustments that might correct this.
• Some people hear a buzzing sound while using their cell phone. Fortunately, both hearing aid and cell phone technologies are improving, so this problem tends to occur less frequently.

It helps to have realistic expectations. Some people expect to hear perfectly when they get their hearing aid, but there likely will still be situations where you won’t hear as well as someone without hearing loss.

Hearing aid care

Proper care and maintenance of your hearing aid will help to keep it working well. Be sure to keep the hearing aid away from heat and moisture. Take it out before showering or swimming. Since earwax can damage a hearing aid, be sure to clean your hearing aid as instructed. Avoid using hairspray or other hair products while wearing the hearing aid. Do not expose it to physical shock, such as dropping it on the floor. When you’re not using the hearing aid, be sure to turn it off and/or remove the battery as instructed by the manufacturer. Replace dead batteries immediately, and keep the batteries away from children and pets, who might swallow them. (If you know or suspect that a child or pet has swallowed a battery of any kind, seek medical help immediately.)

All ears

If you think you might have hearing loss, look into having your hearing checked. In many cases of hearing loss, a hearing aid can help to improve not only the quality of your hearing, but also the quality of your life.