The Ins and Outs of Hearing Aids
Hearing aids are used to improve the hearing and speech comprehension of people who have hearing loss. A hearing aid will not restore your normal hearing because of practical limits to the amount of amplification a hearing aid can provide. With practice, however, a hearing aid will increase your awareness of sounds and their sources. If the inner ear is too damaged, even large vibrations will not be converted into neural signals. In this situation, a hearing aid would be ineffective.
Hearing aids have had a bad reputation with some users, primarily because older models simply amplified sound. New model hearing aids have drastically changed. Instead of making all sounds louder, newer hearing aids make what you want to hear more clear.
Hearing aids are getting smaller and smaller. It is unlikely anyone will notice when you are wearing them. The truth is, people are more likely to notice your hearing loss. People who don’t treat their hearing problems are often isolated from friends and family. Studies show that people who wear hearing aids often have a better quality of life.
Hearing aids work differently, depending on the electronics used. The two main types of electronics are analog and digital.
Analog hearing aids convert sound waves into electrical signals, which are amplified. Analog hearing aids are custom built for each user and programmed to the specifications recommended by your audiologist. Analog, or programmable hearing aids, have more than one program or setting. The user can change the program for different listening environments:
· A small, quiet room
· A crowded restaurant
· Large, open areas, such as a theater or stadium.
This circuitry can be used in all types of hearing aids and usually are less expensive than digital aids.
Digital aids convert sound waves into numerical codes before amplifying them. The codes include information about a sound’s pitch or loudness, so the hearing aid can be specially programmed to amplify some frequencies more than others. These aids can also be programmed to focus on sounds coming from a specific direction. Digital circuitry gives an audiologist more flexibility in adjusting the aid to a user’s needs and to certain listening environments. Digital circuitry can be used in all types of hearing aids.
Different styles of hearing aids 
There are three 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.
Behind-the-ear (BTE) hearing aids have a hard plastic case worn behind the ear that holds the electronic parts. The case connects to a plastic ear piece that fits inside the outer ear. Sound travels from the hearing aid through the ear piece and into the ear. This type of hearing aid can be used by people of all ages for mild to profound hearing loss.
A new kind of BTE aid is an open-fit hearing aid, with only a narrow tube inserted into the ear canal, enabling the canal to remain open. The open-fit hearing aids may be a good choice for people who experience a buildup of earwax, since this type of aid is less likely to be damaged by such substances.
In-the-ear (ITE) hearing aids fit completely inside the outer ear and are used for mild to severe hearing loss. The case holding the electronic components is made of hard plastic. Some ITE aids have 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 feature makes it easier to hear conversations over the telephone and use induction loop systems [link to assistive hearing device article]. ITE aids are not worn by young children because the casings need to be replaced as the ear grows.
Canalaids fit directly into the ear canal and are available in two styles. The in-the-canal (ITC) hearing aid is made to fit the size and shape of a person’s ear canal. A completely-in-canal (CIC) hearing aid is nearly hidden in the ear canal. Because they are small, canal aids may be difficult for a person to adjust and remove. In addition, canal aids have less space available for batteries and additional devices, such as a telecoil.
Both types are used for mild to moderately severe hearing loss. These types of aids usually are not recommended for young children because of the need to be replaced as the child grows; or, for people with severe to profound hearing loss because their reduced size limits their power and volume.
New Hearing Aid Technologies
A middle ear implant (MEI) 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 actually moves these bones. This technique strengthens sound vibrations entering the inner ear so that they can be detected by individuals with sensorineural hearing loss.
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 is required to implant either of these devices, many hearing specialists feel that the benefits may not outweigh the risks.
You and your audiologist will select a hearing aid that best suits your needs and lifestyle and will depend on the kind 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 will also help you understand speech and locate from where the sound is coming.
Price is also a key consideration and often a deterrent to selection because hearing aids range from hundreds to several thousand dollars, depending on style and features. However, don’t use price alone to determine the best hearing aid for you.
You will want to wear your hearing aid regularly, so select one that is convenient and easy for you to use.
Questions to ask when buying a hearing aid
Purchasing hearing aids by mail or telephone order is not recommended , especially if this is a first hearing aid, as it may not include the necessary follow-up to ensure a successful fitting and adjustment to the hearing aid.
Before you buy a hearing aid, ask your audiologist 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 non-refundable 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 audiologist make adjustments and provide servicing and minor repairs? Will loaner aids be provided when repairs are needed?
- What instruction does the audiologist provide?
Most states, but not all, have laws in place that provide for a 30-day trial period for your hearing aid. Some hearing aid dispensers will offer more time. Ask your dispenser to provide a written statement regarding the trial period, with the start and end dates noted, as well as whether the trial period will be stopped if you have to return the hearing aid for repairs during the trial. Find a dispenser you are comfortable with and who will work with you until you get the optimum results for your hearing loss.
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 audiologist 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 audiologist until you are comfortable and satisfied.
Is financial assistance available for a hearing aid?
Hearing aids are covered by some private insurance plans, employee/company plans, the Federal Employee Health Benefit Plan, and Tricare, the plan for active and retired military and their families. Some plans may cover hearing testing, but not the hearing aids.
For eligible children and young adults ages 21 and under, Medicaid will pay for the diagnosis and treatment of hearing loss (including hearing aids) under the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) service. Children may also be covered by their state’s early intervention program or State Children’s Health Insurance Program (SCHIP).
Medicare does not cover hearing aids for adults; however, diagnostic evaluations are covered if they are ordered by a physician for the purpose of assisting the physician in developing a treatment plan. Since Medicare has declared the BAHA a prosthetic device and not a hearing aid, Medicare will cover the BAHA if other coverage policies are met.
Some nonprofit organizations provide financial assistance for hearing aids, while others may help provide used or refurbished aids.
The National Institute on Deafness and Other Communication Disorders’ (NIDCD’s) Information Clearinghouse has information about organizations that offer financial assistance for hearing aids. Or visit Hearing Loss financial help pages for other resources.
Where can I find more information?
NIDCD maintains a directory of organizations that can answer questions and provide printed or electronic information on hearing aids. Please see the list of organizations at www.nidcd.nih.gov/directory.
No one wants to use a hearing aid. You may even have a love/hate relationship with it, but, after a while, you will not want to be without it. Hearing aid(s) coupled with your willingness to tell others how to communicate with you is a winning combination and will get you back into the social scene.
Sources
National Institute on Deafness and Other Communication Disorders
Hearing Loss
Update August 10, 2011
