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March 30, 2007

Hearing aids: How to choose the right one

From: - USA - Mar 30, 2007

Perhaps you've thought about getting a hearing aid, but you're worried about how it will look and wonder whether it will really help. Knowing more about the hearing aid options available to you, what to look for when buying one and how to break it in may help alleviate some of your concerns.

The basics: What all hearing aids have in common

There are many different hearing aids available. However, all hearing aids need certain parts to carry sound from the environment into your ear, including:

  • A microphone. The microphone picks up the sound.
  • An amplifier. The amplifier increases the volume of the sound.
  • A speaker. The speaker sends the sound into your ear so that you can hear it.
  • A battery. The battery provides power to the electronic parts.
All hearing aids work by collecting sounds from the environment through a microphone, amplifying the sound and then directing this amplified signal into your ear by way of a loudspeaker. The amplified signal stimulates your inner ear, which activates nerve fibers that carry the sound impulses to your brain.

Hearing aid styles
Hearing aids come in various styles, which differ in size and the way they're placed in your ear. Some are small enough to fit inside your ear canal, making them almost invisible. Others fit partially in your ear canal. Generally, the smaller a hearing aid is, the less powerful it is, the shorter its battery life and the more it will cost.

With so many styles to choose from, keep in mind that your choice shouldn't be based on looks alone. The style that's right for you should be based on what helps you hear the best.

Common hearing aid styles include:

  • Completely in the canal. The aids are molded to fit inside your ear canal and can improve mild to moderate hearing loss in adults. Though these hearing aids are the smallest and least visible of the available styles, the small style can be a disadvantage. Completely-in-the-canal aids have little space for add-ons, such as volume controls and directional microphones. They're generally more expensive than other styles. And the batteries are smaller, so battery life may be shorter. One advantage to the small size: The ear helps protect the instrument from wind noise, although it doesn't eliminate this problem. Make sure your audiologist (hearing specialist) knows about your lifestyle and where you want to hear better so that he or she can advise you accordingly.
  • In the canal. An in-the-canal hearing aid fits partly in the ear canal, but not as deeply as the completely-in-the-canal aid. In-the-canal aids can accommodate mild to moderately severe hearing loss in adults. This style may contain features that won't fit on completely-in-the-canal aids, but the small size can make the features difficult to adjust. Some in-the-canal aids have a remote control available. If you have trouble with small controls, ask about this option.
  • In the ear. An in-the-ear style of hearing aid fills most of the bowl-shaped area of your outer ear. This style is helpful for people with mild to severe hearing loss. In-the-ear aids are more visible to others and may be more vulnerable to picking up wind noise. But sometimes the larger size makes in-the-ear aids easier to adjust and insert. The bigger batteries in these hearing aids are likely to last longer than those in the smallest aids.
  • Behind the ear. Behind-the-ear hearing aids include a component that rests behind your ear. This component conducts sound to an ear mold that fits inside your ear canal. This type of aid is appropriate for almost all types of hearing loss and for people of all ages. Behind-the-ear aids are the largest, most visible type of hearing aid, though some new versions are smaller, streamlined and barely visible. Behind-the-ear hearing aids can be the most powerful and often are the easiest type to adjust.
  • Open fit. These are very small behind-the-ear-style devices. Sound travels from the instrument through a small tube or wire to a tiny dome or speaker in the ear canal. These aids leave the ear open, so they are best for mild to moderate high-frequency losses where low-frequency hearing is still normal. They appeal to people who want an instrument that is less visible but doesn't plug up the ear like the small in-canal models do.
Are two hearing aids better than one? In most cases, it's better to have two hearing aids. Wearing two (binaural) hearing aids allows more information to reach your brain and makes it easier to hear speech against background noise. You'll have more balanced hearing with two hearing aids, preventing the need to turn your head toward the sound if you're wearing only one. And wearing two hearing aids means neither of the devices needs to be turned up as loudly as when you're wearing just one. That should prevent some feedback. Still, financial limitations or other problems may prevent some people from wearing two hearing aids. Talk to your audiologist about your options.

Hearing aid electronics

The technology inside hearing aids also differs. Hearing aid electronics control how sound is transferred from the environment to your inner ear. All hearing aids amplify sounds, making them louder so that you can hear them better. But various technologies do this differently, including:

  • Basic analog. This conventional technology amplifies all sounds equally. Your audiologist sets the amplification level, though it can be adjusted later. Loud sounds might require you to manually turn down the volume on your hearing aid. This type of technology is best for people who do most of their communicating in relatively quiet situations. Basic analog is the least expensive technology. Analog hearing aids are slowly being phased out. Some companies make only digital hearing aids.
  • Programmable analog. The programmability of this technology means your audiologist can adjust these aids to amplify sounds differently. Softer sounds can be amplified more, and loud sounds can be amplified less or not at all. If you have this type of technology in your hearing aid, you might not need to adjust the volume in loud situations, as you would with basic analog electronics. Some of the programmable analog hearing aids allow you to have multiple settings. This may allow you to switch settings according to your situation, which can be done with a remote control or by pushing a small button on the hearing aid. These aids are being replaced by more flexible digital instruments.
  • Digital. With this type of technology, a computer chip converts the incoming sound into digital code, then analyzes and adjusts the sound based on your hearing loss and listening needs. The signals are then converted back into sound waves and delivered to your ears. The result is sound that's more finely tuned to your hearing loss. Digital hearing aids are available in all styles, and the price you pay will depend on the features you choose. More advanced digital signal processing capabilities tend to translate into higher cost. If price is a concern, let your audiologist know and choose the best combination of features in your price range.
Hearing aid accessories Other ways to customize your hearing aids exist, including:
  • Directional microphones. These microphones pick up sounds coming from in front of you better than coming from behind or beside you. This technology improves your ability to hear when you're in an environment with a lot of background noise. Typically you'll have both a regular microphone and a directional microphone, so you can switch between the two types. This might require a larger hearing aid to accommodate the two microphones.
  • Telephone adapters. This technology, also referred to as telecoils, makes it easier to hear when talking on the telephone. Flipping a switch directs your hearing aid to eliminate sounds from your environment and pick up sounds from the telephone only. Keep in mind that this technology works only with telephones designated as hearing aid compatible — most cordless phones and cell phones aren't.
Paying for your hearing aid

The cost of hearing aids varies widely. A quality analog model can cost from $900 to $1,200, while a digital aid can range from $1,300 to $3,000. Talk to your audiologist about what your needs and expectations are. If cost is an issue, there are still good instruments available at reasonable prices. Medicare and most private insurance policies usually don't cover the cost of hearing aids, though some Medicare plans known as Medicare Advantage plans might. Qualified veterans may be eligible for free hearing aids through the Veterans Affairs.

Before you make a purchase: Follow these tips

When looking for a hearing aid, explore your options to understand what type of hearing aid will work best for you. Also:

  • Get a checkup. See your doctor to rule out correctable causes of hearing loss, such as earwax, an infection or a tumor, and have your hearing tested by a hearing specialist (audiologist).
  • Seek a referral to a reputable audiologist. If you don't know one, ask your doctor for a referral. A good audiologist works with you to find a hearing aid that best fits your needs and desires. This person takes an impression of your ear canal, chooses the most appropriate aid and adjusts the device to fit well. Be cautious of free consultations and people who sell only one brand of hearing aid.
  • Ask about a trial period. A hearing aid should come with an adaptation period. It may take you a while to get used to the device and decide if it's useful. Have the seller put in writing the cost of a trial and whether this amount is credited toward the final cost of the hearing aid.
  • Check for a warranty. Make sure the hearing aid includes a warranty that covers both parts and labor for a specified amount of time.
  • Beware of misleading claims. Hearing aids can't restore normal hearing or eliminate all background noise. Beware of advertisements or salespeople who claim otherwise.
Breaking in your hearing aid Getting used to a hearing aid takes time. Your listening skills should improve gradually as you become accustomed to amplification. The sound you hear is different because it's amplified. Even your own voice sounds strange when you wear a hearing aid.

One common misconception is that the aid restores normal hearing just as corrective lenses restore normal vision. Hearing aids do not restore hearing to normal. As a general rule, a hearing aid usually improves hearing by one-half of the loss.

When you first get your hearing aid, start slowly by listening to the radio or TV in a quiet room. This will give you an idea of how well the device can help you. Then move on to more-challenging environments. Starting off in a loud restaurant, for instance, can be frustrating and confusing.

You may find in some situations that it's best just to remove your hearing aid. When background noise is very loud, hearing aids can be more annoying than useful.

Cochlear implants

In situations of severe to profound nerve deafness, cochlear implants — which help compensate for damaged or nonworking parts of the inner ear — can improve hearing. Cochlear implants have improved in the last several years. If your hearing loss is so severe that conventional hearing aids can't help you, you may be a candidate for a cochlear implant. Talk to your audiologist about this option.

What's new

Hearing aid research is going on all the time. Better instruments and better circuits are being developed right now. If you have hearing loss, don't wait to get help. Just like computers, there will always be something better in the future.

Implantable hearing aids are being developed that will be completely under the skin. These hearing aids will require surgery but aren't yet available. Cochlear implant-hearing aid hybrids are being investigated for people who have mild loss at some frequencies but can't hear some sounds at all. There also are new developments in other devices that help you hear better when hearing aids aren't enough. Ask your audiologist about assistive devices for TVs, phones, fire alarms or anything else you want to hear better.

What to consider

Many people with hearing loss aren't interested in hearing aids. You might think a hearing aid will make you look older or change how strangers interact with you. Some people might think they get by just fine using visual cues to make up for their loss of hearing.

Be honest with yourself. Wearing a hearing aid is much less noticeable than is constantly asking people to repeat themselves or responding to a question with an unrelated answer.

The truth is that a well-fitted hearing aid can greatly enhance your ability to interact with others. Hearing aids can minimize many problems that go along with hearing loss, such as difficulty understanding conversations or hearing timers and beepers. And they can help combat feelings of social isolation.

If your hearing loss affects your ability to communicate with others or makes you feel self-conscious, it may be time to consider a hearing aid. Though it may be awkward at first, over time you'll adjust to the device and enjoy your enhanced ability to hear and communicate in a variety of situations. By wearing your hearing aid regularly and taking good care of it, you'll likely notice significant improvements in your quality of life.

By Mayo Clinic Staff
Mar 30, 2007
© 1998-2007 Mayo Foundation for Medical Education and Research (MFMER).