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 more in both quiet and noisy situations.
However, only about one out of five people who would benefit from a hearing aid
actually uses one.
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.
How can
hearing aids help?
Hearing aids are primarily useful in improving the hearing and
speech comprehension of people who have hearing loss that results from damage
to the small sensory cells in the inner ear, called hair cells. This type of
hearing loss is called sensorineural hearing loss. The damage 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 convert them into neural
signals that are passed along to the brain. The greater the damage to a
person’s hair cells, the more severe the hearing loss, and the greater the
hearing aid amplification needed to make up the difference. However, there are
practical limits to the amount of amplification a hearing aid can provide. In addition,
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.
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 your physician, who may refer you to an otolaryngologist or
audiologist. An otolaryngologist is a physician who specializes in ear, nose,
and throat disorders and will investigate the cause of the hearing loss. An
audiologist is a hearing health professional who identifies and measures
hearing loss and will perform a hearing test to assess the type and degree of
loss.
Are
there different styles of hearing aids?
Styles of hearing aids
Source: NIH/NIDCD
·
Behind-the-ear (BTE) hearing aids
consist of a hard plastic case worn behind the ear and connected to a plastic
earmold that fits inside the outer ear. The electronic parts are held in the
case behind the ear. 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.
A new kind of BTE aid is an
open-fit hearing aid. Small, open-fit aids fit behind the ear completely, with
only a narrow tube inserted into the ear canal, enabling the canal to remain
open. For this reason, 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 addition, some people may prefer the open-fit
hearing aid because their perception of their voice does not sound “plugged
up.”
·
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 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. ITE aids usually are not worn by
young children because the casings need to be replaced often as the ear grows.
·
Canal aids fit 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. Both types are used for mild to moderately
severe hearing loss.
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. They usually are not recommended for young children or for
people with severe to profound hearing loss because their reduced size limits
their power and volume.
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.
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 audiologist. Analog/programmable hearing aids have more
than one program or setting. An audiologist can program the aid using a
computer, and you 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 types of hearing aids. Analog aids usually are less expensive than
digital aids.
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 an
audiologist more flexibility in adjusting the aid to a user’s needs and to
certain listening environments. These aids also can be programmed to focus on
sounds coming from a specific direction. Digital circuitry can be used in all
types of hearing aids.
Which
hearing aid will work best for me?
The hearing aid that will work best for you depends 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 because two aids provide a
more natural signal to the brain. Hearing in both ears also will help you
understand speech and locate where the sound is coming from.
You and your audiologist should select a hearing aid that best
suits your needs and lifestyle. Price is also a key consideration because
hearing aids range from hundreds to several thousand dollars. Similar to other
equipment purchases, style and features affect cost. 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.
A hearing aid will not restore your normal hearing. With practice,
however, a hearing aid will increase your awareness of sounds and their
sources. 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, options and upgrade opportunities, 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 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 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 audiologist make adjustments
and provide servicing and minor repairs? Will loaner aids be provided when
repairs are needed?
·
What instruction does the
audiologist 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
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.
You may experience some of the following problems 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. Ask
your audiologist how long you should wear your hearing aid while you are
adjusting to it.
·
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.
Check with your audiologist to see if a correction is possible. Most individuals
get used to this effect over time.
·
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. See your audiologist for adjustments.
·
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. Talk with
your audiologist.
·
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, however, 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.
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.
Are new
types of aids available?
Although they work differently than the hearing aids described
above, implantable hearing aids are designed to help increase the transmission
of sound vibrations entering the inner ear. 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 moves these bones
directly. Both techniques have the net result of strengthening 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. Because
surgery is required to implant either of these devices, many hearing
specialists feel that the benefits may not outweigh the risks.
Can I
obtain financial assistance for a hearing aid?
Hearing aids are generally not covered by health insurance
companies, although some do. 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. Also, children may be covered by their state’s early
intervention program or State Children’s Health Insurance Program.
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. Contact
the National Institute on Deafness and Other Communication Disorders (NIDCD)
Information Clearinghouse with questions about organizations
that offer financial assistance for hearing aids.
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 is the best possible
match to the remaining hearing for a 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. 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.
Where
can I find additional information about hearing aids?
The NIDCD maintains a directory of
organizations that provide information on the normal and
disordered processes of hearing, balance, taste, smell, voice, speech, and
language.
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