The New Hearing Aids

They're sure not what Grandpa wore.

From the WebMD Archives

Back in the day, Grandpa needed a hearing aid -- war, hunting, and loud machinery had taken their toll. Most likely, his hearing aid was a big, beige "plug" in the ear. When he gave you a bear hug, you heard little whistles and buzzes.

"What many of us remember is Grandpa always fiddling with his hearing aid," says Trisha L. Dibkey, MA, CCC-A, chief audiologist at the University of Texas Medical School at Houston. "He was always turning it up and down, adjusting it so he could hear right - trying to hear whoever was talking, trying to tune out the background noise."

Sometimes, frustration won out - and Grandpa just gave up on the thing.

"It was very difficult to get those old hearing aids adjusted just right," says Earl Bowie, MD, an ear, nose, and throat specialist at Ochsner Clinic Foundation North Shore in Jefferson Parish, Louisiana. "If there was any background noise, or if you were moving around, you would get feedback. Feedback kept many people from wearing a hearing aid."

No wonder that only one in five people who need a hearing aid actually wear one, according to the National Institutes of Health. But times have changed. Today's hearing aids offer greater style and technology options - making them better-performing, better looking, and easier to wear.

New Hearing Aids: Digital Technology and Tiny Microphones

Fast-forward to the age of digital technology. You'd never know Grandpa -- or dad, or you -- even has a hearing problem. Today's hearing aids are much smaller - "virtually invisible," Bowie says. Also, "most hearing aids today contain a microcomputer that is much more sophisticated in responding to noise in the environment, so you don't get feedback and echoes."

Like an excellent stereo sound system, these new hearing aids filter out background noise, clean up and clarify the sound quality, automatically adjust the volume. Plus, they are computer-programmed to match the nuances of each person's hearing loss. "It's like the equalizer on a radio, we can set 16 bands to match their hearing loss at every pitch," Dibkey says. "These hearing aids are tailor-made to match their hearing loss."

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"The directional microphone has been one of the biggest improvements in hearing aids," says David Fabry, PhD, an audiologist with Mayo Clinic for 15 years. He is now the director of clinical research at Phonak Hearing Systems, a company that specializes in wireless communication devices.

Directional mics don't fit into the tiniest hearing aids that nestle hidden in the ear canal. But "if you're looking for better satisfaction with your hearing, then you need a directional mic," says Fabry. "That is the single factor that will preserve speech understanding and filter out noise - and those are the No. 1 concerns that people have -- they want to hear better in a noisy environment."

Do You Need a Hearing Aid?

Thanks to rock 'n' roll, iPods, and a penchant for loud music, more people need hearing aids at a younger age than in the past, notes Bowie. "We see fairly severe hearing loss caused by the indiscretions of youth," he says. "We live in a fairly noisy society, with loud machinery, loud work environments, loud noise in general. Also, people are living longer, and hearing loss naturally occurs as we age."

The most common form of hearing loss - affecting one in four people over 65 -- is called sensorineural (nerve) hearing loss. This type of hearing loss occurs when something like noise, illness, injury, or infection damages either the auditory nerve that controls hearing or the hair cells in the ear that help transmit sound.

Less common is a form of hearing loss called conductive hearing loss. This is caused by earwax buildup, fluid buildup from an ear infection, or a punctured eardrum. Some people have a mixed form of hearing loss - both conductive and sensorineural.

While conductive hearing loss can often be corrected (with medical or surgical treatment), sensorineural hearing loss usually cannot be reversed. That's why hearing aids were created.

To get to the root of your hearing problem - and figure out the answer -- an audiologist will first perform a hearing test. From this test, the audiologist can determine whether hearing aids will help, and which hearing aids are best for your needs. The size of the hearing aid - and the technology - must be decided.

Some people want a simple hearing aid to hear the TV better, and appearance isn't an issue. "But for someone whose day involves conference room meetings, subway trains, noisy restaurants, and church - all these different environments - they're going to want more flexibility, like a directional microphone in a higher-end hearing aid," Dibkey tells WebMD.

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Choosing a Hearing Aid

In the 1970s, the "conventional analog" style of hearing aid debuted, with the volume set to fit your hearing loss. With a separate volume control wheel, you could make adjustments to match the environment you were in. Later models were computer programmed but offered limited improvements in filtering out background noise.

Today, less than 10% of people use conventional hearing aids, Fabry tells WebMD. "Nearly all hearing aids today are digital -- although digital doesn't necessarily translate to expensive. Digital hearing aids are now available in every price category."

Hearing aids are traditionally not covered by insurance plans. However, in recent years some insurance plans have developed contracts with providers for certain hearing aid models -- often with out-of-pocket costs if you choose to upgrade. Employed people may be able to use money set aside in Flexible Spending Accounts - or they can contact their state rehabilitation agency or commission for help.

"Many hearing loss centers offer payment plans to help patients spread out the cost of the aids," Dibkey says.

Hearing Aid Styles

Where the hearing aid is worn - behind or inside the ear - is determined by its size. People with more severe hearing loss often need a larger size to accommodate the added circuitry and wires.

In-the-Ear (ITE): These fit completely in the outer ear and are used for mild to severe hearing loss. The case, which holds the circuitry, is made of hard plastic. ITE aids can be damaged by earwax and ear drainage, and their small size can cause adjustment problems and feedback.

Behind-the-Ear (BTE): These are worn behind the ear and are connected to a plastic earmold that fits inside the outer ear. Sound travels through the earmold (which holds the circuitry) and into the ear. BTE aids are used by people for mild to profound hearing loss. If the earmold is not properly fitted, there can be feedback - a whistling sound caused by either the fit or by buildup of earwax or fluid.

BTE hearing aids can be linked with Bluetooth cell phone technology. "The Bluetooth plugs into the ear hearing aid, so you're hearing directly from the phone into the hearing aid. It cuts out background noise," Dibkey says. "It's very cool."

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Canal Aids: The in-the-canal (ITC) aid is customized to fit the size and shape of the ear canal. It is used for mild to moderately severe hearing loss. A completely-in-canal (CIC) aid is nearly hidden in the canal and is used for mild-to-moderately severe hearing loss. Because of their small size, canal aids may be difficult for the user to adjust and remove. These aids may be damaged by earwax and ear draining.

The in-canal hearing aids are the most popular, says Dibkey. "They're small-sized and fit into the ear canal - but not so deep that reception is impeded by ear wax."

Hearing Aid Circuitry

A hearing aid's inside mechanisms will vary among the devices. Basically, there are three types of circuitry or electronics that are used:

Conventional: This is the traditional analog hearing aid, offering the least-expensive technology. The computer-programmed analog hearing aids are slightly more sophisticated, since the audiologist can create more than one program - like "all-the-time" and "noisy environment" settings - so you can change it, via a remote control, to suit your environment. Cost: $700 to $1,000.

Digital/Programmable: This is computer-programmed technology and can be set to precisely match a patient's hearing loss and response time. Digital hearing aids use a microphone, receiver, battery, and computer chip to provide the most sophisticated hearing aid. Cost: $900 to $1,500.

New-Generation Digital: These hearing aids offer 16 bands - treble, bass, and mid-levels - for the most precision in sound quality and clarity. "We can computer-program a hearing aid on as many as 16 bands, to match their hearing loss at every pitch. It's tailor-made to match their hearing loss," explains Dibkey. "And the directional microphones are clinically proven to be most effective in improving speech intelligibility in noisy situations." Cost: $1,200 to $3,500.

"The newest technology is definitely worth the expense," says Dibkey. "No hearing aid can eliminate background noise entirely, but they're getting better -- and the newest ones are the best we've ever had. And the clarity is amazing. ... It's like comparing CDs and DVDs with records and video tapes."

WebMD Feature

Sources

Published Dec. 14, 2005.

SOURCES: The American Hearing Research Foundation. Trisha L. Dibkey, MA, CCC-A, chief audiologist, University of Texas Medical School, Houston. Earl Bowie, MD, ear, nose, and throat specialist, Ochsner Clinic Foundation North Shore, Jefferson Parish, La. David Fabry, PhD, audiologist; director of research, Phonak Hearing Systems. National Institute on Deafness and Other Communication Disorders.
© 2005 WebMD, Inc. All rights reserved.

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