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What's the difference between an audiologist and a hearing instrument specialist? - Ted Venema PhD
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There are many types of hearing aids available, including different models, sizes, and technologies. Included in this variety is a wide range of advanced features with a solution for almost every hearing impairment. The decision regarding which type of hearing aid will best suit your particular needs is an important one. This decision will be reached by you, after discussing your hearing loss, life style and specific listening needs with your Hearing Health Care Professional. Many factors, such as your audiogram, total costs, dexterity and lifestyle must all be considered to ensure that you are fit with a hearing aid(s) most appropriate for you.
A hearing aid is essentially your personal loud speaker. It is an electronic device that captures sounds, often too soft for you to hear, via a very small microphone. This sound is then amplified or made louder, and transmitted to the hearing organ in your inner ear. The way the sounds are amplified may differ depending on the type of hearing aid chosen for you. However, the goal remains the same: to make sound and the spoken word loud enough for you to hear it. All hearing aids contain a microphone, an amplifier, a speaker (or receiver), and a battery source, as well as a seemingly endless choice of features chosen specifically to meet your listening needs. Hearing aid technology has become increasingly sophisticated over the past few years, with instruments that can determine how much gain or amplification is needed for you, and automatically adjust given the different environments that you are in throughout the day. Your Hearing Health Care Professional will help you to make the best decision.
Size or model type is one of the ways to differentiate between hearing aids. These can range anywhere from tiny aids that fit so deep inside your ear canal that they are almost invisible, to the larger instruments that fit neatly behind your ear. Typically, larger hearing aids are necessary if more gain or amplification is required. Depending on the model size and technology used, prices will vary. Your Hearing Health Care Professional will provide you with the appropriate guidance when deciding which style and model is best for you. Most features (and there’s a wide range of them) remain the same in all sizes or model type. Exceptions to this rule, such as the Telecoil and the Directional Microphone, are due to space limitations. The first three initials will tell you where a hearing aid will fit in or on your ear.
These are called behind-the-ear instruments, or BTE’s. These hearing aids hook over, and rest snugly behind, your ear. The hook is connected to a clear tube and mold which sits in your ear. The sound enters the microphone on the hearing aid, is amplified, and travels through the hook and the mold, directly into your ear canal. The hearing aid is powered by a battery compartment at the bottom of the hearing aid. A BTE hearing aid may or may not have a volume control. The larger size of the BTE allows for more features such as a Telecoil - which enables a hearing aid wearer to hear better and helps to reduce feedback while listening on the telephone, directional microphones – to help hear better in background noise, or Direct Audio Input (DAI) - which can be used with a variety of Assistive Listening Devices (ALD’s). The design of the BTE is often appropriate for people with limited dexterity, for those with chronic wax and ear canal moisture issues, or for people with certain size and shapes to their ear canal. Typically, BTE hearing aids are used for hearing losses which require more power, but they are also very suitable for mild to moderate hearing losses.
These hearing aids are called in-theear, or ITE’s. They are custom made to sit inside the outer ear. These aids are sometimes much smaller than a BTE, with smaller controls and battery size. It is also likely that this style could accommodate a variety of features including a telecoil. The size of your outer ear, along with the features that are considered necessary will enable your Hearing Health Care Professional to determine whether an ITE style is right for you. ITE’s today can provide quite a bit of power, which is useful if you have a severe hearing loss. ITE’s are appropriate for use with every range of hearing loss except for the most severe.
In-the-canal or ITC’s are custom made to sit deeper inside of your ear canal. They are less visible then an ITE, but due to size constraints, provide less gain. Depending in the technology selected the ITC may be limited to fewer feature options then an ITE or BTE. ITC hearing aids would be most appropriate for those with a mild to moderate hearing loss, and no concerns regarding dexterity.
These completely in-the-canal hearing aids are the newest and smallest hearing aid size currently available. They are virtually invisible (unless you know to look for them), and typically can be used on the telephone without feedback – without a telecoil. This style is also the most effective for minimizing wind noise. However, because of their small size, they are more sensitive to wax and moisture issues, and therefore require more frequent maintenance, cleaning and repairs than larger hearing aids.
CIC hearing aids are custom made to sit further down the ear canal, close to the ear drum. Because of the proximity to the ear drum, they require less gain or amplification to overcome the hearing loss. The battery is extremely small, and may be difficult to manage. They also tend to be the most expensive style of hearing aid, due to the miniaturization of all of the components. A CIC hearing aid is most suitable for a mild to moderately- severe hearing loss, but other factors such as dexterity and wax must also be considered.
Technological advances in the past decade have brought about enormous benefits in amplification. Not only are hearing aids smaller, but the newer technology in processing sound translates into a considerable improvement in sound quality making them more appealing to the user. Volume controls are no longer required, as most hearing aids have the ability to determine how loud or soft a sound should be, and all sounds are kept within the comfort level of the user. The features and advances available in hearing aids today allow for a better frequency response to more closely reflect your specific hearing loss, more precise in-office fine tuning and greater overall comfort and satisfaction.
There is so much information available in advertisements and on the Internet, that it becomes very confusing to try to figure out what is most appropriate for you.
What will really help to restore your ability to hear, and your quality of life? While all of the new technology sounds very beneficial, it is possible that it is not right for your specific needs.
The best place to start is with the type of hearing loss that you have. Then, you will want to discuss with your Hearing Health Care Professional what your specific goals are, and where you are having the most hearing difficulty. You will want to make the right decisions to improve your hearing, and will need to consider the amount of power required, your manual dexterity, the size and shape of your ear, budgetary considerations, and features that may be of benefit to you. While you will want to rely on the advice and suggestions provided by your Hearing Health Care Professional, you should also have at least a general understanding of what some of the available features are, and how they may benefit your hearing.
Just as you can define a hearing aid model by its size, you can also differentiate between different aids by the technology or circuits used to amplify and process the sound, and by the different features that are available.
Digital—Hearing aids with digital signal processing (DSP) reflect the newest technology available, and account for the largest growth in hearing aid sales. When sound enters into a DSP hearing aid, it is converted from an analog signal to a digital (or “bit stream”) signal. The power behind this conversion lies in the hearing aid’s ability to process this bit stream much more accurately and with more detail - depending on the fitting formulas made available by the hearing aid manufacturer. When the bit stream has been processed and converted back to the audible signal that you hear, the result will be a sound customized to your hearing loss – a sound that is much more natural and with little or no circuit noise compared to analog devices.
DSP programmable hearing aids are available in all sizes, from CIC through BTE. The range of options varies as much as with size, from models with very basic fitting parameters all the way up to the most advanced technology currently available in hearing aids. Digital does not necessarily mean expensive. It depends very much on the style and the features that you choose together with your Hearing Health Care Professional. Those with very active lifestyles and who are frequently in different environments should seriously consider the more advanced DSP options available. These more advanced options are usually, but not always, on the more expensive end of digital programmable technology.
Some of the more advanced features include special mathematical algorithms designed to improve speech intelligibility or understanding in background noise, and increased user comfort in these situations. These technologies allow your Hearing Health Care Professional more flexibility with frequency shaping or fine-tuning - to more closely fit your hearing loss. This is an area where your Hearing Health Care Professional, with their experience and knowledge, can help ensure that the technology you end up using is closely matched to your needs.
Omni-directional microphones have been the standard type of microphone in hearing aids for many years. These microphones pick up sound from all around you. If you are sitting in the middle of a restaurant, sound will be amplified from all directions. While this is fine, and sometimes even beneficial in a quiet environment, it makes listening in a noisy environment extremely difficult and very stressful for many people. In order to improve the ability to hear speech in these types of environments, directional microphones have been developed. Directional microphones, while not brand new technology, have been improved significantly over the past few years.
Directional microphones are an effective way to improve speech intelligibility in noisy environments. There are many different levels of this technology currently available, all trying to attain the same goal. Hearing instruments with directional microphones will either have multiple microphones built into the device or a microphone with more than one opening. These multiple microphone inputs allows the directional microphones to focus on the sound coming from in front of you, or face to face, and attenuate (minimize) the sounds coming from behind you. The assumption here is that the sound you are trying the hardest to hear, is the speech of the person in front of you. Most of the technology currently available allows you to switch from Omnidirectional to Directional mode very easily. This technology is available in most sizes of hearing aids, but is most common in BTEs and ITEs, as there is a minimum space requirement between the microphones for this feature to work effectively.
Typically, the more sophisticated the hearing aid technology, the more sophisticated the Directional microphone technology. In digital devices, for example different features on the directional microphones can be automated.
Binaural or Monoaural Amplification—Wearing two hearing instruments (also known as binaural amplification) is generally accepted to be the most appropriate for maximum speech understanding. However, there are situations in which your Hearing Health Care Professional might recommend wearing only one instrument (also known as monaural amplification.) Binaural amplification is generally preferred because of the benefits that arise from having an aid in both ears. For example, the ability to detect where a sound is coming from (sound localization or directionality) is much improved with a binaural fitting. As well, speech understanding in noisy environments is much improved when your two ears are working together. Approximately 80 percent of hearing aid wearers with a bilateral (similar hearing loss in right and left ear) hearing loss choose binaural amplification. It is clear that the benefits and improved quality of life derived from wearing two hearing instruments greatly outweighs the cost.
Purchasing a hearing aid is only the first step towards better hearing. As part of your fitting process, the dispenser will teach you how to care for your hearing aid and provide you with the tools to be a successful hearing aid user. You will be taught to insert and remove the hearing aid, change batteries and clean the hearing aid. If your hearing aid has a volume, telephone switch, memory program or directional microphone, you will be taught how to use these options. You will be given guidelines about getting used to your hearing aid and what to do if you have problems. In addition, you should be made aware of support groups or specific assistive listening devices that might benefit you. You should be told about the types of batteries that you can use, how long (and what is covered by) the hearing aid has warranty, costs to see the dispenser again (if any) and how long a trail period you have on the hearing aid. A few weeks after the initial fitting, but before the end of the trial period, a follow-up appointment is mandatory to allow for small changes that might need to be made to the hearing aid - to customize it for your specific listening needs. Once the hearing aid is satisfactory, it is routine for patients not to return to their dispenser unless they are having a problem. As hearing aids are subjected to dirt and ear wax, it is strongly recommended that you schedule a semi-annual cleaning appointment and an annual hearing check-up.
The old adage “you get out what you put in” applies to many facets of life including adjusting to new hearing aids. Some individuals, especially previous hearing aid users adjust and adapt much sooner than some first time hearing aid wearers. However, with the proper hearing aid selection and follow-up, you should, in time, be so comfortable with your amplification that you virtually forget that you are wearing hearing aids.
As with any prostheses, nothing will ever replace what you were born with. Hearing aids are no different. Yet, with the most recent advancements in technology and design, you will most definitely find an improvement in your overall quality of life by making the effort of adapting to hearing aids. “Red for the right and blue for the left” is the easiest way to identity which aid is for which ear. Most custom aids will have the serial numbers in either red or blue and the behind the ear aids may either have an “L” for left or an “R” for the right somewhere on the body of the aid if there is not already a color coded system.
Be sure that you take the time to insert and remove both aids when you first receive them from your dispenser, but don’t be discouraged if this takes some practice at home. Go over the battery installation and removal as well.
Even though they initially may feel foreign in your ears, they should not cause you any pain, headaches or discomfort. If so, stop wearing them and return to your dispenser.
Before your first follow up visit to your dispenser, try the aids in familiar environments and areas that you were previously experiencing difficulties understanding speech. This way you will be able to relay your experiences (including any challenges you’ve had) to your dispenser so appropriate adjustments may be made. The most important key to remember is to not give up. Just understand that you may need to make a number of visits for adjustments or consultations.
Most hearing aids are backed by a minimum
30-day refund or exchange policy.
This give you time to evaluate the hearing
aids in your real-world environment and
make any changes in size or technology
that may be necessary.
For the majority of individuals, hearing loss has slowly increased over ten, twenty or even thirty plus years. When the aid is first used, the new sounds can be overwhelming or even bothersome until your ear(s) and brain fully adjust to the hearing aid(s). One common experience of first-time hearing aid users is referred to as “occlusion effect.” This effect - hearing your own voice differently than before - is sometimes referred to as a hollow, echo or barrel sound to your voice.
You will find that this will soon become normal to you, but reading out loud for 20 minutes a day over a minimum twoweek period will make this transition easier.
There are a number of support groups to help individuals adapt and cope with hearing loss, so check with your dispenser for classes in your area.
Adapting to hearing aid amplification is not a solo journey. Your family and friends also need to be aware of a few tips that will help you hear and understand them even better. Have them get your attention first. Encourage them to call your name, or touch you gently, before they start a question or comment, so that you’ll be able to be more focused and more attentive.
Ask them to speak slower. Slowing down on a delivery of speech will make it much easier to understand what is being said. It gives the brain a little extra time to comprehend. After all it’s the brain that does the “listening”, your ears only hear.
Speak while face to face whenever possible. It’s much easier to hear if you can watch their facial movements and expressions.
Keep your mouth clear. It is more difficult to hear, even with normal ears, when someone is eating, chewing gum, smoking or resting their hand in front of their mouth. A moustache can make lip reading more difficult as well.
Move a little closer. The greater you need to project your voice, the more difficult comprehension will be especially in a noisy environment. So turn down the TV (or other distraction), move closer or even remove yourself from the area of the distraction.
If you have a problem down the road with your hearing aids that you’re unable to fix, your dispenser should be able to assist you - either by repairing it themselves or by sending it to the manufacturer. You may even want to review your cleaning and care procedures with them to ensure you’re not missing something important.
If you are unable to have your concerns addressed to your satisfaction, then you may need to contact your provincial registrar to assist you. You may also contact the Better Business Bureau in your area, which will also be a service to other consumers.
Each province has different regulations and guidelines, but if all else fails, contact Consumer & Corporate Affairs or the Canadian Hearing Instrument Practitioners Society (CHIPS).
The cost of hearing aid(s) can vary greatly due to the differences in technology and style that is needed to correct your hearing loss. The range of services which may be included with your hearing aid can also affect the price. This cost is the responsibility of the person who will be wearing them. However, in some provinces, there are grants from the provincial health plans to cover a portion of the cost.
You may also have third party insurance coverage from a current or previous employer that may cover part or all of the cost. There are also benefits available to qualified Veterans who have served in the Canadian Forces. Veterans Affairs Canada is a national program accessible to veterans in each province and territory. You may know it more commonly as “the DVA”, “the Department of Veterans Affairs” or as your “TAPS card.” The
Workplace Safety & Insurance Board (WSIB) or Workers Compensation Board (WCB) – depending on which province you live in - is a provincially governed agency that provides coverage to individuals whose hearing loss has been at least partly caused by workplace noise. Note: The WSIB was previously known as the Workers Compensation Board (WCB).
Please refer to the resource section at the end of this guide for contact information specific to the province in which you reside.
A standard factory-warranty period offered by manufacturers is fifteen (15) months from the date of manufacture - for repair, adjustment or service of the new hearing aid(s). Some manufactures offer a twenty-five (25) month factory- warranty period as standard on their hearing aids. In many cases, optional coverage can be purchased that will provide for up to four (4) years of factory-warranty coverage.
Often there is between one (1) to three (3) years of lost hearing aid insurance coverage included (or available as an option); there may be a deductible and/or other conditions that apply. As this is usually a “one time only” loss insurance, you would be wise to also insure your hearing aid(s) using your household insurance policy. Most hearing aids also come with one (1) to two (2) years of insurance coverage for significant hearing loss change.
When purchasing a hearing aid(s), be certain you receive a written warranty card to present for service should you need assistance while traveling. Some hearing aid offices and clinics also offer service plans to cover your on-going maintenance at the office. These plans will ensure that you are not charged for office visits, cleaning, programming and/or other services related to the ongoing maintenance of your hearing aid(s). When purchasing a service plan, be certain to receive a written agreement of the items covered and for what time period.
(The scope and conditions of warranties can vary between manufacturers. A deductible may apply and may vary depending on the type of claim. Ask your Hearing Health Care Professional for details about the services they offer.)
The trial period is the period of time that allows you to return your hearing aid(s) – starting from when you receive them. The trial period allows a person to return the hearing aid for credit or to switch to another hearing aid, should one prove unsatisfactory. Currently, most hearing aids are programmed via a computer so, should a hearing aid need fine-tuning, changes can be made on a hearing aid without returning it to the manufacturer. Occasionally, after wearing a certain style of instrument, you might decide you wish to wear something smaller or larger, the trial period allows for such a switch to take place. The length of a trial period is usually between thirty (30) and ninety (90) days depending on the policy of the office or clinic you are working with, specific regulations in your province and/or whether the hearing aid was purchased or copurchased by a government program such as Veteran’s Affairs. The trial period should be stated in writing either on your detailed invoice of purchase or a separate agreement. If not, be sure and ask your dispenser for details. As has already been mentioned, even if you adjust fairly well to your hearing aid, it is strongly recommended that you return for a follow-up appointment prior to the termination of your trial period to allow for minor adjustments to your hearing aid’s programming or fit.
When it comes down to quality of life, hearing aids may not be the only solution. There are a variety of devices available to compliment your hearing aids.
Such devices incorporate flashing lights, loud sounds and/or vibrate to alert you of a phone, doorbell, smoke alarm, baby alarm, siren or even a cars turn signal.
A variety of listening devices are available, which may or may not be used together with your hearing aids, to improve your hearing in difficult listening environments. Most hearing aids have telecoil circuitry available. Telecoil circuits, also known as T-coils, allow you to use a telephone without annoying squeal (feedback). The signal from the telephone by-passes the regular microphone on the hearing aid and is picked up only by the telecoil switch – eliminating room noise from entering that hearing aid and interfering with the conversation.
A telecoil can also be used together with an induction loop system to receive amplified sound from infrared (IR) or FM radio systems at theaters, churches, courtrooms or similar places. A microphone near the speaker sends a signal via a beam of light (IR) or radio frequency (FM) to a wire that you wear. That wire, in turn, provides the signal to your telecoilequipped hearing aid.
Infrared (IR) systems and FM systems have become fairly common in large venues and even for private TV listening. One very positive benefit of these systems is that they allow the user to hear better without the excessive volumes that could disturb others.
Some hearing aids have direct audio input (DAI), which allows a microphone to be directly connected to the hearing aid. Many people find this is very beneficial in a car, a conference or a business meeting.
Close captioned decoders for TV transcribe spoken words into written words at the bottom of your screen. Since 1993, all 13” TVs or larger must have closed captioning capabilities.
Special products are also available to assist you with hearing on the telephone. These range from simple add on amplifiers to elaborate high output volume and tone-adjustable telephones. These devices may also be ordered from your local phone company. Basically referred to as hard of hearing telephones, these may be available either for purchase or rent. Newer products are now available to compensate for the problems of interference caused by digital cellular phones.
A cochlear implant is a device, which is surgically implanted into the patient’s inner ear with a receiver placed under the skin behind the ear. The patient wears a processor, which looks much like a BTE, or body hearing aid, which picks up sound, analyzes it and transmits the sound across the skin to the receiver, which then sends the sounds to the electrode in the inner ear. This type of technology has made a tremendous improvement for people who are unable to benefit from hearing aids due to the profound extent of their hearing loss. Only people with severe to profound hearing losses (70 dB and poorer) in both ears can currently obtain cochlear implants. Should your hearing loss fall into that category and you feel you are not obtaining satisfactory benefit from your hearing aids, you may want to investigate if you should be evaluated for a cochlear implant.