How To Choose
How to Choose a Hearing Aid
It’s simple really... wear them. The best way to choose hearing aids is the same way you choose a new car: Test drive them.
There are over a thousand different models available today. Although most dispensers will sell you any hearing aid you ask for, they can’t all be right for you.
Four major factors we consider when prescribing a hearing aid.
- The nature or class of hearing loss you have. Will the aids we prescribe have enough power for your loss without causing any side effects?
- The abilities and benefits of the many different models. Which ones will work for your loss and work with the answers to questions 3 and 4?
- Your lifestyle. If you are still in the workforce, attending meetings, dealing with customers, etc., you will place a greater demand on your hearing aids. If you are less active, you may do just as well without as many features. Which hearing aids will meet your goals?
- Your budget. Most of us do not have an unlimited budget. Which hearing aids answer questions 1-3 and still fit within your budget?
Let’s break it down and look a little deeper into some of the variables.
POWER
Your loss and power requirements will put you in one of five classes:
- Ski slope losses that need a lot of power in the higher frequencies, but need little or no gain in the low to mid frequencies. A person with this kind of loss needs to make a very careful and informed choice. It’s very easy for this person to end up with a hearing aid they cannot, or will not, wear. A waste of money.
- Those with mild to moderate losses that typically don't go below 50dB can wear an “open fit” hearing instrument and still have sufficient power. Many manufacturers say they can deliver much more power without feedback, but the physics don't work out that way. We will show you this.
- Those with moderate losses need more power across a larger number of frequencies and should wear a conventional model.
- Those with moderate to severe losses need lots of power in most of the frequencies, but can still wear one of the stronger standard power aids.
- Severe to profound losses, where power is the deciding factor, will typically require a high-powered instrument. Like the ski slope loss, this loss needs special attention in order to maximize speech. If you have this kind of loss, be sure to read the John Bomhart story and come join our trial program.
Your power choice is critical. Your hearing instrument must be powerful enough to reach the greatest point of loss without straining. More importantly, the style (size) you choose has to be capable of delivering that power without going into feedback.
Manufacturers can, and do, sell hearing instruments with more power than can be used due to the ear physics. It can be built to deliver lots of “gain," but be quite limited in “usable gain." “Gain” is one term we use to describe the strength of an instrument. “Useable gain” describes how loud you can set a hearing aid before it starts to squeal.
To achieve the full benefit from the power of a hearing aid, the style has to allow that power to be delivered.
A final thought on the power matter: You may try on a hearing aid and it may sound great the day you buy it, but how much reserve power is left in the aid?
Our goal is to provide hearing instruments that will last ten years. If you buy an instrument that sounds good today but has too little reserve power, you may have to replace it next year, or the year after, to keep up with a progressive hearing loss.
Most hearing losses change very slowly, but they all progress. When you come back two years later, will we be able to reshape the output sufficiently? Or, will you have to buy another one because you bought an instrument with no room for growth? How often do you want to buy new hearing aids?
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SIZE, Size, size
Shell sizes fall into the following six general categories:
- CIC. Completely in the canal is the smallest hearing aid and is best worn by those with mild losses. This size is very prone to feedback (squealing). Regardless of the brand or model of instrument, the amount of power (also called gain or volume) that a CIC can deliver is limited by the acoustical properties of the ear and the physics of sound.
CICs do not improve hearing in noisy environments, primarily because they cannot include directional microphones. Sure enough, they make everything louder, but they don’t make it any easier to understand speech. - ITC. In the canal hearing aids are more visible but allow for more power before going into feedback (squealing). ITCs cannot contain useable directional microphones. Some manufacturers will make them with directional mics, but the physics don’t work. The mics are too close together to be of any real benefit. Due to the small distance between the mics, the signal-to-noise ratio does not provide a significant benefit. The difference is certainly not worth paying for.
- ITE. In the ear is the largest size that fits in the ear. Of those that fit in the ear, this hearing aid is the least likely to feed back. Further, it is the only size that fits in the ear and can include directional microphones; Dmics are extremely helpful in noisy environments. Even in ITEs, the mics are closer together than optimum, but they do provide a moderate improvement in the speech-to-noise ratio.
- BTEs designed as “Open Fit” are for a mild to moderate loss. These instruments do a very nice job of delivering the necessary power in the high frequencies without making your voice sound funny.
They often include directional mics, but the benefit of directional mics is less in an open fit system. Still it does help somewhat. - BTEs. Behind the ear works extremely well for a moderate to severe loss. BTEs today are smaller, less visible, and more sophisticated than ever before. With these instruments, you will experience the most natural sound restoration we’ve ever been able to deliver.
- BTEs for a severe to profound loss. The shell is merely the size of the housing. Those models that go in the ear, as opposed to behind the ear, are called “Custom Aids." As a rule, any circuit by any manufacturer can be purchased in any shell size. The only modification to this rule involves the added features.
If the shell is too small, you may not have directional mics, T-Coils, volume controls, program buttons, or access to other accessories like FM systems. The shell size is very important when dealing with the physics of sound.
ALL CICs, from ANY manufacturer, will begin to feed back (squeal) at lower power levels than larger-size shells. The BTE allows for the possibility of more gain (volume) with the lowest likelihood of feedback.
The BTE also provides the most sophisticated and effective directional microphone system available. There are at least a half-dozen other variables that will affect the actual outcome. BTEs are also the most reliable and longest-lasting style.
Hearing aids range from several hundred dollars to several thousand dollars apiece. Does buying a higher-priced hearing aid mean better hearing? Fundamentally, no; but it does buy more options.
Think of it like this: I can buy a brand-new car for under $10,000 or I can spend as much as $500,000 on the most expensive street legal car in America today. It’s not uncommon to spend $20,000, $30,000 or even $60,000 on a luxury car today.
Which of these brand-new cars will take me across country and back? Answer: All of them. Some of them will simply have more creature comforts. Some of them will take off faster or stop quicker, but all of them will take me where I want to go.
All of today’s digital hearing instruments will provide the fundamental requirement of better speech understanding. They all do a pretty good job. The additional options found in these hearing aids allow us to achieve and maintain that improvement in more challenging situations like those found in noisy restaurants or auditoriums.
They provide a more comfortable listening experience in more situations. But all of today’s hearing aids are capable of providing better speech understanding. I say they are capable. I did not say they will. Why not? See Digital Programming for that answer.
We recognize that everyone has a budget. Rather than comparing hearing aids on the basis of price, we recommend you stay within your budget and compare the different hearing aids based on how they perform for you. In other words, learn about the differences and test drive the ones that are best designed for your loss. With so many models available, we can find exactly what you need.
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Almost all of today’s hearing aids are digital. There is nothing magic about the term digital. It simply means the sound is handled like any computerized device. It can be very good; it can be very bad.
Although digital hearing aids can provide a vastly better hearing experience than yesterday's analog instruments, they have to be correctly prescribed and correctly programmed. Analog hearing aids were built at the factory and came “fixed” to the fitter. The fitter could not make many alterations to the output of the instrument.
Digitals come as a blank sheet of paper. It’s up to the hearing aid fitter to shape the output of the hearing aid. If the digital hearing instrument is programmed well, you will have an awesome experience. If it is not, it can be as useless as sticking a rock in your ear.
Who you choose to do your programming is the most important decision you will make when buying new hearing aids. What is the absolute best way to assess a programmer’s skill? Make them prescribe and program a hearing aid for you and then make them let you wear it for several weeks. If they don’t have it close to right within 2-3 weeks, it’s likely never going to be right.
Don’t let anyone tell you that you will adjust to the deficiencies after several months. Don’t expect problems with squealing, background noise, or the sound of your own voice to just go away on their own. They don’t.
If after 2-3 weeks, the majority of the problems are not solved or you cannot tell whether the programmer is making any headway, you should try a different instrument and/or a different dispenser.
Remember, in order for the dispenser to meet your goals, first you have to be in the right class of instrument, with the right power, the right size, and the right price.
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