HEARING AIDS

Please read our disclaimer.

Hearing aids are electrical devices that assist in optimizing perception of speech or other sounds.

WHO NEEDS A HEARING AID ?

In essence, you need a hearing aid if the cost/benefit ratio is reasonable. An "ideal" hearing aid candidate is someone with a mild-moderate bilateral hearing loss, who has experienced a noticeable communication handicap. Many individuals who have good hearing on one side can adjust reasonably well to any degree of hearing loss on the other side. Hearing aids are not indicated for an ear with minor hearing loss, and are also not very useful in an ear with profound hearing loss. In other words, hearing aids are usually most appreciated in people with mild to moderate hearing loss on both sides.

Be sure that you need a hearing aid. It is said that 2/3 hearing aids go unworn. Most states have a 30 day return policy.

SITUATION USUAL BENEFIT
Minimal or no hearing loss Minimal or no benefit (little to gain)
Moderate hearing loss Good benefit
Profound hearing loss Minimal or no benefit from conventional aid, consider cochlear implant if bilateral.

WHAT TESTS ARE NECESSARY BEFORE SELECTING A HEARING AID ?

Audiometric evaluation -- determine type (i.e. sensorineural, conductive or central), degree, and frequency slope. Determine word recognition score with and without amplification. The evaluation should be able to predict the amount of benefit of a hearing aid, in terms of speech comprehension.

Otologic evaluation -- determines whether medical or surgical treatment is possible (i.e. wax removal). Medical clearance is advisable before purchasing a hearing aid. 

TYPES OF HEARING AIDS

Organized by technology (and expense)

  1. Analog. There are several circuits.
    1. Linear peak clipper (least favored in VA study, Larson et al, 2000)
    2. Compression limiter (preferred in VA study)
    3. Wide dynamic range compressor (2nd best in VA study)
  2. Simple programmable. Longer fitting time and follow-up.
  3. Complex programmable.
  4. Digital. Flexible but expensive.
  5. Cochlear Implant (see below). Very expensive, for bilateral acquired deafness.

Organized by appearance and size

  1. Assitive listening devices. A large variety of devices are available at much lower cost than hearing aids. Some of these are free. Telephone companies provide free amplifiers and ringers if patients present a physician or audiologist release. Hotels provide telephone amplifiers in 10 percent of rooms. Examples are devices that flash lights when the telephone rings, vibration devices when the doorbell sounds, flashing smoke alarms, television amplifiers, etc.
  2. Behind the ear (BTE). Cheapest, easiest to adjust, less feedback than other devices. Fairly visible. Most powerful. Fewest number of problems with wax or infections.
  3. In the ear (ITE).  Low visibility; harder to put in and adjust.
  4. In the canal (ITC). Very low visibility. Clearer than #1 and #2. Lower power. Patients with tremor or poor eyesight are not good candidates.
  5. Completely in the canal (CIC). Cannot be seen. Requires tight fit. Hard to adjust and remove. Clearer than #1 and #2. Patients with tremor or poor eyesight are not good candidates for the CIC.

Organized by Binaural/Monaural

  1. Binaural amplification -- aids on both sides. Better than one side only, but more trouble to keep maintained. Binaural amplification minimizes impact of "head shadow" drop off, improves sound localization, widens dynamic range, costs twice as much. Some individuals with bilateral hearing impairment do worse with two aids than one. This usually happens when the ears differ appreciably in hearing impairment, and occurs because the noisy/disorted/louder input from the poorer ear interferes with hearing from the better ear (i.e. binaural interference, see Baron, 2002). Bottom line: we suggest just fitting one ear at a time, and when there is bilateral hearing impairment, generally choosing the better ear for the first aid.
  2. Bicross --aid on one side "pipes" sound to other side, where hearing is better. Most hearing aid users are unenthusiastic about Bicross aids.

How much do Hearing Aids Cost ?

Hearing aids are typically not covered by Medicare or commercial insurance and pricing varies according to the manufacturer, vendor, and service arrangements.   In the Chicago area, these were typical or "ballpark" prices,  as of  June of 1998. 

Hearing Aid Type One ear Both Ears
Conventional 700 (ITE or BTE)-1500$ (CIC) 1400-3000
Programmable 1100(ITE or BTE)-2000$ (CIC) 2200-4000
Digital 2100 (ITE or BTE)-2700$ (CIC) 4200-5400

There are numerous brands and variants. In general, smaller devices, such as the CIC devices mentioned above, are more expensive, and newer/more complex circuitry is also more expensive. Compression circuitry in analog aides is more expensive (but definately a good idea). Greater user control is also usually more expensive. Bilateral aids are often but not always better (Baron, 2002), and in our opinion, usually it is best to be cautious and do one ear at a time.

In Illinois as well as in many other states, there is a 30 day tryout period, which is basically a legally mandated money-back guarantee for the hearing aid device itself. The dispenser is allowed to keep a fee for their services during the trial. As 2 out of every 3 hearing aids are not worn (at least often), and hearing aids are generally not covered by insurance and typically cost in the $1000's, we recommend that you think about this carefully. On the other hand, hearing is a very important sense.

Who dispenses hearing aids ?

There number of methods of obtaining a hearing aid. Probably the most common method is to visit a dispensing audiologist who can test your hearing, recommend an appropriate device, and assist in the maintenance. Hearing aids are also sold in department stores (such as Costco) as well as in other venues. We think that it is best to find a reputable source for your hearing aid, and also a source that will offer a reasonable selection of devices.

Cochlear implants and other implantable devices

An exciting recent development is an ability to provide hearing to some bilaterally deafened individuals through implantation of a device which directly stimulates the hearing nerve (actually the spiral ganglion). Although this device is not generally considered as a "hearing aid", it performs the same purpose for individuals with severe hearing impairment involving both ears. At the time of writing of this section, 12/2002, there are three companies that make implants -- Clarion, Med-El, and Cochlear Ltd. Generally an electode is threaded into the cochlea, as shown to the right. For more details, see the Clarion web site. The picture to the right is from their web site.

Most neurotologists are able to perform this procedure.  Cochlear implants do not completely substitute for a normally hearing ear,and at very best, may allow someone who was previously totally deaf to understand conversation on a telephone. Cochlear implant packages, including the device, surgery, and rehabilitation are much more expensive than hearing aids (roughly $45,000), but when one is indicated, they are generally covered by insurance, unlike the situation with hearing aids. A patient-contributed history is found here. Remarkable improvements in performance have been accomplished since 1980. Further information about cochlear implants can be found at the following sites:

  1. Alexander Graham Bell Association for the deaf
  2. Auditory-Verbal International
  3. Clarion corporation home page

There is also recent availability of a device that is implanted into the middle ear, in essence, implanting the speaker part of the hearing aid. This device seems promising for individuals who are unable to tolerate conventional hearing aids.

REFERENCES