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Re: Hearing aids

Author: sdr
Date: 2007-05-03 14:24

There are over 400 makes and models of hearing aid on the market. Shopping for a hearing aid is like shopping for a car – all the cars have 4 wheels, a motor, and a steering wheel; all the hearing aids have a microphones, an amplifier, some bandpass filters (akin to a graphic equalizer on your stereo), and a speaker. But, you can by the economy model or the model with leather upholstery and a sunroof. These may both be excellent machines, but one has no frills and the other has all the bells and whistles. Same with hearing aids. If you think you might have a hearing loss, see an otolaryngologist (ENT) for an audiogram and ear check-up. If you are a candidate for a hearing aid, consider going to a hearing aid center, not a storefront franchise. The center will carry a range of instruments from reliable manufacturers that cover all the features and price points. If you go to a franchise dealer, you are at greater risk of having a saleperson push you to buy their “top of the line” instrument even if it may not be the best for you. To sell hearing aids in most states you need a high school diploma and a $25 hearing aid dealer license. You are more likely to get good care if you go to a licensed audiologist with a Master’s Degree in Audiology to be your hearing aid specialists. All 50 states in America now have laws that anyone wishing to sell you a hearing aid must provide a minimum of a 30 day money-back trial (unless you make the mistake of signing away this right by not reading the fine print on the sales contract).

Nowadays virtually all hearing aids used digital signal processing technology. I doubt any companies are making analog aids any more. The digitals are much cheaper to manufacture but they garner a greater retail mark-up at the point of sale because they are “digital” (Woo! Woo!). Hearing aid dealers also charge a premium for smaller aids (In the Canal “ITC” vs. In the Ear “ITE” vs. Behind the Ear “BTE”) despite the fact that BTE are almost always superior in every important regard – they are easier to handle, they last longer, they sound better, they are better cosmetically. This last point, cosmetics, deserves special comment. I am a firm believer that a small plastic housing colored like your hair and sitting in the crease behind your ear with only a thin clear plastic tube into the ear is far less noticeable than a chunk of pink plastic filling your ear. In considering any cosmetic downside of hearing aids, you must weigh them against the “cosmetic” aspects of the hearing loss: not knowing when to laugh at the punchline, misunderstanding a question and giving a ridiculous answer, and generally appearing to be “out of it” in any conversation or group. Unfortunately, in our culture anyone with gray hair (or no hair) who is a little “out of it” is assumed to be senile, not hard of hearing. I personally would rather wear the hearing aid and let people draw the right conclusion.

Finally a note about acoustics. The most common forms of age-related hearing loss, as well as acoustic trauma hearing loss, exhibit preferential loss of high frequencies (above 1500 Hz) but tend to spare lower frequencies. When you completely occlude the ear canal, you preferentially block low frequency sound. Thus, with an ITC or ITE hearing aid, you are actually blocking out your best hearing and substituting the tinny electronic sound of the aid. With a BTE and vented earmold you are allowing normal low frequency hearing and supplementing it with amplified high frequency sounds – an effective hybrid solution to the high frequency hearing loss.

-sdr

Oh, and BTW, if you have two aidable ears, you are probably better off with two hearing aids. The eye doctors don't sell many monocles anymore either.
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Steven D. Rauch, MD
Assoc. Prof., Otolaryngology
Harvard Medical School
Mass. Eye & Ear Infirmary

Tel: 617-573-3644
Fax: 617-573-3939
Email: steven_rauch@meei.harvard.edu
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