Hearing loss is common. It is not an illness or disease; it is however, second only to arthritis as a health problem for people over the age of sixty-five. About twenty-eight million people, one in ten, Americans experience impaired hearing.
Assess Your Own Hearing Problem
How to start? The first thing is not to take any advice or recommendations from anyone else: your spouse, children, neighbors or anybody. Get up one morning and begin to keep track (maybe make notes) of what’s going on with sounds in your life. If someone says “please” and you hear “cheese” remember that (write it down). If someone says “door” and you hear “more” pay attention to that, don’t ignore it or block it out or blame the speaker, just recognize that it happened. Don’t argue with anybody or pay attention to their “you need a hearing aid speech”. Observe your days with regard to sound, what is the number on the TV volume control when you watch it by yourself – what is the number when someone else in the house is controlling it? When you go out do you hear the birds? What about your air conditioner, your fish tank, the sound of your feet on the rug, running water? Pick out things that make sounds and noises that you know and make note of what you’re hearing or not hearing; music, rain, wind, traffic, etc. If someone asks did you hear the phone, door bell, whatever, answer them honestly and make note of it. After a while you will begin to see what’s going on with the sounds in your life. You may be mixing up S’s and T’s and D’s and C’s, having difficulties 耳鳴成因 hearing all the consonants, having difficulty hearing your grandchildren, notice that low pitch sounds are louder than high pitch sounds. These observations are important when you are ready to move forward for hearing help.
Go To Your Doctor
Not a hearing dispenser, to your doctor, your GP or an ENT. Visit a physician before buying any kind of listening device. By skipping a formal medical evaluation, you may fail to diagnose a serious problem, such as an infection, ear tumor, or excessive wax buildup. Furthermore, a formal evaluation will provide a piece of information often taken for granted: whether or not a hearing aid will help you with your hearing loss. You can do this during your regular doctor’s visit; take your time, you’re not going to die of hearing loss. Hearing loss tends to stay the same or get worse over long periods of time. Your hearing will not get worse because you’re not wearing hearing aids. The issue is the sounds of life that you are missing without getting hearing help. If you experience any sudden hearing loss see your doctor quickly.
Now that you have your own assessment of your hearing loss, and your doctor’s assessment and recommendation, you are better prepared than ninety percent of people who seek hearing help. Remember hearing is one of your senses, and it’s your right to decide what you like. If you don’t like the taste or smell of something you avoid it. If you touch something and it hurts you don’t touch it again. Your goal, besides better hearing, is better hearing that you are comfortable with.
Define Your Hearing Objectives
The first step is to determine your primary objective. No hearing instrument can completely solve one problem never mind all hearing problems. Select what hearing problem you would like to improve most; whether it’s hearing the TV, conversations with your spouse, hearing at work, at church, at family gatherings – this will give you a starting point, your primary objective. All other problems become secondary objectives that you should also prioritize.
Now that you have clear goals, you don’t have to feel pressured into making these types of decisions while you shop. You can now control the process of purchasing the best possible solution for you at the lowest possible price, not because of what somebody else tells you but because you know what you want. Now we need to consider what type of hearing device will best fulfill your objective(s).
Types of Hearing Devices
1. Assistive Listening Devices (ALDs). ALDs are designed to improve hearing in specific listening situations. They are designed to emphasize ONE signal. That signal might be a faraway voice (e.g., a lecturer in an auditorium), listening to TV, trying to converse in a restaurant, use a telephone or hear your alarm clock. The most common ALDs are wired devices; one example is the pocket talker. A pocket talker looks like a transistor radio and is designed for close listening situations. Normally, a pocket talker comes with a plug-type microphone. Ad from one web site:
Can’t Hear In Restaurants, Automobiles . . .
. . . Or Other Places With Background Noise?
The Portable Amplifier That Helps You In Difficult Listening Situations
The price is $149 plus $12 Shipping and Handling.
ALDs can also be found in Radio Shack, Sharper Image and some hearing aid stores.
Similar in purpose but more flexible are wireless systems. They work much like a radio station; one part (the transmitter) accepts sound input and transmits the signal through the air; the other part (the receiver) receives the signal usually with headphones. Because these systems are wireless they provide more flexibility than the Pocket Talker. TV Ears is an example of an infrared wireless ALD; the transmitter is plugged into the audio out connector on the TV and headphones which contain the receiver can be used up to 50 feet away with line of sight. The headsets have a volume control. Systems start at $130.00.
Other ALDs include amplified phones, alarm clocks that also vibrate your bed, wireless door bells and more. For any one specific hearing problem there probably is an ALD solution.
2. Over-the-Counter Hearing Aids. My definition of an over the counter hearing device is any amplifier that has the physical characteristics of a hearing aid in size and shape but requires no hearing test, office visits, or custom fittings. You can purchase them directly on the internet or by mail order. They are designed to fit most and to provide peak amplification for voice range frequencies, the frequencies we have the most difficulty hearing as we age. What started as a choice of a very few just ten years ago has grown dramatically. These devices are manufactured with regular hearing aid components. The price range I see for analog units on the internet is $180 to $350, Digital $380 to $480+ and new Open Fit Hearing aids $499 to $1895+. All have a money back guarantee. I’ve seen the guarantee period from thirty-days up to ninety-days. Some will charge a restock fee and most will not refund the shipping and handling fee.
3. Dispensed Hearing Aids. My definition of a dispensed hearing aid is an amplifying instrument that is built to amplify sounds according to a hearing test and is custom molded to your ear canal, with both of these services conducted in person by a licensed hearing dispenser. When you purchase dispensed hearing aids you are also purchasing the services and follow on support of the licensed dispenser. The cost per unit varies from $700 for a basic unit to over $3000+ for a very sophisticated unit.
Hearing Aid Styles
1. Behind-the-Ear (BTE) hearing devices are a crescent shaped shell worn behind the ear. A flexible tube with a custom ear mold is connected to the BTE. Sound travels from the BTE through the tube into the ear. BTEs are particularly effective at preventing feedback problems, Because of its size it is able to incorporate more signal processing options and larger, easier to operate controls.
2. In-the-Ear (ITE) devices fit in the outer ear. The case, which holds the components, is made of hard plastic or a flexible acrylic material. ITE devices can be damaged by earwax and ear drainage. Volume control, feedback and battery changing can present problems for some people because of their small size.
3. The In-the-Canal (ITC) hearing device is worn in the ear canal. The face plate of the device is not visible without looking directly in the ear. ITC over the counter hearing aids usually have a multi-tip fit system or a flexible shell. ITC aids maybe difficult for the user to adjust and remove again because of their small size.
4. Completely-in-Canal (CIC) hearing device is largely concealed in the ear canal. The very small size limits the operational ease of a volume control, limits the size of the battery and makes it more difficult to handle when not in the ear. The small size does however get the device further in the ear and closer to the ear drum. Because the microphone is deeper in the ear the outer ear has more chance to do its job, so for many the device sounds more natural.
5. Open Fit also called Open Ear hearing aids are becoming more available and very popular. They are mini Behind the Ear instruments with very thin tubing and a soft dome that’s virtually invisible, even to those looking directly at your ear. Open Fit units require no fitting and keep the ear canal open to reduce the plugged-up sensation. You get clean, crisp, natural sound with Open Fit hearing aids. I believe there is no better choice for people with high-frequency hearing loss. Common wearer frustrations, such as the sound of your own voice, noise when you chew food and excessive whistling are resolved with the Open Fit. It is the most discrete and comfortable hearing instrument you can wear.
Let’s start shopping – mail order
- You’ve assessed your own hearing problem,
- You have visited your doctor, had you ears checked and received his or her consultation on your hearing problem.
- You have defined a primary objective and prioritized secondary objectives.
- You have learned that they are three categories of hearing help products (assistive listening devices, over the counter hearing aids and hearing aids)
- And there are five styles of hearing aids. (BTE, ITE, ITC, CIC and Open Fit).
If you can, begin on the internet. If you don’t have the internet, get in touch with a family member or friend who does. If you have someone and it’s possible for you to be there with them, schedule some time where both of you can search on-line together. At the least have someone look for you. Make sure they know what your objectives are. They can search and then print out information on products that will be of interest to you.
If you only have one objective to meet and style is not an issue go to Google and search for assistive listening devices. On the right hand side of the page there will eight to ten sponsored text ads. All of these are ‘links’ which means that when you click one with your mouse it will take you to the advertised site. This is where you start your search; each page of Google will have these ads. These companies are spending dollars to advertise their products indicating that they are viable functioning companies. The top ad on the first page is spending the most money and each one below that is spending a little less. From these companies you will find many different devices for many objectives; hearing the TV, the telephone, the door bell etc. You may be able to meet your objective with a very affordable and effective solution.
If you have decided that you want an over the counter hearing aid or a dispensed hearing aid, the first decision you need to make is style. Eliminate any of the styles that you absolutely will not wear keeping in mind, however, that performance, features and price options will become more of a factor the more you restrict yourself. Rank the styles in order from most interested to least interested. Say you like the ITC style the most. Find an ITC over the counter hearing aid on the internet that you can buy direct, in other words you can place your order on the internet or call a toll free number to order, and it is simply shipped to you. You do not have to go to an office, be tested or fitted. Use the search method we described for assistive listening devices to find the sponsored ads. Make sure that the company has a clear return policy, use only a credit card (your credit card company will protect you). Remember your objectives and select the right or left ear accordingly. I recommend that you do not buy both ears unless you’re an experienced hearing aid user. The purpose is to try an ITC device and get a feel for its amplification. Only buy from a company that will return the full product cost. Most will keep the service, shipping and handlings fees, usually $20.00 or less. Make sure there are no restocking fees. In a few days you will receive an ITC unit with batteries to try for at least thirty days. Take at least ten days to try the device. Work with it only for a couple hours a day when you first get it and increase the time you wear it each time you wear it. These devices are like a shoe, you need to break it in a bit and give your brain a little time to adjust to the new sounds. Seventy to eighty percent of those who try one of these find that they do work. If you not solve your problem to your satisfaction, simply return the device and wait for your refund. Think about it, you are out around $25.00; the non refunded shipping and handling plus $3 to $5 return receipt postage and insurance.
Now, what did you learn? Was the ITC too big or too small? Accounting for breaking it in discomfort were there any other fit issues, raw spots, irritation? Was squealing a problem? Was it too loud, not loud enough? Could you adjust the volume? Make notes and begin to research the next logical choice for style. Do it again with another style or variation on the style. Do not rush to do it again, it took a long time for your hearing loss to develop do not try to solve it tomorrow. I get a kick out of people who haven’t heard well for years and expect to hear like they used to when they first put it in their ear. Take your time and you will prevent mistakes; it will be worth the effort and save you money.
If you find a style but the amplification or fit is not to your liking, you still have many options. Try another manufacturer with a different fit system, try a digital (or analog) device, again you are only risking the shipping and handling fee. You are in your own home, you have plenty of time and you’re protected by your credit card company. There is no better way to learn about hearing devices.
If you try two, three or more over the counter hearing aids and determine that they will not work for you do not be discouraged, you simply need to buy a dispensed hearing aid.
Buying at Retail
Let’s go through some of the things that you may have heard or will encounter and how to deal with them.
Audiologist and hearing aid dispensers in most states are licensed by the state to sell hearing aids. In most states you can not fit and sell hearing aids without a license.
Hearing Aid dispensers are not doctors and cannot give you a medical diagnosis or opinion. A hearing aid does not require a prescription. A hearing test and its results is not a medical evaluation when administered by a hearing dispenser.
Hearing dispensers have no formal higher education requirement to be eligible for a license. They must pay a fee, take a course of instruction designed by the Hearing Authority in their state, pass a written test, and serve an internship under a licensed dispenser.
Most audiologists are not doctors. They do have a formal education, most often with Masters Degrees; more and more are getting doctorates. Until fairly recently they did not dispense hearing aids.
Some states require proof of a hearing evaluation by a MD; your dispenser must inform you of this requirement; you have the right to waive the hearing evaluation.
When you see an ad in the paper for something free, it’s a loss leader; they will try their best to sell you a more expensive hearing aid. Call them and ask them if you can get a copy of the free test results to take home without making a purchase.
The $379 (or other low price) Hearing Aid ad can be a bait and switch. You will get tested, (make sure and ask if there is a fee for the office visit and/or test if you do or do not make a purchase) and the tester may tell you that your loss is too severe for the inexpensive device advertised. Here’s where you’re over the counter hearing aid experience pays off. Did the ad specify if the device was custom molded or not? Is it the style you prefer? The dispenser should have a unit you can try, with your experience you will know if the amplification is going to meet your needs. If the ad says custom fitted and the style and amplification meets your needs, make them deliver. Do not pay the full amount until you receive it and try it in their office.
Some dispensers become manufacturers. They make cases (shells) the best they can in the back room and use parts purchased in a secondary market. The unit may or may not be acceptable to you; if the dispenser moves or closes it may be difficult to get the unit serviced by another dispenser.
Watch out for Brand name ads at low prices. Some manufacturers make low budget, low tech hearing aids as well as the very high quality, expensive units. There is no way you could ever tell the difference from physical appearance, just because the name is on the unit does not make it a high quality unit. Again your experience will help.
Make sure you know what free servicing means if you respond to a free servicing ad or receive that service with your purchase. You may be led to believe that it means free repairs, most often it doesn’t. Servicing is the cleaning, moisture removal and minor adjustments done in office. Repairs are most often sent to a lab. Remember that their first purpose is to sell you as many hearing aids as they can, repairs can also be expensive. Read the fine print and ask the questions. Speaking of repairs it’s interesting to note that the majority of hearing aid repairs are due to moisture or wax, often the repair is a simple vacuuming with a needle vacuuming machine all dispensers should have. This service should come free with your purchase or should not cost more than a few dollars. Find out what was done to make your repair. If you feel repairs are too costly or happening too frequently take the unit to another dispenser, he might help you out, but remember his job is to sell you another hearing aid.
Be careful of the “covered by your Insurance / HMO” ads. Although some insurance companies will cover some amount toward a hearing aid purchase, it’s not unheard of the devices being over priced before the insurance portion is applied. You may still be paying full retail. Also find out if the insurance money is to be paid to you or the dispenser before you go in.
Some will tell you smaller hearing aids will sound better. It’s not necessarily true. Dispensers will sometimes charge more for smaller aids and make a larger profit. Here again your started device experience will help.
Hearing aids do not filter out all background noise. Do not be lured into thinking that they do, no matter how expensive they are. Most hearing aids are designed to help you hear and understand speech. If you are somewhere where many people are talking, how is that hearing aid going to know which voice to amplify? It won’t, all people speak in the same general frequency range. That is not to say that all hearing aids are alike; there are some hearing aids that work better in noise than others, again they will cost more money. You will still hear the noise but it will be less bothersome and more natural.
Digital technology is better. This is a sales tool. First of all you need to be aware of the term digital as it applies to hearing aids. There are analog units that are digitally programmed. All this means is that a computer is used by the dispenser to “tune” the analog circuitry. Do not be misled into believing it is a fully digital unit. Your coffee maker is often programmed by a digital chip, is your coffee maker digital?
Fully digital units sound the best. In many cases I agree. The more expensive the digital unit the better it should sound. Digital units allow for more beneficial features. Noise suppression, background noise reduction, feedback suppression, automatic volume control, push button presets that can be programmed for different environments, (work, noisy areas, movies etc) are some of the capabilities. I don’t think the sound quality is that big a deal. An analog circuit in my opinion sounds just as good as most digital circuits. Again your over the counter hearing aid experience will pay off. Always remember your primary objective. If you go in to buy a pick up, don’t get sold a Cadillac.
A hearing aid is a device worn in a hostile environment. Your ear creates wax that can damage the unit. You can forget and wear it in the shower, you can put it on the table and have the dog think it’s a treat, you can drop it in the toilet, you can get it wet in the rain, you can spray it with hair spray, you can lose it and on and on. These problems don’t care if the device cost $300 or $3000. Solve your hearing objectives for the lowest cost possible.
Using hearing aids successfully takes time and patience. Hearing aids will not restore normal hearing or eliminate background noise. Adjusting to a hearing aid is a gradual process that involves learning to listen in a variety of environments and becoming accustomed to hearing different sounds. Try to become familiar with hearing aids under non-stressful circumstances a few hours at a time. Before you buy a hearing aid, know the answers to these important questions:
Are there any medical or surgical considerations or corrections for my hearing loss?
Which design is best for my hearing loss?
What is the total cost of the hearing aid?
Is there a trial period to test the hearing aids? What fees are nonrefundable if they are returned after the trial period?
How long is the warranty? Can it be extended?
Does the warranty cover future maintenance and repairs?
Most importantly shop! Try as many devices and types of devices as you need to know what has the best chance to work for you within your budget. It took many years for your hearing to diminish to the point where you are seeking help, a few weeks or even months should not be your issue. You are making a lifestyle change that will have impact on your daily life and finances. Make sure to consider the cost of batteries and repair/servicing.
You are now prepared as you can be to make one of life’s most difficult lifestyle purchases. With what you have learned you can save hundreds and ever thousands dollars with an ALD or an over the counter hearing aid. You will also be able control your costs and save a lot of money on dispensed hearing aids.
I believe it should be your right to purchase hearing aids anywhere. As you know everybody’s ability to hear reduces as they age. Like our eyes, our ears age and provide less sound. With the advent of miracles drugs and better medical care we will all live longer and healthier lives. But there are no pills for the ears. Ready-made eyeglass magnifiers have been available for many years; no exams, medical waivers, fittings, and associated fees. The hearing industry has been and continues to be a highly regulated industry and by their own statistics they have sold about the same number of hearing aids (two-million) each year for the last decade or more while increasing the average cost per unit dramatically. Many of us (more than twenty- million) need hearing help and can not afford it. Better prepared consumers with the help of family and friends can find affordable help and over time the cost of hearing aids will become affordable.
Bruce Garry is a registered nurse with thirty years experience working in mental health and aged care. He has just two criteria for any health care intervention: it has to be effective and doable.