What is the Best Hearing Aid for You?
Sergei Kochkin, Ph.D. - Better Hearing Institute, Washington, DC
There is nothing more important to the manufacturers of hearing aids and hearing healthcare professionals than your satisfaction with their product and services. Like any smart professional, they know that satisfied clients lead to repeat business and to positive word-of-mouth advertising for their products. The hearing aid industry is interested in delighting you, in meeting your needs and finding the best hearing aid for you. The industry is people-oriented in that it allows significant interaction and communication between the person with the hearing loss and the hearing healthcare professional to assure that they have done all things possible to meet your needs. It is important to emphasize that you have a roll to play in acquiring the best hearing aid for you. Here are some suggestions for optimizing the chances that you will be one of these delighted hearing aid wearers.
How will I know I've found the best hearing aid for me?
Simply stated, satisfaction is having your needs, desires or expectations met. Another way of looking at satisfaction is that you are fulfilled, based on a promise which may have come from the hearing healthcare provider, literature, a website, advertising or a mixture of these sources. You have very specific needs and the purpose of the hearing healthcare provider is to find the best hearing aid for you. Thus, during the process of rediscovering your hearing it is important to determine what your needs are, what outcomes you are looking for, and most importantly, how you'll know when you've fulfilled your needs. Many people go into their hearing healthcare practitioner with a vague concept of the best hearing aid for them: "I can't hear," or "It seems as if people are mumbling more," or worse yet, "My wife says I don't listen to her."
I believe you will have a more fulfilling hearing aid experience if you dig deeper to comprehend the impact your hearing loss has had on your life emotionally, behaviorally, mentally and socially. Write the issues down because they will become a roadmap for both you and your hearing healthcare professional. Also, many hearing healthcare professionals have assessment scales designed to help you understand problems caused by your hearing loss. Once you know your problems, you can better identify the best hearing aid. This list also becomes a contract between you and your hearing care professional.
Identification of communication situations that cause you the most difficulty is a critical first step in solving your hearing loss problems. If you can describe difficult listening conditions, your hearing care provider can address the problems and develop strategies to help you manage them. If you need more information, ask for it. Some people want highly technical information about hearing aid systems and hearing loss, while others just want a brief overview of hearing aids and their function. Most providers will be happy you asked, and will give you information such as consumer literature, data sheets, brochures, videotapes and other types of instructional materials. Ask for clarification if you need it. Many complex concepts can be explained in an uncomplicated way.
Motivation in finding the best hearing aid
Advanced hearing aid technology can now compensate for most hearing losses, but there are still millions of hearing aid candidates who are not ready to accept this fact. Is there a missing link? I think so. People with hearing loss are in different stages of readiness. At one extreme the individual is in denial about the hearing loss. If either a family member or a professional insists on hearing aids at this point, behavior is unlikely to change and most likely such a person would be dissatisfied if pursuing hearing aids.
Individuals highly motivated to improve their hearing have an infinitely better chance of success with hearing aids. Such motivated people recognize their hearing loss and are open to finding the best hearing aid for their needs. They tend to seek out relevant information related to their hearing loss and the technology needed to alleviate the hearing problem. The most highly motivated hearing aid candidates have a willingness to discuss their feelings about their hearing problem and explore some hearing options that might be available to them. When they are fitted with hearing aids, they eagerly explore their new technology, discuss problems during follow-up visits with their hearing healthcare professional, and patiently learn to adapt to their technology.
A positive attitude in finding the best hearing aid
The most important personality trait that one could possess is a positive attitude, not just toward the process of obtaining hearing aids, but toward life in general. Motivation is a key to success in finding the best hearing aid. This means a willingness to try hearing aids, adapt to new solutions, and keep frustration at a minimum when obstacles arise. If you view your circumstances as beyond your control, there's a higher probability that you'll be less successful in adapting to change, including hearing aid use.
Hearing aid studies have shown that people who have a positive outlook on life do better with hearing aids. They have a positive self-image and believe they're in control of their life. My recommendation is take charge and be determined to improve the quality of your life with today's modern hearing aids!
Age of your hearing aids
It is human nature to want to keep your hearing aids as long as possible in order to maximize value. However, it should be kept in mind that hearing aids do break down over time; ear canals change in shape, and your hearing loss will change over time. In the research that I have conducted, customer satisfaction is at its highest in the first year of use (78%). After 5 years of use, satisfaction drops significantly to 58% and after 10 years of use even lower to 51%.
So, it's important that you make sure that both the physical and audiological fit of your hearing aids is optimized for your hearing loss today rather than the way it was five, ten or fifteen years ago. I would recommend that you replace your hearing aids every four years; if your hearing aids are programmable you may be able to keep them longer since your hearing care provider can usually adjust them to the degree of hearing loss you currently have.
Choice of Technology
I have conducted extensive research across dozens of technologies. There is no doubt that customers are more satisfied with programmable technology. Advanced programmable technology allows the dispenser to adjust the hearing aid to your specific hearing loss characteristics with more precision. If the product does not meet your needs then the hearing healthcare professional can adjust the hearing aid at their location versus sending it back to the manufacturer for adjustment. This additional flexibility is worth at least 10% customer satisfaction points even with the budget-priced programmable product, because there is a greater likelihood that your needs will be met.
The tools for fitting advanced technology hearing aids are also more advanced. For example, some manufacturers store hundreds of "real world" sounds in the computer and allow you to see how your hearing aids will sound in those situations. This tremendous feature allows the hearing aid dispenser to dynamically adjust the hearing aids based on your personal reaction to sounds. If you can afford advanced technology, do not hesitate to purchase programmable hearing aids.
A second advanced feature to consider is directional hearing aids. They have either two or three microphones in them. Because of their design they are able to reduce annoying background noise and have been proven in both the lab and in the real world to improve your ability to understand speech in more difficult listening situations. I have conducted three studies on directional hearing aids. I found a 17% customer satisfaction improvement in two studies and a 26% improvement in another. The latter achieved a 90% customer satisfaction rating, the highest I have ever seen in a hearing aid. If you are an active person, then directional hearing aids will result in enhanced speech intelligibility in more listening situations.
In these three studies conducted between 1996 and 2001, I found significant improvements in 100%, 93%, and 31% of listening situations measured. Compared to a 30% customer satisfaction in noisy situations for the average hearing aid, these directional hearing aids respectively had customer satisfaction ratings of 67%, 48% and a 49%. More studies are underway, but it is safe to say programmable directional hearing aids unequivocally should be the technology of choice where applicable.
Controls on Your Hearing Aid
Your goal is to purchase a hearing aid that never needs adjustments. It should graciously determine the volume you need and adjust its directionality by sensing if you are in quiet or a variety of noisy situations. If you have a completely digital hearing aid, when it comes across steady state noise like in an airplane cabin or around an air conditioner, it should improve your hearing comfort in these situations by making the sounds more tolerable. In addition, it should not give you feedback (whistling, buzzing or squealing) as it amplifies sounds around you. It should restore your ability to enjoy some soft sounds (e.g. leaves rustling, bubbling of a fish tank, etc) while sensing very loud sounds and making them comfortable for you (loud sounds should never be painful to your ears).
While the industry has in principle developed automatic hearing aids, some people need to personally control their hearing aids. Research has shown, especially among experienced wearers, that some people (roughly a third) still need either a volume control, multiple memory switch (quiet versus noisy situation switch) or a remote control in order to control volume or to access different hearing aid strategies for handling different listening environments. Some people need control of their hearing aid for the following reasons: the automatic feature does not meet their needs in 100% of listening situations; psychologically the hearing aid wearer simply must have control of their hearing aids; or they are long-term hearing aid wearers who are used to a volume control and are therefore unwilling to part with it through habit.
It is very important that you determine your needs with respect to control of the hearing aid. You don't want to fiddle with your hearing aids every ten minutes but then again you don't want to be frustrated because your hearing aids work well in most situations but not in 10% of your favorite situations (e.g. listening to soft music). This is an area that needs to be explored with your hearing healthcare professional.
One of the most important aspects of an enjoyable hearing aid experience is that you like the sound quality of hearing aids. So when you test-run your hearing aids, make sure that you consider the following dimensions of sound quality:
- Do you like the sound of your voice?
- Is the sound clean and crisp (sound clarity)?
- Is the sound too tinny?
- Does your hearing aid seem to plug up your ear and in fact muffle sound?
- Does it make some pleasant soft sound audible to you?
- Are loud sounds uncomfortable to you?
- Are your hearing aids natural-sounding?
- Does music sound pleasant and rich in texture?
- Does the world sound like you are in a barrel?
- Does your hearing aid whistle, buzz or squeal on its own?
With today's modern digital hearing aids, most of these problems should be solved. If you notice any of these problems during the trial run and in your follow-up visits, by all means talk to your hearing healthcare professional about these issues. Such professionals are now capable of adjusting your hearing aids to your satisfaction. The extent to which all of the possible sound quality issues can be resolved is of course, governed by the severity of your hearing loss. In other words, some types hearing losses are simply more conducive to restoration of rich sound quality in many listening environments while others are not.
Do NOT Purchase Based Only on Cosmetics
Over the past ten years the hearing aid industry has reduced the size of hearing aids to near invisibility. People can now wear them with greater comfort and we're finding very small CIC hearing aids have their distinct advantages such as on the telephone and in outdoor situations. Some people are concerned with cosmetics and prefer the least noticeable hearing aids, in the way that you might choose contact lenses instead of framed eyeglasses. The problem is that the smallest hearing aid may not be the most suitable hearing solution for you for a variety of reasons. Your specific hearing loss may require more power than available in CICs, you might not have the manual dexterity to manipulate them, or your ear canals may not allow them to be retained in your ears.
Because of hearing loss stigma or embarrassment, many consumers come into hearing healthcare care offices and start off the dialog with, "I would like one of those invisible hearing aids that I saw on TV." A likely response may be something like: "We carry invisible hearing aids, but I first need to examine your ears, measure your hearing loss, assess your lifestyle and manual dexterity and then discuss how your hearing loss is impacting the quality of your life. You may or may not be a candidate for these hearing aids." If it is determined that you are not a candidate for CIC hearing aids and you still insist on buying them, the professional hearing healthcare provider will not fit you with the product because in essence they would be giving you the wrong prescription for your hearing loss.
Developing Realistic Expectations During the Trial Period
Follow the instructions you are given during the initial stages of adjustment. These are designed to help in formulating realistic expectations of what to expect from your hearing aids. You may need a specific wearing schedule for hearing aids. One experienced in-the-canal hearing aid wearer obtained CIC instruments a few years ago. He was in his early 30s and had used hearing aids since he was a teenager. When he returned for his two-week recheck, he was asked how long he could wear the instruments in the beginning. He said that he could only use them for 15 minutes at a time. Within two weeks he was wearing them full-time and they were completely comfortable. Had he not been counseled that the deep insertion of the shell tip with CIC hearing aids may take extra time to fully adjust, he might have become discouraged and given up on that particular style of hearing aids.
Be patient with yourself. If you have the best hearing aids for your hearing loss and your lifestyle, hang in there. Make sure you're comfortable with the advice you've been given. Ask questions. Remember, your provider is your advocate. Satisfied hearing aid wearers are not shy when it comes to telling others about their success, but unfortunately, neither are the ones who are dissatisfied. No two people are alike, and it's not a good idea to assume that if someone has had a bad experience, that all hearing aids are bad. You could very well be one of the overwhelming majority who has a good experience! There are many reasons why someone may not have been successful, so don't project these conditions and improbabilities onto yourself. Also, do not expect someone else's hearing aids to work for you. Would you wear their eyeglasses and decide whether you can be helped by glasses based on this experience?
Be realistic. Hearing aids will not permit you to hear the flapping of hummingbird wings near a jet engine. Remember that it takes time to get used to hearing aids, especially if you're a new wearer. Keep in mind that background noise is almost always part of your environment, and adjustment to it is required. In time, you will tune out many of these everyday sounds. It's important not to become disappointed or frustrated while your brain begins to adjust to a whole new world of sound. If you're an experienced wearer trying new hearing aids, understand that they might not sound like your old ones. Before you reject them, allow neural hook-ups in the auditory system to adapt to these new sounds. You just might find that you like this new sound better than the old one.
Ear Wax Protection
One of the common causes of hearing aid failure is that moisture and earwax fill up the receiver tubing of the hearing aid causing the hearing aid speaker to no longer function correctly. I strongly suggest that you purchase hearing aids with proven methods of keeping earwax out of the hearing aid. I have personally studied more than 90,000 hearing aid owners over a two-year period and determined that it is possible to reduce hearing aid repairs by 50% due to receiver failure by using a wax guard at the end of the hearing aids.