Hearing Aids – What are they and how do they work?

Hearing Aids - How they work

What is a hearing aid?

In my 26 years as a Hearing Aid Dispenser, people are often put off by hearing aids because the ones that are more visible, appear to be big and bulky – when actually, most of the time these days, you can’t even see most hearing aids that people wear because they are so discreet. Bigger hearing aids tend to be most suitable for people with severe hearing losses, but even that is changing now with the rapid advancements in technology.

A hearing aid is an electronic device that you can either wear in your ear or behind your ear. Basically, it makes some sounds louder so that a person with a hearing loss can listen, communicate, and participate more fully in daily activities. A hearing aid can help people hear more in both quiet and noisy situations. However, only about one out of five people who would benefit from a hearing aid actually uses one!

In simple terms, a hearing aid has three basic parts: a microphone, amplifier, and speaker. Sound is received into the hearing aid through a microphone, which then converts the soundwaves into electrical signals and sends them to an amplifier. The amplifier increases the power of the signals and then sends them to the ear through a speaker.

How can hearing aids possibly help me?

Essentially and primarily, hearing aids are useful in improving the hearing and speech understanding of people who have a hearing loss resulting from damage to the small hair cells in the inner ear. This type of hearing loss is referred to as a sensorineural hearing loss (SNHL). The damage can occur as a result of disease, ageing, or injury from noise or certain medicines. SNHL accounts for about 90% of reported hearing loss – it is usually permanent and can be mild, moderate, severe, profound or total.

A hearing aid magnifies sound vibrations entering the ear canal. The surviving hair cells detect the larger vibrations and convert them into neural signals that are passed along to the brain. The more severe the damage is to a person’s hair cells, the more severe the hearing loss, and therefore greater hearing aid amplification is needed to make up the difference. However, there are practical limits to the amount of amplification a hearing aid can safely provide. Unfortunately, if the inner ear is too damaged, even large vibrations will not be converted into neural signals. In this situation, a hearing aid would be ineffective.

How can I find out if I need a hearing aid?

If you have a problem with your eyesight, we all tend to act pretty quickly and go and get our eyes tested. It’s affecting everything you do because you can’t see clearly. You notice any problems pretty much immediately. As our hearing gradually deteriorates, often over many years, it’s not always noticed right away. I qualified as a registered Hearing Aid Dispenser in the UK in 1994 and noticed very early on in my career that your family and friends are more likely to notice your hearing problems ages before you do.

Here are several pointers for you to indicate whether it’s time to check your hearing:

Are you always saying “Pardon” or asking people to repeat things?

This is the clearest indicator that you may have a hearing loss. Are you struggling to hear people if they’re actually looking at you or facing you? You may have convinced yourself that people are mumbling or muttering and not speaking clearly?

The most common type of hearing loss is Presbyacusis.

This is whereas we get all get older, it’s more common to lose the high-frequency sounds of things around us. Are you noticing that you struggle to hear children or female voices more than struggling with men’s voices?

People tell me the TV’s loud but I don’t think it is!

Even though they have the technology to improve sound quality, it’s often very difficult to follow TV shows or movies. Quite often you can hear them talking but incidental and annoying background music drowns out the voices. However, if you’re often turning up the volume to a point where those around you complain about how loud it is, the issue may not be with your TV or the quality of the soundtrack itself.

If you have always liked listening to pretty loud music, or regularly go to concerts or the cinema (which can be ridiculously loud), then you should get your hearing checked.

Do you get buzzing or ringing sounds in your ears?

Tinnitus occurs when you hear sounds in your ears when no external source is present. Most people experience this – some more than others – sometimes it’s very distressing indeed. It often simply fades away and can be quite a long time before you hear it again. However, if the ringing doesn’t fade away, it’s best to check your hearing. Whilst tinnitus isn’t always a symptom of hearing loss, it is a common first sign.

I shouldn’t bother going out into groups – I can’t tell what they say!

The biggest problem for people with hearing loss is trying to hear what people are saying in pubs, restaurants or when out shopping. Struggling and straining to understand people in these situations can leave you feeling shattered. If a typical day of talking with family, friends and colleagues leaves you mentally and physically tired, then you should get your hearing tested.
Family tell me I don’t hear the doorbell, phone or the microwave ping!

Do you often have missed calls or people saying they’ve been knocking on your door for a long time? This is a typical issue for people with a hearing loss, especially if we’ve already established that you already have your TV or radio turned up louder than everyone else likes it.
Get your hearing tested as soon as you can. Whilst it can be tough to admit your hearing isn’t as good as it used to be, it’s best to act early. With the right support and technology, which Hear4U can offer you, your hearing loss doesn’t need to keep you from enjoying your life and your family.

Are there different styles of hearing aids?

Styles of hearing aids

  • Behind-the-ear (BTE) hearing aids consist of a hard plastic case worn behind the ear and connected by tubing to a custom made earmould that fits inside the outer ear (concha). The electronic components are fitted in the case behind the ear. The processed sound travels from the hearing aid, down the air tube, through the earmould and into the person’s ear. BTE aids are used by people of all ages for mild to much more profound hearing losses.
  • Nowadays, there is a new, much smaller BTE aid available, which is much more popular and so discreet too – it is an open-fit hearing aid – or a receiver in the canal aid for the more advanced systems on the market. Small, open-fit aids fit behind the ear completely, with only a narrow tube or receiver wire inserted into the ear canal, enabling the canal to remain open. These open-fit hearing aids are often a very good choice for people who suffer from a regular buildup of earwax since this type of aid is less likely to be damaged by said wax. In addition, people often prefer the open-fit hearing aid because their perception of their voice does not sound “plugged up.” This is called auditory feedback and is a very common complaint among new hearing aid users – the rehabilitation we offer you helps you to understand and ignore that.
  • In-the-ear (ITE) hearing aids fit completely inside the outer ear and are used for mild to severe hearing loss. The case holding the electronic components is made of hard plastic. Hearing aids have advanced incredibly in the last couple of years – read my Blog on this website on the latest Phonak Marvel Virto-M hearing aids – which allow you to stream mobile phone calls, induction loop sound, tv sound, via Bluetooth signals, and also allow you to control the sound and background via an app on your smartphone. Some ITE aids may also have certain added features installed, such as a telecoil. A telecoil is a small magnetic coil that allows users to receive sound through the circuitry of the hearing aid, rather than through its microphone. This can make it easier to hear conversations over landlines (which have an induction loop fitted) and also helps people hear in public areas that have induction loop systems installed. These loop systems can be found in many churches, schools, airports, and auditoriums. ITE aids are not usually worn by young children because the casings need to be replaced quite regularly as the ear grows.
  • Canal aids fit into the ear canal and are available in two styles. The in-the-canal (ITC) hearing aid is made to fit the size and shape of a person’s ear canal. A completely-in-canal (CIC) hearing aid is nearly hidden in the ear canal. Both types are used for mild to moderately severe hearing loss.
  • As they are small, canal aids may be difficult for a person to adjust and remove. If you have poor dexterity, you would almost certainly struggle with such small instruments. In addition, canal aids have less space available for batteries and additional devices, such as a telecoil, and may not benefit from the advantages of Bluetooth technology. They usually are not recommended for young children or for people with severe to profound hearing loss because their reduced size limits their power and volume.

“Surely all hearing aids work the same way?”

Hearing aids work quite differently depending on the electronics used. The two main types of electronics are analogue and digital – although analogue aids are a thing of the past now.
Analogue aids convert sound waves into electrical signals, which are amplified. Analogue/adjustable hearing aids were custom built to meet the needs of each user. The aid was programmed by the manufacturer according to the specifications recommended by your audiologist. Analogue/programmable hearing aids had more than one program or setting.

An audiologist could program the aid using a computer, and you could change the program for different listening environments—from a small, quiet room to a crowded restaurant to large, open areas, such as a theatre or stadium. Analogue/programmable circuitry could be used in all types of hearing aids. However, advancements in technology led to these analogue systems being phased out and replaced by…..

Digital aids convert sound waves into numerical codes, similar to the binary code of a computer, before amplifying them. As the code also includes information about a sound’s pitch or loudness, the aid can be specially programmed to amplify some frequencies more than others. Similar to a graphic equaliser these days on a stereo system. Digital circuitry gives an audiologist more flexibility in adjusting the aid to a user’s needs and to certain listening environments. These aids also can be programmed to focus on sounds coming from a specific direction. Digital circuitry is used in all types of hearing aids today. As mentioned previously, Bluetooth technology allows so much more to be done for people today – streaming calls, tv sound, mobile audio apps, loop systems etc to the hearing aids.

“Which will be best for me?”

The hearing aids that will work best for you depends on the type and severity of your hearing loss. If you have a bilateral loss (both ears), two hearing aids will be recommended because they will provide a more natural signal to the brain. We’re born with two ears, and if you have a loss in both, correcting your hearing in both ears also will help you understand and distinguish speech better, and also help you figure out where the sound is coming from – localisation. Hearing aids generally now have directional microphones to assist there too.

At Hear4U, our qualified audiologists will select a hearing system that best suits your needs and lifestyle. Price is obviously also an important consideration because hearing aids range from several hundred pounds to several thousand pounds. (We list our prices clearly and openly on our website). As with other big purchases, style and features you want will affect cost. However, it is very important that you don’t use price alone to determine the best hearing aid for you. Just because one hearing aid is more expensive than another does not necessarily mean that it will better suit your needs – our audiologists will discuss the most suitable options for you.

It is also very important to realise that hearing aids will not restore your hearing to normal. This is not possible, and patients don’t always realise this. Nothing is as good as your own ears when your hearing is “normal”. If you follow our rehabilitation advice given during your follow up appointments with us, your hearing aids will increase your awareness of sounds and their sources. As you progressively get used to them, you will want to wear them more regularly, so it’s important that you choose a system which is convenient and easy for you to use. If you don’t like the look of a particular aid, then don’t buy it because you’re unlikely to wear it.

Another important consideration is what aftercare you get with this major purchase and change in your life – including follow up appointments, repairs, annual services and hearing checks, upgrade opportunities, and the hearing aid company’s reputation for quality and customer service. The reviews we get from Google tell you all about us and our pride in what we do.

What questions should I ask?

Before you buy a hearing system, you may wish to ask our Hear4U audiologist these important questions:

  • What features would be of most benefit to me?
  • Do the benefits of newer technologies outweigh the higher costs (eg Bluetooth, smartphone apps, tv streamers etc)?
  • How long is the warranty? Does the warranty cover future maintenance and repairs?
  • Can you make adjustments and provide servicing and minor repairs? Can the aids be adjusted if my hearing changes?
  • What instructions does the audiologist provide?

How can I adjust to my hearing aid?

Hearing aids take time and patience to use successfully. Wearing your aids regularly will help you adjust to them.
It is important that you familiarise yourself with your hearing aid’s features. When your system is fitted with our audiologist present, you will be asked to practice putting in and taking out the aid, cleaning it, identifying right and left aids, and replacing the batteries – unless you have the modern rechargeable system which doesn’t require batteries. Ask how to test it in listening environments where you have problems with hearing. Learn to adjust the aid’s volume and also for sounds that are too loud or too soft. Our audiologist will work with you as much as necessary until you are comfortable and satisfied.

Please understand that all the “new” sounds you will hear are sounds you used to be able to hear. At the start you will believe that everything is too loud, tinny and unnatural but, gradually building up the time you wear the system, will allow your brain to settle down and everything will become more normal.

You may experience some of the following concerns as you adjust to wearing your new aid.

  • They feel uncomfortable. Some new hearing aid users may find them to be slightly uncomfortable at first. Ask your audiologist how long you should wear your hearing aid while you are adjusting to it.
  • My voice sounds too loud. This the “auditory feedback” I mentioned earlier. This sensation that causes a hearing aid user’s voice to sound louder inside the head is called the occlusion effect, and it is very common for new hearing aid users. If you have quite a hearing loss and never worn an aid before, it will sound like you are shouting. You’re not – you just haven’t heard your own voice properly for a long time. Check with your audiologist to see if a correction is possible, although most individuals get used to this effect over time.
  • I get feedback or whistling from my hearing aid. A whistling sound can be caused by a hearing aid that does not fit or work well or is clogged by earwax or fluid. See your audiologist for adjustments – wax blocking your ear canal can cause these issues.
  • I hear loads of background noise. A hearing aid can not completely separate the sounds you want to hear from the ones you do not want to hear. Sometimes, however, the system may need to be adjusted. Our audiologist will discuss this.
  • I hear a buzzing sound when I use my mobile phone. Some people who wear hearing aids or have implanted hearing devices, experience problems with radio frequency interference caused by modern smartphones. Both hearing aids and mobile phones are improving all the time so these problems are occurring less often. When you are being fitted for a new hearing aid, take your mobile phone with you to see if it will work well with the system – particularly if you choose to buy Bluetooth aids which can stream calls and apps from your phone to your aids.

How should I look after my hearing aids?

This is vital – as with any major purchase you make in your lifetime. Proper maintenance and care will extend the life of your hearing system. Hear4U provide a superb aftercare service, but we can’t be with you all the time – especially in the light of the Coronavirus pandemic. It is therefore crucial that you look after your system – so make it a habit to:

  • Keep your hearing aids away from heat and moisture.
  • Clean hearing aids as instructed by your Hear4U audiologist. Earwax and ear drainage can damage a hearing aid – change wax filters regularly.
  • Avoid using hairspray or other hair care products while wearing hearing aids.
  • Turn off hearing aids (open the battery), or place them in your charger when they are not in use
  • Replace dead batteries immediately if you don’t have rechargeable aids.
  • Keep replacement batteries and small aids away from children and pets.