Huh?Filter: Advice needed on getting a hearing aid

June 29, 2009 10:22 AM

Huh?Filter: Advice needed on getting a hearing aid

My beloved husband has suspected hearing loss for years. It's time we get him a hearing aid, he has trouble hearing basic conversation. Can anyone advise on the first step and maybe the best device that is out there now? What kind of doctor should he see?

posted by mad_little_monkey to health & fitness (23 comments total)

He needs to see an audiologist, who will evaluate his level of hearing loss (through sitting in a sound booth, evaluating noises and seeing how long it takes for him to acknowledge them as they increase in volume--in both ears) and then tell you all about the latest technologies in every price range. If you're going to spend any money, spend it well--just go ahead and see an audiologist.
posted by Dukat at 10:30 AM on June 29

He needs to see an audiologist. They even have them inside some Costcos these days.

My mom has hearing loss, and she's been very disappointed with all of her hearing aids. They cost at least $1500 per ear, her insurance doesn't cover it, and they constantly malfunction, so I have no recommendations for you there.
posted by Ostara at 10:33 AM on June 29

Audiologist. He or she will be able advise him on which type of hearing aid would be best for his type of hearing loss.
posted by lullaby at 10:36 AM on June 29

Call up an ear, nose and throat doctor (if you don't have one already). They probably have an audiologist in-house, or if not, they can recommend one. Does he have trouble HEARING or COMPREHENDING? Two different things; the tests will show which one applies and which aid is best.

Yes, they are expensive. Yes, you get what you pay for. Yes, they are worth every penny and your husband will be amazed at what he's been missing.

My experience has not been like Ostara's mother's. I've worn hearing aids since I was 5. Part of the money you spend on them goes for service. If one malfunctions, take it back. All of my audiologists have been extremely helpful, often cleaning and performing basic service/adjustments for free.

Good luck. I imagine it's an adjustment to get them as an adult.
posted by desjardins at 10:41 AM on June 29

I'm going to Nth what Dukat said, see an audiologist. If you need a reccomendation, your family doctor/internist's office will probably be able to help you.

I'm severely hard of hearing and have had hearing aids since I was 5.
Some basic hearing aid info can be found from NIDCD

It is impossible to reccomend a best product without knowing your husband's type and degree of loss. There are several styles of hearing aids that provide different levels of power. I doubt he needs head bangers (larger behind the ear) like I do though :) As far as brand, I like my current Nu Ear better than other brands I've had before.

Do not try to use those one size fits all hearing aids. They are an enormous waste of money. Each person's loss is a bit different, different pitches are affected differently. A professionaly fitted hearing aid matches your hearing loss.

Feel free to memail.
posted by Librarygeek at 10:46 AM on June 29

This month's Consumer Reports has an article on hearing aids, and describes the different types and such.
posted by smackfu at 11:13 AM on June 29

Seconding desjardins - see an ENT to rule out something fixable before finding an audiologist. HAs are expensive, albeit very helpful, and mine have never been covered by insurance.

If he does need a hearing aid, here are some random things to anticipate:
- Most types of HAs cause occlusion, where you feel like your ears are plugged up even though you can hear better.
- There is one type of HA that doesn't cause occlusion (the open fit or mini BTE), and you hardly know you're wearing them, but they don't work for all types of hearing loss. Ask the audiologist if your husband fits the profile. They are really comfortable; I was borderline for that type and tried it anyway, and almost cried when I had to return them.
- It is tough to use a standard phone if you have hearing aids because of feedback; bringing the phone close to your ear causes the HA to whistle. I have a mobile bluetooth headset that circumvents this; your husband may want to look around for one that works for him.
- Sometimes the volume is set correctly but can still cause discomfort for a while. Think how it would be if all of a sudden the volume on everything you heard was turned up. At the end of the day, sometimes it's like YES!! SILENCE!! (That said, it shouldn't cause headaches or anything, and he should quickly get used to the aids).
- You can't exercise with them, or wear them to the beach, etc. Sweat or heat + expensive electronics = not good.
- Sometimes it takes a couple of tries to get the fit right. If your husband experiences whistling, feedback, or has to mess with them to get them to stay in the ear, keep going back to the audiologist until they get it right. You should not have to pay for adjustments or if they have to re-cast the mold so long as you bring it back within a reasonable time.
- Batteries are $14 for eight at my local supermarket, or $10 for thirty at Costco's pharmacy. Sometimes cheap batteries are expired and don't last very long but Costco's are good. Yay Costco.
posted by txvtchick at 12:07 PM on June 29 [1 favorite]

- It is tough to use a standard phone if you have hearing aids because of feedback; bringing the phone close to your ear causes the HA to whistle.

Make sure your husband's cell phone is compatible with the hearing aid he chooses. I can't hear a damn thing on most smartphones; I do well with flip phones (I currently have the Samsung Flipshot, used to have a Motorola RAZR VM3).

Ask the audiologist if the hearing aid has a t-coil. This allows it to receive electrical impulses directly from telephones and other audio devices and blocks other noises (i.e. he can talk on the phone while in a busy restaurant). Don't buy one without this.

When I use my mp3 player, I swear by the Epic headphones from the HATIS corporation (who also make headsets for phones, but I don't need those). I almost cried when I got them. Earbuds don't work for obvious reasons. I had to turn up traditional headphones so loud that I'd bother other people. These are completely silent to bystanders but produce excellent sound for me.
posted by desjardins at 12:42 PM on June 29

I am also a longtime hearing aid wearer and wanted to add to what desjardins has said. Seeing an audiologist is required to have a hearing aid "dispensed" (pharmaceutical terminology), but it is worth putting in some time to shop around for an audiologist before you commit to having the testing done. Most audiologists dispense for just a couple of the manufacturers, so you will almost never get a "choice" of all the models available. This has been explained to me as owing to the fact that many of the major manufacturers make very similar technologies, so offering aids from multiple manufacturers is kind of redundant. Also, each manufacturer has its own set of software that the audiologist has to learn and maintain, in order to fit and program your aid. So if there is a particular brand or manufacturer that you are interested in, it's best to find out ahead of time if your audiologist offers that brand. Last time I purchased hearing aids, I managed to find a great audiologist who actually dispensed nearly all of the manufacturers, which is the first time in my life I've encountered this.

I've found that once the hearing test is done, you're pretty much stuck with that audiologist in terms of getting your hearing aid. I've never had an audiologist who would accept a test from another provider, so you'll pay for a test with each audiologist you visit (usually around $100). There are numerous manufacturers out there, many of excellent quality, and many of good-to-low quality (tied largely to cost). I wear two behind-the-ear (BTE) Widex Inteos that cost $3,000 each (yes, the cost can make your head spin). Prior to this I wore the Oticon Adapto. I've also worn Siemens and Beltone in the past. Hearing aid technology has evolved quite a lot in the past 20 years, and no two aids have ever been the same for me.

The brands may not make much of a difference to many wearers, and I'm certainly not suggesting that you self-prescribe. Just that you be an educated consumer. I have a hearing loss that's hard to fit, and I buy a new set of hearing aids every 3-5 years, so I try stay on top of the newer developments in hearing aid technology and am conscious of what manufacturers are offering and which one I might like to try next. But the industry makes it very difficult for consumers to get good information about their products, and comparison shopping is often like apples to oranges. It's really not a very consumer-friendly business.

Most health insurance policies will pay for a hearing test if prescribed by a doctor or ENT specialist. But they will usually only pay for one per year (if at all), and almost no health insurance provider will cover the cost of your aids (I've never heard of one that did). If you are old enough to qualify for Medicare, they will usually pay a portion of the cost of your aids.

You'll get a 30 day trial with any hearing aid purchase (I believe this is required by law) after which you can return a hearing aid (minus the cost of the earmold they make for you). I returned a set of hearing aids that I once purchased when I felt that I wasn't getting the benefits promised for the big price tag, and I felt like the audiologist I was going to wasn't that committed to getting the fit right for me. This meant starting over again with a new audiologist, but when you're spending a lot of money on a device, it's worth it to make sure you have the right one, and a good relationship with your dispenser.

I also agree with desjardins about the phone issue. If your husband spends a lot of time on the phone, you may want to look specifically into aids that pair with cell phone technology. Once the aid is in your ear, it can actually be *harder* to hear the phone than when your're not wearing them. Having a compatible phone/aid is worth considering if that's a major form of communication for you.
posted by amusebuche at 2:04 PM on June 29

If you're a costco member, you can get a general idea of the extent of his hearing loss by getting it tested by their hearing loss center audiologist for free. After that, definitely find a good ENT.
posted by palionex at 2:12 PM on June 29

I buy a new set of hearing aids every 3-5 years

Piggyback question: do they only last that long? Or is this unusual? (I'm about to go in for my first hearing aid fitting next week, so this is a timely question for me...)
posted by ook at 2:35 PM on June 29

Ook, I've always been told to expect 5-6 years out of an aid, but I always find that audiologists act surprised when they're still in good shape after 4 years. Three years is on the short end of the range for me, and then it was only because I wanted the technology upgrade, not because the aid stopped working. I've always taken good care of my aids, but I do find that around the 5 year mark is when they start needing repairs and become less reliable. (And that's assuming that you don't drop them on a hard surface or accidentally get into the shower with them, which can shorten their lifespan considerably.) Since I started working as a consultant, I find the aids more essential than ever, so I've been more proactive about replacing them in recent years. (I think my dad's been wearing the same Siemens ITE model for 8 years, without problems.)
posted by amusebuche at 3:18 PM on June 29

My audiologist said they should last 6-7 years, which fits my experience. But I have had to send them in for repair at around the 3-4 year mark. In a repair, the manufacturer replaces the chip for a hundred bucks or so.

Any longer than 6-7 years, I suspect the aid would not quite fit as well because the shape of your ears changes over time.
posted by txvtchick at 3:26 PM on June 29

Okay, thank you -- good to know that you can replace the chip rather than buying whole new ones every single time, I guess.
posted by ook at 4:32 PM on June 29

Any longer than 6-7 years, I suspect the aid would not quite fit as well because the shape of your ears changes over time.

You should get a new mold made about once a year, not necessarily because your ear has changed, but because the material hardens and doesn't conform to your shape as tightly, leading to whistling. It's around $50 for a vented silicone mold. There is no way an earmold should last 6-7 years.

My aids have generally lasted around 5-6 years, but I tend to avoid situations that induce sweat. If you're outside a lot or exercise frequently, it will probably not last as long.
posted by desjardins at 4:34 PM on June 29

I would go to an ENT first, just to get a full physical exam (of the ear, nose and throat of course) and rule out any kind of infection or surgically correctable issue. The ENT can refer you to an audiologist.

Do not get the one size fits all cheap hearing aids. They can actually damage your hearing even more (as wearing earphones turned up all the time can). You get what you pay for.

Also, you pay out the ass for hearing aids (I personally think the fact that most insurance companies don't pay for hearing aids like they will pay for most other durable medical equipment like wheelchairs, etc. is a class-actionable case of discrimination of the hearing impaired) but your audiologists will usually do most of the care and maintenance for free. They program your hearing aids based on your hearing loss, but you are usually in a quiet audiologists office and not in the real world. So when you go out in the real world, if something isn't working for you...go back and have them make adjustments.

Also, it is incredibly tiresome and annoying when you first start to wear aids. You hear sounds you haven't heard in years and your brain needs time to learn to filter everything out. It will happen, but sometimes it helps to wear the hearing aid for one hour, then two hours, then three a day and work up. It takes a little patience.

BTW, I wear phonak behing the ear aids with an attached fm system. They cost $7000 in 2004 and will last around 8 or so years. (I have a severe loss and mine are very high end, so you might not need to go up in price that much) however, remember to account for this cost in your budget because it is a significant investment.
posted by Bueller at 5:37 PM on June 29

oh, also...I do have a tcoil on my hearing aids and hearing aid compatible telephones, but I NEVER wear my hearing aids on the phone. It has just never worked for me and makes things worse. YMMV, of course, but I just got a $30 phone amplifier from radio shack and that's what I use for the phone.
posted by Bueller at 5:39 PM on June 29

You should get a new mold made about once a year, not necessarily because your ear has changed, but because the material hardens and doesn't conform to your shape as tightly, leading to whistling. It's around $50 for a vented silicone mold. There is no way an earmold should last 6-7 years.

I think we're talking about different types of aids. The in-the-canal and in-the-ear types that I've worn are made of hard material and definitely don't need to be recast every year.
posted by txvtchick at 8:00 PM on June 29

As a former HIS (Hearing Instrument Specialist) in the State of Florida and a hearing aid wearer for... 29 years: I tend to agree with most of the previous comments.


I do want to point out some differences you should be aware of...

Medical professionals:

An ENT is your best bet as there may be other things affecting his hearing besides age-related or exposure-related loss. (They may have an in-house or external audiologist do a hearing test)

An audiologist is trained in testing and diagnosing ear conditions and loss types, but not all ENT or Audiologists prescribe Hearing Aids (as a medical device). The ones that do are often set up for only a few different brand lines and essentially fit your loss to the brand they carry. If you find someone who works across the board in brands then that's a rare find.

An HIS or your standard "hearing aid store" type office is usually a brand-specific or limited brand availability and will usually provide a free test and will fit your loss to the brand/model they sell (not too much different than car salesmen in the sales asspect)

While all of these professionals are attempting to help you, the HIS is essentially a medically trained salesperson. An audiologist is a medical professional who also happens to sell hearing aids. An ENT is a medical doctor who is going to provide a diagnosis and possibly refer you to an audiologist or HIS for fitting of an HA, but may also do it in-house.


FYI- I became an HIS purely to learn more about my own hearing loss, and because the brand franchise allowed me to be a "service" guy who tweaked and fixed hearing aids wherever possible so that new aids weren't always required. I also did testing and fitting of aids when needed and provided assistance and understanding that many of the above professionals do not always possess. of course, there are exceptions to these generalizations, I met many great folks in all these spots, but as a whole, the above holds true in most cases.



Types Hearing Loss:

There are a lot of causes and conditions of loss, so only thorough testing is going to determine what might be best for your husband.

Don't be afraid to get 2nd 3rd and fourth opinions. Get referrals and recommendations from other clients of whomever fits the HA.


Types of hearing aids:
Again, depending on the type and severity of the hearing loss, different types of aids are available.

The main types are:
Analog or Digital

An analog HA has a specific circuit that will generally boost sound in specific frequency ranges and the circuit used is determined by the type of loss.

A digital HA has a circuit that can be modified by 1, 2, 3, 4 as many as 16 and 32 channels. Channels can be defined within frequency ranges to allow more customized adjustment of what ranges are boosted, left alone, or even reduced in intensity.

The main styles are:
CIC: Completely in the Canal
ITC:In The canal
ITE:In the ear
BTE: Behind the ear

Don't fixate on a certain size because a lot of factors come into play.

With a CIC you almost don't see a thing, except for the small pull tab (which is basically just a piece of fishing line) and it's either on or off (you use the battery door as a switch) These need to be very well-tuned and will require several followup visits to ensure a proper fit and sound quality. The drawback is they are very small and those with arthritis or limited hand mobility may have some trouble.

An ITC is a little bigger, visible unless covered by hair or if you have a very deep canal. They do usually have a volume control, and sometimes have a button for switching preset settings.

An ITE is very common and is almost always visible and usually can work with most types of loss (is also usually the least expensive fit)

A BTE is usually, but not always, the most powerful circuit and fit as it doesn't need to fit into a cramped unusual fit and can be mass produced and configured later. They are definitley the most visble as they also require the use of a mold and tubing to channel the sound from the hearing aid to the ear canal.

I mention visibility above because many people are vain. I even tried CIC's once (at no cost through my HIS employer_ but they were not right for my loss, so I still wear and have almost always worn, BTE style HAs due to the severity of my loss.



I just realized how long this is getting......


There are loads of other options and upgrades one can get (mostly on digital hearing aids) like directional microphones, T-COIL (for induction telephones), noise reduction (for sudden decibel level changes, and a bunch of others. Only getting tested and checking out your options and liberally exerting your rights as a patient and a consumer will get you the best match for your husbands loss.

If he's willing, get tested at more than one place and use different types of professionals. As was previously stated, once you purchase, that person is likely to be the "face" and you will initially have several interactions with that person for fitting and adjustment and ongoing checkups periodically over the years. You want to be comfortable with them and trust that they are doing whats best for you.

Once fit for the HA(s) have him pay attention... hearing loss is not just physical, it's also mental and requires a little more focus to adjust to different listening environments, if things sound "A little off" then you need to report that back to the dispenser and try for an adjustment or an explanation (little things like the "ding" of the microwave or hearing road noise again can really unsettle people who havent heard it in years. A gradual loss loss seems shocking with a sudden improvement. Just be patient and try to understand that it's not really an instant fix, but there will be immediate improvement, and and more gradual improvement as time goes on.... all depending on if he gets a good fit and interacts with the dispenser for tweaking and adjustments.


One final word, as this is long-winded enough:

While some hearing loss issues can be fit and does show improvement with just one hearing aid, don't be tempted to get just one HA if two are prescribed. Even if cost is a consideration, many people often end up feeling "lopsided" or disoriented when they hear primarily out of one ear, not to mention the mental side of how our brains interpret sound) They are truly an investment in his (and your) health and well-being. Ask yourself, would I buy contacts or eyeglasses for just one eye? Would you want half your body's ability in anything boosted on only one side (throw but can't catch - catch but can't throw)

Sorry for the length. Hope it helps.
posted by emjay at 8:55 PM on June 29

You people are awesome. This is so much more information than we have gotten with our research. We're set up right now with an Audiologist at HearUsa (through insurance) at the end of the month, and thinking that an ENT visit prior to that is in order.

My husband is also a Mefite - he's Slacktastic - and I've shared this with him. You'll likely see a post from him here. Thank you all so very much.
posted by mad_little_monkey at 8:34 AM on July 1

Thanks for all the info!

Interesting about the heat and sweating. I do work mostly outside in Florida's heat and humidity.
I also regularly fly in a helicopter wearing an aviation headset and have wondered about how that will work. I guess I can take them out for that since I can turn up the volume on the headset.

Too much loud music, aircraft noise and maybe a little heredity have taken their toll.

Any other input will be appreciated.
posted by Slacktastic at 9:22 AM on July 1

Slacktastic - you need to use something like a Dri-Aid every night. This will mitigate the effects of the humidity.

Also, I'd take it off whenever you don't need it, like when you're alone around the house (I put my phone in my pocket on vibrate).
posted by desjardins at 9:11 AM on July 2

Slacktastic - I also live and work in Florida. The heat and humidity can be brutal. They do make water-resistant hearing aids (similar to watches that can go underwater) but if you've ever trusted a watch to stay dry on their measurements, you likely had a busted watch at some point.

I'd recommend that you consider some type of water-resistant aid or other moisture protection (they also make little "rubbers" that slip over the hearing aid to protect from most moisture and some dirt and other debris, but this sometimes affects the microphones.)

As for the helicopter bit, and with your hearing aids... louder isn't necessarily better, and is often overwhelmingly loud to give you the comprehension you may need. During testing, you may find that the sound level (think decibel levels) that you hear and understand the words best at sounds lower than you'd expect.. sometimes even described as "muffled." COnsider using the T-Coil option in the aids as most heavy duty headsets like that work very well with t-coils (plus it can essentially tune out the air/motor noises too). If moisture/sweat becomes an issue, when you take the aids out and use just the headset - only turn it up as load as you can reasonably hear clearly and try not to overdo it on the decibel levels.


I second the Dri-Aid kit (I think the jar type is better than the pouches personally) and they also have other options like the Dry & Store (which I use) which also uses desiccants to remove moisture, but uses a UV light to kill germs (another thing to look out for if you are taking it in and out a lot and sharing headgear/sweat) and also cycles warm air through the box and has helped me with the sweat/oil buildup from my hair and also drys out the wax that tends to buildup and makes it flake away.

Dry-Aid desiccants can be renewed a number of times in an oven if you follow directions, the DrynStor uses replaceable blocks, but I have restored blocks a few times without too much trouble.
posted by emjay at 6:45 PM on July 3