Hearing Aids

What Is a Hearing Aid?

A hearing aid is an electronic, battery-operated
device that amplifies and changes sound to allow
for improved communication. Hearing aids receive
sound through a microphone, which then converts
the sound waves to electrical signals. The amplifier
increases the loudness of the signals and then sends
the sound to the ear through a speaker.

How Common Is Hearing Loss

and What Causes It?
Approximately 28 million Americans have a hearing
impairment. Hearing loss is one of the most
prevalent chronic health conditions in the United
States, affecting people of all ages, in all segments
of the population, and across all socioeconomic
levels. Hearing loss affects approximately 17 in
1,000 children under age 18. Incidence increases
with age: approximately 314 in 1,000 people over
age 65 have hearing loss. Hearing loss can be
hereditary, or it can result from disease, trauma,
or long-term exposure to damaging noise or
medications. Hearing loss can vary from a mild
but important loss of sensitivity, to a total loss of
hearing.
There are different types of hearing loss. Conductive
hearing loss occurs when sound waves are prevented
from passing to the inner ear. This can be caused by
a variety of problems including buildup of earwax
(cerumen), infection, fluid in the middle ear (ear
infection or otitis media), or a punctured eardrum.
Sensorineural (nerve) hearing loss develops when
the auditory nerve or hair cells in the inner ear are
damaged by aging, noise, illness, injury, infection,
head trauma, toxic medications, or an inherited
condition. Mixed hearing loss is a combination of
both conductive and sensorineural hearing loss. A
conductive hearing loss can often be corrected with
medical or surgical treatment, while sensorineural
hearing loss usually cannot be reversed.

How Do We Hear?
Hearing depends on the following series of
events that change sound waves in the air
into electrical impulses that the auditory
(hearing) nerve carries to the brain. The
ear has three major parts, described as the
outer ear, middle ear, and inner ear.
Sound waves enter the outer ear (pinna)
and travel through a narrow tube (ear
canal) that leads inside the ear to the
eardrum (tympanic membrane). The
eardrum vibrates from the incoming
sound waves and transmits these
vibrations through three tiny bones
called the ossicles (the malleus, incus,
and stapes) in the middle ear. They
amplify the sound and send it through
the entrance to the inner ear (oval
window) and into the fluid-filled
hearing organ (cochlea).
The vibrations create ripples in the
fluid that bend projections from tiny
hair cells in the cochlea, causing electrical
impulses that the auditory nerve, or
eighth cranial nerve, sends to the brain.
The brain translates these impulses into
what we experience as sound.

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People with hearing loss may experience some or all of the following problems:

Difficulty hearing conversations, especially when there is background noise.

Hissing, roaring, or ringing in the ears (tinnitus).

Difficulty hearing the television or radio at a normal volume.

Fatigue and irritation caused by the effort to hear.

Dizziness or problems with balance.

How Can I Find Out If I Have Hearing Loss?

If you think you might have hearing loss, visit your physician, who may refer you to an otolaryngologist or
audiologist. An otolaryngologist is a physician who specializes in ear, nose, and throat disorders, and will
investigate the cause of the hearing loss. An audiologist is a hearing health professional who identifies
and measures hearing loss and will perform a hearing test to assess the type and degree of loss.

How Can Hearing Aids Help?

On the basis of the hearing test results, the audiologist can determine whether hearing aids will help.
Hearing aids are particularly useful in improving the hearing and speech comprehension of people with
sensorineural hearing loss. When choosing a hearing aid, the audiologist will consider your hearing
ability, work and home activities, physical limitations, medical conditions, and cosmetic preferences.
For many people, cost is also an important factor. You and your audiologist must decide whether one or
two hearing aids will be best for you. Wearing two hearing aids may help balance sounds, improve your
understanding of words in noisy situations, and make it easier to locate the source of sounds.

What Are the Different Kinds of Hearing Aids?

There are several types of hearing aids. Each type offers different advantages, depending on its design,
levels of amplification, and size. Before purchasing any hearing aid, ask whether it has a warranty that
will allow you to try it out. Most manufacturers allow a 30- to 60-day trial period during which aids can
be returned for a refund.
There are four basic styles of hearing aids for people with sensorineural hearing loss:

In-the-Ear (ITE) hearing aids fit completely in the outer ear and are used for mild to severe hearing
loss. The case, which holds the components, is made of hard plastic. ITE aids can accommodate
added technical mechanisms such as a telecoil, a small magnetic coil contained in the hearing aid
that improves sound transmission during telephone calls. ITE aids can be damaged by earwax and
ear drainage, and their small size can cause adjustment problems and feedback. They are not usually
worn by children because the casings need to be replaced as the ear grows.

Behind-the-Ear (BTE) hearing aids are worn behind the ear and are connected to a plastic earmold
that fits inside the outer ear. The components are held in a case behind the ear. Sound travels
through the earmold into the ear. BTE aids are used by people of all ages for mild to profound
hearing loss. Poorly fitting BTE earmolds may cause feedback, a whistle sound caused by the fit
of the hearing aid or by buildup of earwax or fluid.

Canal Aids fit into the ear canal and are available in two
sizes. The In-the-Canal (ITC) hearing aid is customized
to fit the size and shape of the ear canal and is used for
mild or moderately severe hearing loss. A Completely-inCanal (CIC) hearing aid is largely concealed in the ear
canal and is used for mild to moderately severe hearing
loss. Because of their small size, canal aids may be difficult
for the user to adjust and remove, and may not be able to
hold additional devices, such as a telecoil. Canal aids can
also be damaged by earwax and ear drainage. They are
not typically recommended for children.
Body Aids are used by people with profound hearing
loss. The aid is attached to a belt or a pocket and
connected to the ear by a wire. Because of its large size,
it is able to incorporate many signal processing options,
but it is usually used only when other types of aids cannot
be used.

Do All Hearing Aids Work the

Same Way?
The inside mechanisms of hearing aids vary among devices,
even if they are the same style. Three types of circuitry, or
electronics, are used:

Approximately 28 million
Americans have a hearing
impairment. Hearing loss
is one of the most prevalent
chronic health conditions
in the United States,
affecting people of all ages,
in all segments of the
population, and across
all socioeconomic levels.

Analog/Adjustable: The audiologist determines the

volume and other specifications you need in your hearing
aid, and then a laboratory builds the aid to meet those
specifications. The audiologist retains some flexibility to
make adjustments. This type of circuitry is generally the
least expensive.

Analog/Programmable: The audiologist uses a computer to program your hearing aid. The circuitry
of analog/programmable hearing aids will accommodate more than one program or setting. If the aid
is equipped with a remote control device, the wearer can change the program to accommodate a
given listening environment. Analog/programmable circuitry can be used in all types of hearing aids.

Digital/Programmable: The audiologist programs the hearing aid with a computer and can adjust
the sound quality and response time on an individual basis. Digital hearing aids use a microphone,
receiver, battery, and computer chip. Digital circuitry provides the most flexibility for the audiologist
to make adjustments for the hearing aid. Digital circuitry can be used in all types of hearing aids and
is typically the most expensive.

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What Can I Expect From My Hearing Aids?

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 nonstressful circumstances a few hours at a time. Programs are available
to help users master new listening techniques and develop skills to manage hearing loss. Contact your
audiologist for further information about programs that may suit your individual needs.

What Questions Should I Ask Before Buying Hearing Aids?

Before you buy a hearing aid, ask your audiologist 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?

Can the audiologist make adjustments and provide servicing and minor repairs? Will loaner aids
be provided when repairs are needed?

What instruction does the audiologist provide?

Can assistive devices such as a telecoil be used with the hearing aids?

What Problems Might I Experience While Adjusting to My Hearing Aids?

Become familiar with your hearing aid. Your audiologist will teach you to use and care for your
hearing aids. Also, be sure to practice putting in and taking out the aids, adjusting volume control,
cleaning, identifying right and left aids, and replacing the batteries with the audiologist present.

The hearing aids may be uncomfortable. Ask the audiologist how long you should wear your
hearing aids during the adjustment period. Also, ask how to test them in situations where you
have problems hearing, and how to adjust the volume and/or program for sounds that are too loud
or too soft.

Your own voice may sound too loud. This is called the occlusion effect and is very common for
new hearing aid users. Your audiologist may or may not be able to correct this problem; however,
most people get used to it over time.

Your hearing aid may whistle. When this happens, you are experiencing feedback, which is
caused by the fit of the hearing aid or by the buildup of earwax or fluid. See your audiologist for
adjustments.

You may hear background noise. Keep in mind that a hearing aid does not completely separate
the sounds you want to hear from the ones you do not want to hear, but there may also be a problem
with the hearing aid. Discuss this with your audiologist.

What Are Some Tips for Taking Care Of My Hearing Aids?

The following suggestions will help you care for your hearing aids:

Keep hearing aids away from heat and moisture.

Replace dead batteries immediately.

Clean hearing aids as instructed.

Do not use hairspray or other hair care products while wearing hearing aids.

Turn off hearing aids when they are not in use.

Keep replacement batteries and small aids away from children and pets.

What Research Is Being Done on Hearing Aids?

The National Institute on Deafness and Other Communication Disorders (NIDCD) supports more than
30 grants for scientists to conduct studies on hearing aid research and development. These studies cover
areas such as the application of new signal processing strategies and ways to improve sound transmission
and reduce noise interference, as well as psychophysical studies of the impact of abnormal hearing
function on speech recognition. Other studies focus on the best way to select and fit hearing aids in
children and other difficult-to-test populations, and on reducing bothersome aspects such as feedback
and the occlusion effect. Further research will determine the best ways to manipulate speech signals in
order to enhance understanding.
To improve hearing aid performance, especially in noisy situations, NIDCD has entered into two
collaborative ventures. The first was formed between NIDCD and the Department of Veterans Affairs
(VA) to expand and intensify hearing aid research and development. The program includes a contract
for the development of hearing aids as well as clinical trials. The knowledge gained will be used to help
people choose the best hearing aid for their particular type of hearing impairment.
In the second collaboration, the National Aeronautics and Space Administration (NASA) and the VA
have joined NIDCD in surveying all Federal laboratories for acoustic and electronic technologies that
might improve hearing aids. The most promising technologies have been presented to auditory scientists
and hearing aid manufacturers in the hope of forming research partnerships that will lead to commercial
application of these technologies.

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Where Can I Get Additional Information?

Alexander Graham Bell Association for
the Deaf (AGBell)
3417 Volta Place, NW
Washington, DC 200072778
(202) 3375220 (Voice/TTY)
(800) 4327543 (Toll Free)
(202) 3378314 (Fax)
AGBELL2@aol.com (E-mail)
www.agbell.org (Internet)
American Academy of Audiology (AAA)
8300 Greensboro Drive, Suite 750
Mclean, VA 221023611
(703) 6109022 (Voice/TTY)
(800) AAA2336 (Toll Free)
(703) 6109005 (Fax)
www.audiology.com (Internet)
American Academy of Otolaryngology-Head
and Neck Surgery (AAO-HNS)
One Prince Street
Alexandria, VA 22314
(703) 5191589 (Voice)
(703) 5191585 (TTY)
(703) 2991125 (Fax)
entinfo@aol.com (E-mail)
www.entnet.org (Internet)
American Association of Retired Persons
(AARP) Disability Initiative
601 E Street, NW
Washington, DC 20049
(202) 4342477 (Voice)
(877) 4347598 (Toll Free TTY)
(202) 4346406 (Fax)
www.aarp.org (Internet)

February 2001
NIH Pub No. 994340

American Speech-Language-Hearing
Association (ASHA)
10801 Rockville Pike
Rockville, MD 20852
(301) 8975700 (Voice)
(301) 8975700 (TTY)
(800) 6388255 (Toll Free)
(301) 8977355 (Fax)
actioncenter@asha.org (E-mail)
www.asha.org (Internet)
Better Hearing Institute (BHI)
5021B Backlick Road
Annandale, VA 22003
(703) 6420580 (Voice/TTY)
(800) EARWELL (Toll Free Voice/TTY)
(703) 7509302 (Fax)
mail@betterhearing.org (E-mail)
www.betterhearing.org (Internet)
Hear Now
4248 Park Glen Road
Minneapolis, MN 55416
(800) 6484327 (Toll Free)
(612) 8286946 (Fax)
cbetz@harringtoncompany.com (E-mail)
www.hearingaid.org (Internet)
Hearing Industries Association (HIA)
515 King Street, Suite 420
Alexandria, VA 22314
(703) 6845744 (Voice)
(703) 6846048 (Fax)
Self Help for Hard of Hearing People, Inc.
(SHHH)
7910 Woodmont Avenue, Suite 1200
Bethesda, MD 20814
(301) 6572248 (Voice)
(301) 6572249 (TTY)
(301) 9139413 (Fax)
national@shhh.org (E-mail)
www.shhh.org (Internet)