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Subject :  Excellent Advice, long and from 2008, but worthy of a read
posted by kacey on Tue Jan 26, 2010 6:24 am
from:
http://en.allexperts.com/q/Hearing-Aids-3747/2008/10/buy-wrong-hearing-aid.htm
Expert: Kelly Kelley - 10/15/2008

Question
I was recently diagnosed with mild hearing loss, in the middle-ranges. My problem is that I cannot always understand human speech when there are high levels of background noise. I hear high and low frequencies well. The ENT said that this congenital and not the normal pattern that he sees in aging adults (I’m 52). I bought Oticon Delta 8000 in September and am unhappy with the results. They’ve been adjusted twice. Currently, I am assaulted anytime there is a lot of background noise if I am outdoors, I can’t understand my husband because the birds or the wind are too loud. Also, the dome works itself out of my ear, I constantly have to push it back in. I cannot use the aids while on the phone, which is part of my job. Thank you for any advice you can provide.

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Answer
Hi Tracey,

I am working on your answer. I will have it posted either late this evening or in the morning. You do have a unique loss. By unique, I do not mean we have not seen this type of loss on more than one occasion. I have seen the loss, it is rare and without a high level of technical skill, impossible to fit. The loss you describe, we call the cookie bite loss. It is not a severe loss and is not hard to find a hearing aid that can power the loss. However, it is on of the most difficult losses to achieve success with. I will explain this at length in my full reply. I have fit a number of Oticon Delta 8000s and 6000s, and for the right loss it is a good hearing aid; but I will be explaining why this would not be the instrument of choice for your loss. Do to the technical design of the hearing aid it is a ‘physics impossibility’ for this aid to address your needs in a way that will make you happy. If you keep this aid it will end up in the dresser drawer. I will recommend that you return the hearing aid as soon as possible. You should be able to get a refund.

Back with you soon,

Kelly

Ok let’s start this discussion with an explanation of speech, frequencies (pitch), and your loss. The first picture to see in your head is the operating range of your ears and how speech or other sounds fit in that range. We hear, all things working well, from around 20 Hz to 20K Hz (20,000 Hz). The low note on the piano is around 34 Hz, just up from the bottom of our hearing range. Middle ‘C’ is around 250 Hz, and the high note on the piano tops out at 4k Hz (4,000 Hz). Most of us gradually lose our high frequency perception as we age. Most of us over the age of 40 cannot hear above 8K Hz, but that is still a full octave above the high note on the piano, right? So with normal hearing we still fully enjoy music. In the overall scheme of things Middle ‘C’ at 250 Hz is actually a mildly low pitched note as far as our ears are concerned.

Where does speech come into the picture? The center of the universe for understanding speech is 2K Hz. That is 3 octaves above middle ‘C’. The area generally specified as the speech processing area runs from 250 Hz to 6K Hz. I like to extend that out to 8K and in fact recently (past couple years) more hearing aid manufacturers are addressing that extended area with their new hearing aid models. However having stated that, I will state that the most critical area for speech understanding runs from 1K Hz to 3500 Hz. I would further narrow that down to the area from 1500 Hz to 3200 Hz when a person has real difficultly with speech comprehension.

Let’s digress from the speech area and explore the contribution of the frequencies outside the narrow area I have defined as the critical speech area. These areas are important to a hearing aid wearer. They impact the quality of sound whether speech, music, or environmental.

As I sit here thinking about this topic, I offer this caveat; there is no way I can give you a ‘complete’ understanding of all the facets that impact the selection and programming of today’s hearing aids. So as you read, yes, you may end up with other questions. Expect that. There will also be technical areas totally unaddressed which also impact the hearing aid experience. However, the direction we go in and the information I give you is built on a large base of fundamentals. I cannot build this picture for you from the ground up with every excruciating detail; what you get is mostly the end result with a bit of explanation about the underlying structure. That makes this paragraph a digression from the digression.

Getting back then to the ‘outliers’; the frequencies not directly responsible for speech resolution. The greatest importance, of these areas, is their contribution to making sound palatable. Hearing aids must sound as natural as possible to the listener or the listener will reject the solution.

In the low frequencies we have a battle of Noise VS Quality. Too much low frequency and the listener complains of background noise and low speech discretion. You might also have problems with the sound of your own voice. Too little low frequency and you have sound quality issues. They won’t sound natural to you.

In the high frequencies there is a problem balancing the clarity of speech VS the hearing aids sounding scratchy or tinny. There are also problems with certain sounds being too sharp and obnoxious. Sounds like crumply paper, toilets flushing, running water, and clinking dishes and keys.

For both of these situations the problem is complicated by the programming resolution of the hearing aids. This is a direct result of too few bands or channels. When I am programming below 1500 Hz and the only two bands I can adjust are the 250 Hz and the 600 Hz I can only ballpark the settings. The same problem exists above the 3K Hz frequencies. This dilemma is a greater problem with hearing aids that have a limited number of adjustable bands. Any hearing aid with eight or fewer bands has a low probability of working for cookie bite losses. I will not be able to specifically target the frequencies I need to adjust for you.

There is another element we call compression that comes into play. In today’s hearing aids we can alter the gain (power level) at certain places on the frequency scale. This function is generally expressed as bands. The hearing aid then performs an automatic gain altering function while the hearing aid is in use. We call this compression. The compression function is performed in separate areas generally defined as channels. Today’s hearing instruments are performing on the fly adjustments to a number of other variables. Those functions are also adjustable. We can make them more aggressive or less aggressive. So even if I had the gain curve (we call this wave shaping) adjusted perfectly the auto adjusting functions can mess with those settings unless I also have the compression functions set right. The compression functions are set in a manner similar to the frequency shaping. I may have the lows set right while you are in a quite room, like my programming room, but when you leave and your environment changes and the instrument senses that, it alters the programming as I have instructed it too. Unless my instructions are right for that function, the hearing aids will not achieve their intended goal. There are further functions layered on top of these fundamentals. Some of the functions work to reduce environmental noise, some work to enhance speech, some work to isolate the speaker. All of them further reconfigure the fundamental wave shape and compression parameters. Even with this very simplified description of the workings of the hearing aids you can see it requires a good technician to grasp the inter-relationships of the functions and make the hearing aid fit your loss.

We can add to that the fundamental processing problems of the ear and complexities of cochlear function. The cochlea is the part of the ear where sound waves are turned into brain waves.

The problem is multifaceted and can be traced to the design of the ear. Imagine if you will a piano with 15,000 keys. Now a normal piano has 88 keys and therefore 88 strings. Before a normal piano can produce music it must be tuned by a specialist. The same statement will be true of a piano with 15,000 keys. Your ear is like the piano with 15,000 strings. Let’s add another layer of complexity and imagine that every piano with 15,000 strings is made with strings of different materials so that the specialist tuning the piano has to figure out a different tuning system for each piano he tunes. Now imagine the specialist cannot see or hear the piano he/she is tuning. They have to tune the piano based on the perception of sound from an assistant with less than perfect pitch. Further, each time they tune the piano they must work with a different assistant and none of the assistants has ever tuned a piano. You are the assistant in this scenario. The assistants have never learned the vocabulary words for the differences of sound so the professional tuner has to adapt to the vocabulary of the assistant. Finally, the last layer of complexity; every few months the manufactures’ of the pianos change the game. They make their pianos function differently and they make dozens of models in many different sizes each with different physical properties.

There are over 1,000 different models available to choose from and each of them has to be individually fit to each ear. But the hearing impaired person doesn’t know this. In fact the public thinks of the hearing aid - like they think of a toaster. You just go buy one and plug it in. If it’s a good toaster you get good toast. If it’s a better toaster you get better toast. If it’s a great toaster you get great toast. What is not understood is the importance of the fitter. You can buy the most expensive hearing aids on the market and there is no guarantee they will provide better hearing. You can buy the cheapest hearing aid on the market and you might end up with the best hearing aid money can buy - for your hearing loss; which brings us to the observation that a hearing aid comparison chart is almost worthless to you. We routinely work with over 300 different models. Our studies help us, help you, sort through these different technologies and weed out the ones that will not do a good job with your loss. But first we have to know a lot about your loss, your sensitivity to sound, and your ability to process speech.

If I took the time to make a comparison chart that listed the available functions and features of all the hearing aids we have trialed with our patients, the only thing you could do with that chart is hang it on the wall and throw darts at it. In fact, we have just such a chart that we use daily in our selection process but the chart was designed for us. It works for us because we understand the physics of sound and take the time to learn how each company designs and programs their hearing aids. We know the results of their processing philosophies. We learn this through constant, real life, trial programs with actual hearing impaired patients. It is not practical for each hearing impaired person to trial 300 different hearing aids looking for the one that works best for them.

Ok then, where does the Delta 8K fit into this picture? The following excerpt comes from the Oticon literature:

“Clarity: The amplification strategy in Delta for mild high frequency hearing losses is designed to boost clarity and thereby enhance speech understanding, especially in noisy surroundings.”

Deltas are really geared towards normal age related high frequency losses. They do well when a person has good hearing out to 2-3K with a mild fall off after that. They do not work well for cookie bite losses. I will explain this a bit further in a moment, but first a bit of general info on the Delta.

Deltas came to market several years ago. We bought our first Deltas in May, 2006. In the following six months we fit a number of sets. We still have a set of Delta 8K and Delta 6Ks in our research program. However, by the end of the first year we quit recommending the deltas. The reasons were fourfold.

1. The low power and focus on high frequency emphasis limits the type of loss this instrument will do well with.
2. The feedback management was not very sophisticated or very effective.
3. Wave shaping was difficult, limited by the number and position of the bands.
4. Technology was moving fast at this point in time and a number of other products fit the same loss category with better results.
5. The Delta is a receiver in the ear product and has the problems I explained in my BTE recap.

Long story short on the Delta is that they have been surpassed in performance by a number of other products that are not only better in performance but are either equal or better in price. You can get more bang for your buck.

The biggest problem with the Deltas is the number and location of the bands. The Deltas give us adjustment handles at the following seven frequencies 250, 750, 1.5K, 2K, 3K, 4K, 7K. Very quickly we can see that the outliers in the lows and in the highs only provide 2 handles each. Therefore I can adjust these areas in a general manner and must rely on the engineer’s algorithms to smooth the wave in between these areas. The Delta algorithm is not real good at that. The end result is I end up with a jagged wave form. If the curve of the wave lands at a good spot for you, you will like the hearing aid. If it does not suit you there is no way to ever fix it regardless of how many adjustments I make. The question we have to ask next is, “if it works well today, what will happen when my hearing changes and we have to change the wave?” Will it still sound good?

The more critical problem with the deltas occurs within the actual speech range. In the most critical speech range, especially for a cookie bite (and partially for a reverse cookie bite) there are really only three handles; the 1.5K, 2K and the 3K. Again, I can adjust these sliders, but the internal program is responsible for shaping the wave between these frequencies. I can only ballpark the output. If it works it’s sheer luck.

Let’s compare this with a different instrument. The Phonak Micro Eleva. This is a 16 band instrument with excellent feedback control. The Eleva has handles at the following frequencies: 140, 320, 480, 640, 800, 960, 1.1K, 1.3K, 1.5K, 1.8K, 2.2K, 2.5K, 2.9K, 3.7K, 5.1K, 8.2K. I obviously don’t have to explain how extensive the wave shaping can be with this instrument. Additionally, the compression channels are identical to the wave shaping bands. I will not even begin to go into the upper level functions and how well they work. This instrument is in the same price bracket as the Deltas. The Directional microphones are more advanced. Speech enhancement and noise reduction functions are equally sophisticated. There are other instruments that also achieve performance levels at or near these instruments.

Quickly now, lets cover the slipping out of your ear problem. Thin tube fittings and receiver in the ear fittings are not quite one size fits all. However, the ‘fitting’ choices are limited. If they will not stay in your ear you will have to have a custom earmold made for the receivers of the Delta. There are no other solutions. If I had time I would give you an essay on this topic. However suffice it to say, fix the problem with a custom earmold or try a different hearing instrument solution.

At this point the best solutions are:

Phonak, Micro Eleva, Micro Savia Art (20 bands), Micro Exelia.
Widex Inteo IN-m, or Passion 115 (This is RIC product like the Delta)
Magnatone Evok 727 (a middle level price)
Audina Sparo AD (an entry level, but still sophisticated enough)
Unitron Yuu Moda II or the Yuu Moxi (a RIC product). These have 20 bands/channels but are technically challenging to program. Some one really has to know what they are doing.

I have written too much and I have written too little. I will leave you now with my final caveats. Your specific complaints of background noise and wind noise are all addressable with the right instrument. Do not settle for less than perfection. Hearing aid problem do not go away and they do not get better over time. Your hearing loss is mild and normally I would recommend a few less costly hearing aids. However due to the difficulty with cookie bites, in order to achieve success you must have a more sophisticated hearing aid.

One final thought on cookie bite losses. When they are mild they are a nuisance to the patient and our success rate fitting them is only about 50% with any hearing aid. But we don't make the patient buy them in order to figure this out. We make them wear them and do all the adjusting up front. If we get it right they buy a set. About half the time the patient decides the cost is not worth the benefit. When the cookie bite gets worse, or more of your outlying frequencies diminish in response to sound, your problem becomes a greater challenge. At this point you are more likely to accept some of the drawbacks of hearing aids vis-a-via the cookie bite loss. At this point you get a more definitive result wearing hearing aids. Then you feel more comfortable with the cost/benefit ratio. Because of the nature of cochlear performance every person has a different opinion of every hearing aid. With cookie bite losses we make sure those individuals compare at least three different technologies before making a choice.

I apologize for the delay in posting this reply. It took longer to write than I anticipated. I did not have any pre-written information for the cookie bite loss. The only time I have covered this material is during an actual patient conference. I hope you have gained enough knowledge to avoid the really bad choices. Even more so I hope you have enough information now to make a better than average choice.

Best wishes,

Kelly



I am going to add two reviews to this write up. The first review covers some of the challenges you face due to the state of the industry. The second review is a recap of the performance levels of BTEs.

Review One, State of the industry.

I am going to step off into the dark side of the industry. What I write now is not about the scientific question of selecting a hearing aid. It is about the formation of the industry and gives you an inside look at what you may be facing when you go to buy a hearing aid. The industry is in a state of flux and is not equal across the board. Many dispensers have your best interest at heart; some however have their own best interest at heart. If you have an understanding of the makeup of the industry you will likely be able to tell which kind of fitter you are dealing with. I will offer this caveat however; many patients come to us and relate a story that goes like this.

“I bought these hearing aids eight months ago from “xxx”. They seem like really nice people and I think they sold me a good hearing aid. However, I have been going back for adjustments every other week for the past six months and I still can’t hear well. They have tried really hard and are great people to work with but I am beginning to wonder if they know how to program these hearing aids. I heard about you guys from a friend who bought their hearing aid from you. They tell me you are very good. Do you think you can help me with these hearing aids?”

We hear these stories every day. A brief history of the industry helps explain why we are in this state. Hearing aids used to be “analog devices”. That means they were non-computerized and very simple devices. In the past ten years almost all hearing aids became computerized. It used to be there was very little a fitter could do to tune a hearing aid. What you got was what you got. In the meantime, the science of hearing aids evolved. The products coming out of the factory are truly modern miracles. However the science of fitting and dispensing has not evolved. Most fitters have no scientific background in the science of sound. They really don’t know what they should know in order to adequately fit hearing aids. That said, let’s look at what the average patient faces when they go looking for a hearing aid.

When you step into the average dispensers’ office you are likely to buy the brand they are selling. Why is this?

Regardless of which professional is sitting in the seat, the fundamental structures are almost always identical. What fundamental structures? Hearing aid manufacturers design and manufacture hearing aids. They do not sell and fit them to the public. Hearing aid fitters (all fitters, we call them dispensers) buy hearing aids from manufacturers and resell them (and fit them) to you the public (they do not make them). In this relationship, if I agree to a partnership with one of the manufacturers, by agreeing to sell mostly their hearing aids, there are written and unwritten financial benefits for me the dispenser. I have a motive then, to dispense one brand of hearing aid. Each manufacturer typically makes some thirty odd different models. So this structure is like a car dealership. I may sell Fords, Chevys, or Toyotas. I cannot mix those brands on the same lot if I am a new car dealer. However, within each brand I will have many different models to offer you.

When you come on the lot and ask me, “which is the best car made?” You can be sure it will be one of the models I sell (even if it’s not the best choice for you). When you walk into a typical dispensing practice the odds are very high that you will walk out with whatever brand they are selling and they will do their best to convince you it’s the best on the market. Really now, can they all be the best on the market? Somewhere out there though, there really is a best model, for YOUR loss.

How did hearing aids all get to be $7000 for a set? Simple math really, I make more money if you buy the top of my line. You walk into a dispensing practice. Let’s say for the moment it’s my practice and I am just like the fellow down the street. I sell one brand which has a number of available models. Because I sell one brand, I am going to sell you one of those models. You don’t know the difference. I am not going to sell you some other brand even if you come in and ask about it. I could mind you. Any dispenser can purchase and sell any hearing aid. In this respect it’s not like car dealerships, there are no franchises (Beltone and Miracle ear are two exceptions, however these hearing aids are actually made by two major manufactures. Siemens makes Miracle ear.)

So how much will the hearing aid cost? $7000. That’s for my best model of course. If you can’t afford $7000, how about $5000, if not $5000 how about $3000? That is the good, better, best method of selling hearing aids. It doesn’t really matter what you need or what technology will really do the best job for you. I have already proven that, I only sell one brand. Therefore, I will pick your hearing aid based on how much you will pay and the deal I have made with the manufacturer. I don’t really know, or care, much about the technology you will be buying. In fact, I may even sell you a hearing aid that only has enough power for today. You won’t know that because today when I fit you, it will sound plenty loud enough. When you come back next year, or the next, and ask me to turn it up you will find out then that the hearing aid I sold you doesn’t have enough power. I will recommend you buy a new set (this increases my income). I am in the business of selling hearing aids. I cannot restore your hearing.

This is a bit bleak. I know there are many good people selling hearing aids. However, our industry has no mandatory fitting guidelines. I can literally sell you anything, right or wrong. Buyer beware is the key here. Our own industry surveys tell us many patients are being poorly fit. Ask enough hearing aid wearers and you will find a high rate of dissatisfaction exists in this industry. The good news is, it does not have to be this way. There are many excellent hearing aids out there. But there are over a thousand different models to choose from and you have to get the right ones for your loss, lifestyle, and budget. This is where you will have to do your own homework.

Review Two: BTEs

Why BTEs?

BTEs are almost always the best choice. There are however hundreds of different BTEs available. The BTEs themselves fall into six different classes. The differences in the classes are primarily power and shell size. Do not confuse the progression through the different classes as being more or less expensive. The fact is there are over one thousand different hearing aids out there. Each class, even each model, or technological level can be found from many different manufacturers and at widely varying price levels. The typical hearing aid dispenser/audiologist will not offer you this wide range of selection because the typical hearing aid office specializes in one brand. They may offer the other brands if you insist but that is a far cry from being expert in all the models out there.

Explanation: Delivery system. The delivery system of the BTE is the part that carries the sound from the BTE (which is sitting atop your ear) down into the canal. This is usually done by attaching a clear plastic tube to the BTE. The other end of the tube then goes into something shaped to fit your ear. We call that part the earmold. The tube and earmold make up the delivery system. There are a hundred or more variations of the tube and earmold delivery system. The delivery system plays an important part in the overall success of the fitting. It accounts for about 20% of the sound modification or the final acoustics of the system. The choice of delivery systems cannot be overlooked.

Class One: Open fit. Good for mild losses only.
The smallest BTEs (sometimes called OTEs) are for folks who are just beginning to know they have a loss. They are for mild hearing losses only. If your loss progresses beyond the usable power range of these instruments you have to buy new ones. These BTEs come with either a size 10, or size 312, battery. The size 10 battery will last from 3-5 days. The size 312 battery will last from 10-14 days.

Class Two: RIC or RIE. Good for mild to slightly moderate losses.
This is a new type of BTE. This BTE does not use a standard delivery system. Instead of a tube and earmold running down from the BTE, they run wires down to a speaker which is encased in some form of earmold and is placed into your ear canal. They typically call these RICs or RIEs (Receiver In Canal or Receiver in the Ear.) Remember, Receiver = Speaker. They are all the rage with manufacturers and dispensers today. We don’t promote RICs. I’ll go into the explanation further on.

Class Three: Crossovers. Good for mild to moderate losses.
Crossovers start our just like the open fit class and are often the same exact size or very close in size; they are the smallest of BTEs. Although they start with a thin flex tube the earhook mount is designed to accept a standard sized tube. Later as your power needs increase you can simply switch to a standard tube with a custom earmold and that will allow you to ramp the power up without causing the hearing aid to squeal (we call that feedback). These typically come with a size 312 or a size 13 battery. The 312 battery will last about 10 days. The size 13 battery will last about 3-4 weeks.

Class Four: Standard BTE. Good for mild to moderately-severe losses.
This instrument is your average BTE. It is much smaller than BTEs used to be even just three years ago. Yet, it delivers all the high tech and power of the best hearing aids on the market. Interestingly these aids also function like a crossover. That means we can start you with a thin tube delivery system as long as feedback is not a problem. Later we can switch back to the standard tube and earmold system for full access to all the power of the hearing aid.

Class Five: Standard Power BTE. Good for moderate to severe losses.
This BTE often looks identical to the standard BTE. In fact it likely has the same exact shell and the same exact circuit. By installing a more powerful speaker system (we call that the receiver (Receiver = Speaker). You can get more power from the same circuit. These come with size 13 batteries and the battery will typically last about 2-3 weeks.

Class Six: A True Power BTE. Good for severe to profound losses.
This BTE is usually in a larger shell. They come with size 13 or size 675 Batteries. The size 675 batteries in these aids usually last about a month.

How do you know what class of instrument to start with? It depends on your level of loss. The first specification to look at is the power rating of the BTE that is being recommended. Every hearing aid is rated by the manufacturer. Included with the software that is used to program the hearing aid is a chart of the power range of the hearing aid. Your fitter should enter your audiogram into the programming software. The software will show you a graph which plots your hearing loss on top of the operating range of the hearing aid. Your loss should fall mostly in the middle of the operating range of the chart. If your loss is below 75% of the operating range that hearing aid is not a good choice. This is true even if you feel like you are hearing well, with that aid, at this time.

The reason it’s not a good choice is there will not be enough spare power if your loss changes. Although hearing losses typically progress very slowly, they do get worse with time. Any hearing aid you buy today should be able to cover a reasonable change over the next 5-10 years. If the hearing aid sounds ok today and it is operating at 75%-80% (or worse) that means when you go back next year, or the year after, to have them increase the volume a bit, they may not be able to. Your hearing aids may be maxed out. If that happens you will have to buy new hearing aids again; that is not your goal here.

An additional concept relating to the power of the hearing aid is the frequency specific power of the hearing aid. This is very important but it gets a little technical. Hearing aids have to provide power across a wide number of frequencies. You might think of frequencies like keys on a piano. Hearing aids cannot, and do not, produce the same amount of power for each of the different keys. So even if you have a perfectly flat loss the hearing aid can only provide medium power to most notes. A hearing aid will often ‘peak out’ on one note only. So a hearing aid that will reach a 65 Decibel loss may only do so at one or two notes; which is fine if that’s the only frequency/note you need help with. The rest of the notes might fall short of power. In these cases you will say “yes, I can hear, but I cannot understand the words”. So to put it in a nutshell, make sure there is more power than you currently need. (Please read my other responses for further insight into available gain and usable gain.)

I would also like to point out that is not reasonable to expect good quality sound from a hearing aid that is turned all the way up. If you are operating above 90% of the power range of the hearing aid you begin hear the effects of over ramping the instrument. This introduces distortion in the sound. These distortions are not necessarily perceivable to a listener, but they have the effect of reducing clarity of speech. You would not listen to your TV or radio with it cranked all the way up and you do not get maximum benefit from a hearing aid turned all the way up. All amplification systems suffer from this same characteristic.

Let’s go back to the BTE topic. The next topic I would like to cover and set aside is the hearing aid with the wires that run down to a speaker in the ear. These are typically called RICs (Receiver In Canal.) They are all the rage with manufacturers today. We don’t promote RICs. There is nothing wrong with the concept of the RIC and they often produce very good sound. Dozens of manufacturers make them. The reason we shy away from them is because they have the same problems as a hearing aid you wear in the ear, like the canal aid (ITC = in the canal) or the ITE (In the Ear) a bigger version that takes up the canal and most of the outer ear. When you put the speaker in the ear, or down in the canal, it is often plagued with ear wax or oil and moisture problems. BTE’s typically having far fewer repairs than canal aids. In our experience they have about one tenth as many breakdowns. That is understood by looking at the biggest reason hearing aids breakdown. Earwax, oils, and moisture get on the speaker while it is in the ear. These breakdowns account for about 85% of all repairs we send to the factory. The BTE overcomes these problems because the speakers reside outside the ear. At least that is the way it was historically. Now along comes the RIC and you have a BTE with the same problems as the canal aid. The RIC is still a better choice than the canal aid, but if you are going to wear a BTE, why not get all the advantages of a BTE?

Now let’s discuss the Thin Tube style of delivery. Thin tube is great for people with mild losses. Beyond that you run into a host of problems. That said, we fit lots and lots of thin tube fittings, but only when appropriate. We would NOT fit a 65 DB flat loss with a thin tube. To explain why not in a single sentence I would say, “Our patient would be unhappy and in about six months, after he figured it out, he would be very very very unhappy.”

If you are coming out of a worn out, marginal, hearing aid that really never worked well, it will be easy to make a mistake. I could put you in an underpowered BTE with a thin tube and have you believing you are doing well, because you will be comparing it to the poor hearing you are coming out of. Or, if you have never worn hearing aids everything is louder with any hearing aid. Right at first you think, “This must be working and it’s so much better than no hearing aid.” However, unless all considerations are on the table, available power, left over power, and feedback potential you may still be making a poor choice of hearing aid.

Ask for top of the line earmolds by Westone. We pay for these earmolds when our patients go into our trial program. Ear molds are a very important part of the fitting. They account for about 20% of the end result. A bad ear mold can turn a good hearing aid into a poor performer. A good ear mold can improve even a bad hearing aid.

BTEs also have better directional microphones. We rarely ever fit a hearing aid without directional microphones. They are just too important. The placement and separation of the directional microphones is superior on a BTE. You cannot get the same benefits from any in the ear hearing aid.

BTEs have more potential. What does that mean? Honestly it means they are a better choice. They last longer. They can provide more power and deliver it with better quality. They can have more features. They have superior directional microphones. They have less feedback potential. They do a better job of reaching severe to profound losses. Today some of the designs are even less visible than canal aids. They require fewer repairs. What’s not to like?

I hope this is helpful. It can be difficult to work through the choices. Start with BTEs and try them out. Don’t buy a hearing aid you haven’t worn. Don’t accept counseling that tells you a problem with the hearing aid will go away over time. They never do.


October 17, 2008

Thank you for the review. Yes you may print this out and use it in your quest. It will be interesting to see how your audiologist responds. We have an open door policy with regards to all fitters. Anyone is welcome to come and sit in on our patient sessions. However, in the past six years, despite the open invitation we have had only two fitters come and watch. One fitter drove out from Louisiana. We ended up spending a week together.

All of our work is factual, done with scientific equipment not usually found in a dispenser’s office but common to the electronics industry. We did not need to invent the equipment, it already exists. Further, none of our conclusions are speculative or theoretical. All of our work is done, and our conclusions drawn, from work done with actual patients over time and at our expense. We do not receive or ask for grants, research allocations or outside money from industry or government.

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Hard of Hearing Advocates 245 Prospect Street, Framingham MA 01701
Phone: (508) 875-8662 Fax: (508) 875-0145, Email: hoha@charter.net