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Hearing Aids

 We work with you for SUCCESS

At HearBright, we take the time to help you achieve better hearing - the right way. Our Audiologists have knowledge of brain plasticity in relation to speech understanding, sound perceptions, and the effect of hearing aids. When your hearing has declined slowly over the years, a sudden increase to normal hearing by fitting hearing aids at full volume is not ideal. The HearClear® Program utilizes gentle step-by-step adjustments of your new HearBright hearing aids so that your auditory system will not be "shocked" into good hearing. We monitor your progress weekly, bringing you to better hearing at your own pace.

Sonic Innovations Sonic Innovations, headquartered in Salt Lake City, Utah, is a world-wide manufacturer of small digital hearing aids. The company is based in the United States, and has provided over 1 million hearing aids in 25 countries. Overview Ion 400

Unitron Hearing Hearing aid fitting is becoming more precise, sounds can be highly refined and speech intelligibility and comfort are enhanced. Today, Unitron puts those advantages within everyone's reach with the most complete line-up of digital products designed to meet every lifestyle, hearing loss and budget need. Passport Smartfocus

Audina Audina offers American-made hearing aids at very reasonable prices. Quality technology offers pure digital, multi-band, and adaptible features, but extra costly features of Bluetooth compatibility, datalogging, and wireless binaural communication are not added to save cost. Good reliability. Sparo Open Fit

Phonak The Phonak Group is a world leader in advanced hearing instruments and wireless communication. Phonak's line of premium power instruments for hearing losses from severe to profound are well known. They also specialize in wireless systems for school classrooms. Phonak is Naida

Oticon ConnectLine is a completely integrated system ConnectLine delivers improved performance in terms of speech intelligibility and sound quality since sounds are streamed directly to the hearing aids via the user friendly Oticon Streamer. Oticon ConnectLine

Siemens Hearing For over 125 years, Siemens has dedicated itself to designing and building the world's most technologically advanced hearing aids and wireless systems to fit all types of hearing aids. Siemens Life

Widex Hearing Widex hearing aids have helped millions of adults and children and Widex innovations have had a profound impact on the hearing aid industry. As a result of the company's outstanding past performance since 1956, the Widex name is today synonymous with superior technological achievements. Widex Consumer Guide to Hearing Aids Widex Passion

Starkey Starkey hearing instruments create an unparalleled listening experience while eliminating some of the most frustrating characteristics of older hearing aids. From our custom hearing aids to our standard products, your hearing professional will prescribe to your unique hearing needs and lifestyle. Starkey S Series Starkey S Series 2

ReSound ReSound ReSound

How Hearing Aids Work

While the processing of modern hearing aids is complex, and computer programming is required to make some of the adjustments, the basic components that make them work has not changed. The basic function of a hearing aid is as follows:

• Sound waves enter through the microphone, which converts acoustic signals into electrical signals.
• The amplifier increases the strength of the electrical signal.
• From the amplifier, the signal is then transformed back to an acoustic signal by the receiver (a miniature loud speaker).
• From the receiver the signal is channeled intro the ear canal, either through a small tube or through an ear mold.
• A battery is required to power the hearing aid and enable the amplification process.

Many hearing aids also have user controls (e.g. toggle switch, volume control wheel, push button, or remote control) that enable the wearer to adjust a variety of hearing aid parameters, including:

• Turning the hearing aid "on" or "off"
• Changing the volume
• Switching to the telecoil
• Switching between omni- and directional-microphone settings
• Switching to a different pre-programmed memory

Styles of Hearing Aids

Hearing aids have been available in four styles: body, eyeglass, behind-the-ear (BTE), and in-the-ear (ITE). Included in the category of ITE hearing aids are in-the-canal (ITC) and completely-in-the-canal (CIC) styles (all shown in the figures below). While body and eyeglass style hearing aids were regularly used 40- 50 years ago, they comprise only about 1% of all hearing aids marketed today. Instead, most individuals choose ITE (approximately 80%) or BTE (approximately 20%) style hearing aids. This transition in style, use, and preference is occurring for a number of reasons, including the reduction in the size of the components, durability, and cosmetic concerns on the part of the consumer.

The ITE style hearing aid fits directly into the external ear. The circuitry is housed primarily in the concha (external) portion of the ear. Due to the miniaturization of the component parts (including the microphone, receiver and battery), it is possible to make hearing aids small enough to fill only a portion of the concha (ITC) or fit deeply into the ear canal (CIC). All three of these styles have typically been considered to be more modern and cosmetically appealing. However, modern BTE hearing aids have become smaller and at times are less noticeable than some ITC hearing aids. Other features of in-the-ear instruments are as follows:

• More secure fit, and easier insertion and removal than with BTEs.
• Improved cosmetic benefits with smaller styles (CIC, ITC).
• Less wind noise in the smaller styles than with BTEs.
• Directional microphone technology available for most styles, excluding CICs.
• Deep microphone and receiver placement with CICs may result in increased battery life and high frequency amplification compared with other styles.
• All components are integrated into a one-piece shell, which may be easier to handle and operate than for BTE styles.

The BTE style hearing aid is housed in a small curved case which fits behind the ear and is attached to a custom earpiece molded to the shape of your outer ear. Some BTE models do not use a custom earpiece; instead the rubber tubing is inserted directly into the ear. The case is typically flesh colored, but can be obtained in many colors and/or patterns. Other features include:

• BTEs may be the most appropriate choice for young children, as only the earmold needs to be replaced periodically as the child grows and the ear changes in dimension.
• Typically, BTEs are the most powerful hearing aid style available, and may be the best option for persons with severe-to-profound hearing loss.
• FM and direct auditory input is routinely available as an optional or standard feature.
• Telecoil circuitry is often more powerful than with ITEs.
• Non-occluding earmolds may be used with BTE hearing aids, if a medical condition exists or if the patient reports a “plugged” sensation when wearing other hearing aid styles.
• Directional microphone technology available with most BTE styles and models.
• Larger battery sizes used in BTEs may be easier to handle than smaller styles for those with limited manual dexterity or vision deficits.

 

 

 

Guide to Hearing Aid Technology

 

In addition to the basic features of hearing aids discussed earlier, there are many other features available in modern hearing aids-some of them are for convenience and ease of use, others are designed to improve speech understanding or listening comfort.

Adaptive Feedback Cancellation:

Acoustic feedback (whistling from the hearing aid) can be annoying, embarrassing, and in some cases, prevent the hearing aid wearer from using the correct amount of gain. Many of today's hearing aids have an automatic feature that quickly detects acoustic feedback and cancels it. This feature is designed to manage transitory feedback (e.g., caused by placing one's hand or a telephone next to the ear), and is not a solution to a poorly fitted ear mold or hearing aid.

Automatic Gain Control-Output (AGCo):

AGCo or output compression is used to put a "ceiling" on loud sounds. It handles the output after the amplifier, and can be adjusted to correspond to the patient's threshold of discomfort (maintaining sounds below this level).

Automatic Gain Control-Input (AGCi):

AGCi, or input compression, often referred to wide dynamic range compression (WDRC) is used to "repackage" the speech signal (and other incoming sounds) to correspond to the reduced dynamic range of the hearing aid user. That is, if the incoming sounds have a 60 dB range, and the patient only has a 30 dB range of useful hearing, the sounds might be "compressed" by 2:1 to fit into the useful auditory region. The notion is that most people with a hearing loss need more gain for soft sounds than for average, and more gain for average sounds than for loud. WDRC accomplishes this automatically-in fact, if the WDRC is programmed correctly across frequencies, many hearing aid users have little need for a volume control.

Digital Noise Reduction:

With digital hearing aids, it is possible for the hearing aid to analyze an incoming signal and differentiate speech from a broad-band noise signal. This can be accomplished simultaneously in several channels. If the dominant signal is believed to be noise in a given channel, there is a reduction in gain. Note, however, that what a typical hearing aid user might consider to be "noise," (background talkers at a party) might not be considered "noise" by the hearing aid. While this feature has the potential to improve speech understanding in typical difficult listening situations, this has yet to be verified by research.

Digital Signal Processing:

Until recently, the majority of hearing aids utilized analog signal processing. This has changed rapidly the past few years, and today, nearly all hearing aids sold in the U.S. utilize digital signal processing. The advantage of digital processing is that less space is required, allowing manufacturers to include many more "programmable features" in a small package. Through the use of digital signal processing, the hearing aid can conduct an analysis of an incoming signal, and make a reasonable classification of the content-speech versus broad-band noise versus acoustic feedback (whistling) versus music, for example. This classification can then be used to trigger automatic activation of other special features.

Directional Microphone Technology:

Using special microphones or phase cancellation signal processing, it is possible to configure a hearing aid so that sounds from the side, and especially the back of the hearing aid user are amplified less than sounds originating from the front. It can serve as a type of "spatial" noise reduction if the user is correctly positioned. Directional technology is available on all hearing aid styles except CICs (because of size constraints). Importantly, directional technology does not improve localization of sounds. Research has shown that many hearing aid users prefer directional technology for listening in noise, usually when:

• the noise originates from behind the listener,
• the talker is in front of the listener,
• the listener is close to the talker,
• the room has low reverberation.

Some hearing aids automatically switch to a directional mode when the signal type and/or input intensity are matched to the characteristics of the algorithm. Adaptive directional hearing aids automatically tracks a dominant single noise source (e.g., a car passing by someone on a sidewalk), attempting to provide maximum reduction in gain toward the location of the source.

Multiple Channels:

The majority of today's hearing aids have multiple channels. Each channel represents a portion of the frequency range important for understanding speech. One advantage of multiple channels is that features such as gain and compression can be programmed differently to reflect changes in the patient's hearing across frequencies. Multiple channels also are useful for implementing other features such as digital noise reduction and feedback cancellation (which will be discussed later). There is no consensus regarding how many channels are enough (or how many are too many)-to some extent, this depends on the feature utilized within the channels.

Multiple Memories:

A memory is a location to store hearing aid settings that are designed for a particular listening situation. It is common for hearing aids to have two or three memories. For example, in a hearing aid with three memories, it is common that memory one will be for listening in quiet, memory two will be for listening in noise, and memory three will be for telephone. On the other hand, many hearing aid users find that a single memory works in a variety of listening situations, and may only use one memory. Changing memories is accomplished by using a button (or toggle switch) on the hearing aid, with a remote control device. In some digital hearing aids, it happens automatically.

Telecoils:

With this special circuit, electromagnetic signals can be picked up from the handset of the telephone and amplified in a manner similar to the amplifying function of the hearing aid. Although many hearing aid wearers report benefit with this circuit, there is substantial variability across hearing aids. Telecoils are not available in some smaller custom-made models due to space limitations. Often, hearing aids with multiple memories will devote one memory to the telecoil. In these instruments, the telecoil can be accessed through a push button on the hearing aid or by the use of a remote control device.

 

Gus Mueller, Ph.D. Vanderbilt University, Nashville, Tennessee
Ruth Bentler, Ph.D. University of Iowa, Iowa City, Iowa