TechnologyIn addition to changing styles, hearing aids have experienced dramatic improvements in the technology, or circuitry, used to amplify sound and how the aid is modified to your hearing needs.
Conventional Analog hearing aids amplify speech and noise alike, although they may have features and adjustments that can modify the sounds differentially. Until recently, this was the basic technology of hearing aids. This type of aid is generally the least expensive, but it may not be reprogrammed if your hearing changes over time.
Digital Programmable (DSP or digitized sound processing) hearing aids convert sound waves into digital signals. A computer chip in the aid converts sound waves to numbers and then analyzes and manipulates the numbers according to a set of rules (algorithms) programmed into the chip.
The computer chip can tell, mathematically, if the incoming sound has the sound wave pattern of noise or of speech. It blocks out continuous background noise, while selectively amplifying the sound patterns of speech. DSP allows for more flexibility in programming the aid so the sound it transmits matches your specific pattern of hearing loss. This is typically the more expensive design, although sales of DSP accounted for over 90 percent of all hearing aids sales in 2006.
How much do they cost?Manufacturers don’t set retail prices (hearing care professionals do) so you may find the same hearing aid costs $300 less just across town. However, it’s important to know how hearing aids are priced so you will know what to compare and what you will get for your money.
Quality service and product selection may be even more important than bottom-line price. An office with a broad range of products from more than one manufacturer has more options in recommending the most appropriate aid for your needs.
You need to compare prices and services among hearing care professionals. Find out exactly what’s included in a quoted price. Hearing care professionals generally quote one price for the whole package of services. Ask them to break out the separate charges for testing and evaluation, fitting, and follow-up care, as well as the aid. Keep in mind that you won’t know the full cost of a particular aid until you have had your hearing tested. To make a fair cost comparison, you will need to know the full specifications of the recommended hearing aid model.
If you are going to get a second opinion, insist on getting a copy of your audiogram. You should be able to get a second opinion based on the initial audiogram. If the second dispenser wants to retest you, you shouldn’t have to pay for testing more than once.
The second dispenser may recommend a different model or offer you a different price. If the second dispenser recommends a different model, ask what the differences are. It may be that the dispenser doesn’t stock a particular brand.
In pricing hearing aids, also watch for excessive, nonrefundable fees, such as a high “restocking” fee if your first aid doesn’t work out and you need a different style. Ask if you will have to pay any fees if you return the aid within the trial period. Find out how many return visits for adjustments or cleaning you will get.
DecibelsDecibels are like degrees on a thermometer. As temperature increases, so do the number of degrees. As the volume of sound increases, so do the number of decibels. Normal conversation is usually between 45-55 dB. You will be tested for both Hz and dB at each of four to eight frequencies because hearing loss is not usually the same at all frequencies. Some low frequencies (most background noise like traffic and fans) can be heard at very low volume, while high frequency sounds (flute and child’s voice) are hard to distinguish at softer volume.
Be skeptical of “free” hearing tests. The cost of a “free” test may show up in the price of the hearing aid or in the difficulty you will have in getting a copy of your test results. Be sure you find out in advance how much “free” testing will cost if you do not buy an aid and only want a copy of your audiogram. Make sure that no hidden strings come with any “free” test, such as being free only if you buy a hearing aid that same day. As with any consumer purchase, also be wary of any “sale” price. It could be the price the dispenser normally charges for that hearing aid.
Noise LevelsBoth the amount of noise and the length of time you are exposed to the noise determine its ability to damage your hearing.
Noise levels are measured in decibels (dB). The higher the decibel level, the louder the noise. Sounds louder than 80 decibels are considered potentially hazardous.
The noise chart below gives an idea of average decibel levels for everyday sounds around you.
PainfulRock music peak
Firearms, air raid siren, jet engine
Jackhammer
Jet plane take-off, amplified rock music at 4-6 ft., car stereo, band practice
Extremely loudRock music, model airplane
Timpani and bass drum rolls
Snowmobile, chain saw, pneumatic drill
Lawnmower, shop tools, truck traffic, subway
Very loudAlarm clock, busy street
Busy traffic, vacuum cleaner
Conversation, dishwasher
ModerateModerate rainfall
Quiet room
FaintWhisper, quiet library
What should you know about batteries?All hearing aids require batteries. Replacing batteries is one of the ongoing costs of wearing
hearing aids. Be sure you learn from your dispenser which type of batteries to use, how to insert them properly, and how to test them. How long a battery will last depends on the battery type, your aid’s power requirements, and how long you use it each day. Batteries may last from several days to several weeks.
Batteries come in different sizes depending on the size and power needs of your hearing aid. Hearing aids typically use one of five different sizes—675, 312, 13, 10, and 5. Compare prices on batteries and consider buying them in bulk, on sale, or from battery clubs to save money.
You can conserve the battery’s life by turning off the hearing aid when you are not using it. Find out if you should open the battery door or remove the battery at night. You can extend the life of your spare batteries if you store them in a cool, dry place, but don’t put them in the refrigerator because the moisture reduces battery life. And don’t carry them around loose in your pocket or purse; keys or coins could short out your battery. Keep them in the original packaging until you need to use one. If they rattle around together, they can short each other out.
If you accidentally swallow a battery or get a battery burn, contact your doctor or call the National Button Battery Hotline at 202-625-3333.
Be sure to pull the paper tab off the battery just before inserting it. The paper tab lengthens
the battery’s life from the time it is manufactured to your use. When you remove the paper tab, put the tab on your calendar to remind you when you last changed your batteries.
Paying for Hearing AidsAccording to a 2004 national survey by the hearing industry’s MarkeTrak, the average price of a hearing aid was $1,369. For most people, this is a sizable investment that they have to pay out of their own pocket. Although only about 37 percent of the aids sold in 2004 were paid for by Medicare, Veterans Administration, union benefits, insurance policies, or HMOs, it may pay for you to look for sources of possible coverage for your aids or hearing care services.
What about private insurance coverage?Hearing aids are a major uncovered health care expense. Many private insurance policies do not cover the cost of testing or of the hearing aids, but check with your carrier to find out what might be available.
Written Contract
You should insist upon a written contract. Everything you have been promised needs to be in writing. Typical terms in your agreement should include:
• Name of dispenser, state registration number, registration expiration
• Manufacturer’s name and model, color, serial number, manufacture date
• Itemized price
• Length of trial period
• Any nonrefundable costs
• Payment terms
• Repair policy
• Warranty terms by either the manufacturer or dispenser
• Insurance policy options
• Procedures if the aid malfunctions
• Time required for repair
• Repair costs
• Loaner aid policy during repair
What should you know about warranties?The aid’s warranty is an important part of its overall value. Most manufacturers have some sort of warranty—one to three years. Be sure you know all the terms of the manufacturer’s warranty and what it covers. Ask if the dispenser has any warranties in addition to the manufacturer’s. You can also buy an extended warranty that takes effect after the manufacturer’s warranty expires.
For all warranties, know what is and is not covered. Some questions to ask include:
• Are parts, fittings, and adjustments included?
• Will the warranty provide you a new aid if the dog eats it, or you drop it, step on it, lose it on a camping trip, or drop it in a glass of water?
• Will you get an upgrade, or the same model?
• How many years will your aids be covered under the warranty?
Should you buy hearing aid insurance?Unlike a warranty that covers manufacturing defects and wear-and-tear, insurance covers damage and loss. The annual cost of this insurance runs from $50 to $150, depending on the type of hearing aid you have. Obviously, the more technologically advanced aids have higher insurance costs. Your dispenser should have information on insurance coverage and rate schedules.
Read the policy thoroughly before you buy. Find out if your manufacturer includes any loss and damage coverage in the price of your hearing aid. If so, extra insurance may not be necessary. Also check to see if your home insurance policy covers lost or damaged aids. Be sure you understand the difference between the manufacturer’s warranty, any optional extended warranty, and loss and damage insurance.
After CareAdjusting to your new aids?
A hearing aid won’t cure your hearing loss, just as prescription glasses don’t cure any vision problem. You will still have difficulties hearing in some situations, but so do many people.
When you first start wearing a new hearing aid you will need to do some adapting. New aids aren’t as easy to get used to as new glasses, even your first day with bifocals. You will have to figure out how to work with your aid, as well as new ways to hear. Don’t be surprised if, at first, it all seems somewhat overwhelming. Getting used to hearing aids takes some patience and practice.
You will need to practice identifying the left aid and right aid, putting in and removing
your aids, and replacing the battery. If you find them uncomfortable, you may want to wear them for only a short time the first few days.
One aid or two?If you have a hearing loss in both ears, your hearing care professional will probably recommend that you purchase two (binaural) hearing aids. About 80 percent of aid users with bilateral loss wear two aids. Two aids should improve your safety because you can tell better where sounds are coming from, such as on-coming cars. Binaural aids also improve your understanding
of words in noisy locations and give you better overall hearing in difficult situations, such as outdoors or in cars.
Obviously, two aids are more expensive than one, although you may get a discount for the second aid. You might get by with just one aid if your hearing loss is much greater in one ear. Your “good” or better ear may be able to balance your hearing ability.
One aid may be sufficient if your usual listening environment is relatively quiet, rather than in a noisy office.
It’s important that you wear them in a number of different hearing environments to see how they work. Your own voice may be surprisingly loud. Your hearing specialist may be able to adjust your aid to correct this problem. Most people get used to it over time.
You can expect to return three to five times for follow-up visits, or tune-ups, with your dispenser. Because of the wide variety of possible adjustments, you will need to work closely with your dispenser to get the right settings. If your hearing aids create feedback, or “whistle,” you may need setting changes or have wax or fluid removed from your ears.
Remember! If your aid is uncomfortable or unsuitable after a short time of trying it out, you should go back to the dispenser—within 30 days. You may need to review with the dispenser how to work with your aids, or have the dispenser make some adjustments in the settings, or return them for a refund or replacement.
What is aural rehabilitation?Most new users need some coaching on new listening skills. Be sure your dispenser offers
you and your spouse or family special sessions using visual clues such as lip movements
and facial expressions to get the most out of your aids. You and your family need to become accustomed to new talking and listening skills. Some hearing care professionals bring together small groups of new users to share similar experiences and solutions.
What are common courtesies in talking with a hearing aid user?
Once you have become accustomed to your new hearing aid, you may want to offer some suggestions to your friends and family about how they can help you hear better. You should give them these pointers:
• Get my attention first—I may need to get ready to listen to you, so use my name or tap me gently on the arm before speaking.
• Slow down—Because I still need to figure out what you are saying, you need to give me more time to process what you are saying.
• Face me—I can understand more of what you are saying if I can see your face.
• Keep your mouth clear—No need to exaggerate your lip movements, but don’t try to talk to me while you are eating or chewing gum.
• Come closer—Your voice will be louder and lip-reading will be easier, if you are no more than three feet away.
• Turn it down—The noise of the TV, dishwasher, or air conditioner bothers me more than it bothers other people, so turn it down or off.
Where do you go to complain?If you have a problem with your hearing aid that you can’t fix, you should first talk with the dispenser. Your dispenser should make adjustments and minor repairs. For major repairs, your dispenser may return your hearing aid to the manufacturer, whether or not it is still under warranty.
If you can’t work out a fair solution to your concerns with your dispenser, get in touch with the state licensing board, state attorney general, or local office of consumer protection. Their telephone numbers should be listed in the blue pages of your telephone book. Many state laws govern hearing aid sales and licensing of hearing specialists. Your state attorney general can tell you what laws apply to hearing aid sales and warranties in your state.
You will also do other consumers a service if you report problem providers to the Better Business Bureau (
www.bbb.org for online complaint form and list of local office addresses) and the Federal Trade Commission (FTC) Consumer Resource Center (toll free 877-FTC-HELP, or mail to FTC, CRC-240, Washington, DC 20580, or go to
www.ftc.gov). The FTC is responsible for monitoring the business practices of hearing care professionals.
Although the FTC cannot resolve individual problems, it can take action against companies that mislead or deceive consumers by giving inaccurate information about hearing loss, hearing aid performance, refund policies, or warranty coverage.
What should I know about other assistive devices?In addition to your hearing aids, you may find other products helpful if you have difficulty understanding speech while attending a religious service, watching a play or television, or talking on the telephone. For safety’s sake, you may also need to “see” or “feel” certain sounds. You can get most assistive devices through your hearing care specialist.
Alerting
Alerting devices use a flashing light, loud sound, or vibration to warn you of a telephone,
doorbell, smoke alarm, baby, alarm, siren, or car turn signal. If you have a hard time hearing an alarm clock, you could use a device that vibrates your pillow. Or you could attach a strobe light to a smoke detector. A vibrating watch can remind you when it is time to get to a meeting.
Listening
Various listening devices can be used with or without your hearing aids to improve your hearing in difficult listening environments.
Most hearing aids have telecoil circuitry that allows you to receive sound directly from the infrared or FM systems, eliminating background noise.
You can use personal listening systems in places where it is hard to face the person who is speaking, as in a car. Useful indoors or outside, the speaker clips a small amplifier to a belt and talks into a small microphone and the listener wears earphones or headphones that amplify the speaker’s voice. A doctor or a lawyer may find this system useful in conversations with patients or clients who don’t use hearing aids.
An induction loop may be useful in a variety of settings. The loop is a wire that surrounds a designated area, such as certain pews in a church, a hotel check-in counter, or even the inside of your car to make it easier to talk with a passenger. A microphone near the speaker sends a signal via the wire to your hearing aid equipped with a telecoil.
Infrared systems may be used indoors in theaters, courtrooms, or auditoriums. This system uses an invisible light beam to transmit sound from the speaker to lightweight earphones or a neck loop (if your aids are equipped with a telecoil switch). You also can use an infrared system to amplify television programs without disturbing others in the room. Personal FM systems are similar to infrared systems, but transmit using radio waves.
Closed-caption decoders transcribe spoken words on your television into written words at the bottom of your screen. All televisions with 13 inch or larger screens must have closed-caption capability.
Telecommunicating
Special products are also available to help you talk on the telephone. You may want a special telephone with a flashing light to alert you to an incoming call, or one with an amplifier that you can switch on when you use the phone. New products are coming out to address the problems electromagnetic interference causes hearing aid users trying to use digital cellular phones.
Telecoil circuitry allows you to talk on the phone without your hearing aid whistling. With telecoil capability in your hearing aid and in your phone, you bypass your hearing aid’s microphone and pick up a telephone signal directly through the telephone.
