“Any clinician who starts by strongly recommending a particular hearing aid, without first doing this ground work, should be regarded with caution.”
When working with hearing aids each day, one of the most common questions I’m asked is “which hearing aids should I buy?” It’s such a common question, and is premature in most cases, that I thought I would address it here.
Hearing aids are as individual as you are and are more personalized than any spectacles you might wear. That’s because in addition to a hearing aids’ style and prescription, an Audiologist must consider a range of fit and management options for the patient. A good clinician will also consider the devices integration with any existing technology the patients uses, such as mobile phone or television.
No one can accurately recommend a hearing aid of any kind without understanding a range of important details; your case history, lifestyle, ear composition, and your current hearing levels. Only once that basic information has been gathered can an Audiologist consider if hearing aids are appropriate or recommended.
Any clinician who starts by strongly recommending a particular hearing aid, without first doing this groundwork, should be regarded with caution. You simply can’t start with a certain device and then work backwards to the patients’ type of hearing loss, then finally finishing by asking what their hearing goals are. It just doesn’t produce good patient outcomes .
Click each link to read the case study.
For the purposes of the argument, let’s assume hearing aids are recommended.
Here are some of the factors that I, as an Audiologist, consider before doing anything else;
– What kind of a hearing loss do you have?
– How social are you and how do you spend your time?
– In what kind of situations do you find you’re trying harder to hear?
– How dexterous are you with your hands and arms?
– What is your level of comfort and interest in technology?
– Are you concerned about how hearing aids look when wearing them?
Let me give you a few examples of how this works in real life. These are actual scenarios from my clinical work at A Better Ear, but I’ve changed some details to protect the identity and privacy of my valued patients.
A fully subsidised option for a quiet Cleveland pensioner
Dana is in her 80’s. She has a quiet lifestyle with her husband living in a retirement village in Cleveland. When Dana came to our clinic, she’d already been to see her regular Audiologist but felt that something wasn’t quite right about their recommendations to upgrade her hearing aids.
One of the biggest concerns Dana had was cost. She rightly pointed out that given her quiet lifestyle there could be little justification for high end hearing aids. She knew she was eligible for fully subsidised hearing aids on the Government Hearing Services Program (HSP) and was suspicious that the hearing clinic was trying to take advantage of her by “upselling” her to a more expensive device than she needed.
Dana had a significant hearing loss in both ears but was in the habit of only wearing one hearing aid because that’s all she “needed”. She reported to me that she found one enough but that trying to adjust the volume via the little wheel on the back of the hearing aid was very difficult. Through conversation, I found that Dana was interested and motivated to understand the facts of her loss and the reasons for my recommendations. We performed a full audiological assessment and discussed the results of my findings, what they said about the nature of her hearing loss and what courses of action were recommended in such cases. We discussed the types of aids that would be appropriate for Dana in the context of her lifestyle and listening goals.
Which hearing aid did Dana choose?
After due consideration Dana agreed upon a pair of Unitron T Insera 500 custom hearing aids with a remote control for ease of volume control. The T Insera 500 is what’s referred to as ‘free to client’, meaning they are available with no gap payment on the HSP. They are a high-quality aid that performs very well in simple environments; perfect for Dana. With a hearing loss on both sides, Dana came to understand that by using two hearing aids it assists her to identify the location of sounds in her environment as well as stimulating both the left and right auditory nerves, keeping Dana’s brain and hearing anatomy more active and healthy.
I see Dana every few weeks because she walks past the clinic on her way to the Donald Simpson Centre, often dropping in with a question or observation about her aided hearing. By allowing the consultation to be led by what Dana wanted, balancing that with what was best for her rehabilitation, and letting the circumstances dictate the best hearing aid, I have a satisfied patient, Dana has improved hearing and her trust in Audiology has been renewed.
Quality and performance for a musician.
Craig is a working musician living in the Redlands who has hearing damage as a result of noise exposure during his career. It was feedback from his wife and his band mates that convinced him to seek advice on his hearing. Being a muso, he needed the most realistic and natural sound possible in a few different band environments. He didn’t want to pay more than necessary (who does!) but wasn’t concerned about the hearing aids visibility or its appearance. Apart from his musical requirements, his needs were simple. He needed good performance in complex noise environments, he had a good budget but wasn’t prepared to throw around money on hearing aids that didn’t perform well.
Which hearing aid is best?
Craig’s is a good example of how it is not all about the hearing aid! The device we chose (Phonak Marvel R 30) is a fantastic hearing aid with superior sound quality and many intuitive and responsive automatic features, but even the worlds most advanced hearing aid will under-perform if it is tuned automatically, or if the Audiologist relies on the standard ‘out of the box’ tuning. For best results hearing aids should be manually tuned to match the patient’s prescription using tiny microphones to take Real Ear Measurements (or REMS). It was the tuning of the hearing aid to his prescription and the setting up of several software settings (or hearing aid “programs”) suitable to Craig’s circumstances that made his hearing aids really sing!
We agreed upon a 2-week period between Craig’s hearing aid fitting and his follow up appointment (where I check all aspects of the hearing aids comfort and performance). This was at Craig’s request in order to allow him to test the hearing aids at a concert he was attending as a listener, and to use them with his band in a live performance setting.
The feedback I received from Craig was great and he’s gone on to recommend some friends! It goes to show, when you take the time to understand the patient’s circumstances and align the selection of hearing aids with the outcome they are seeking, fantastic results follow.
” At the end of the day the best solution is the one the patient uses”
Struggling to hear speech in the office.
Lydia came to see me as a referral from a friend of hers whom I’d treated. She is in her late 50’s and works in Brisbane in a policy role for state government. Her work involves meetings where she was finding it difficult to keep up with conversations (as usual, meeting rooms have terrible acoustics). She suspected the difficulty she was having may have indicated a hearing loss and knew that hearing aids might provide a solution. She was however of the understanding that she would need to spend $8000 or more to get “a good pair”. Naturally this made her anxious.
After thorough testing, which included a strenuous hearing in noise test, I found Lydia had a very specific mild hearing loss in her high frequencies. By performing a test specifically designed to challenge discrimination of speech in noise I was able to replicate exactly the problem she had described.
“Is a hearing aid right for me?”
Which hearing aid is right in this circumstance? Well it might surprise you, but in this circumstance, it’s not ideal to prescribe hearing aids. The problem is that hearing aids would provide amplification to the healthy part of Lydia’s hearing, which doesn’t need it, thereby creating a new problem without solving the intended one. In a practical context, Lydia’s would hear more of everything she didn’t want and would continue missing the parts she wanted to hear.
NuHeara IQ buds provided the solution. IQ buds aren’t hearing aids – they are referred to as ALD’s (assistive listening devices) and incidentally, are covered by the HSP for pensioners and DVA card holders. ALD’s like NuHeara’s IQ buds is a growing field of peripheral devices that are appropriate as transitional devices or where hearing aids aren’t the solution. For Lydia they provided a means to reduce the background noise that was troubling her and focus on the speech that she wanted to hear.
Although the IQ buds represented the best hardware option for Lydia, they are new technology and she hadn’t used anything like them before. IQ buds can offer a range of advanced features, but they can also be set-up quite simply, and the mobile phone APP used to adjust them is very user friendly.
At the end of the day the best solution is the one the patient uses, so I set up the buds in their basic and most easy to use form and ran numerous practices with Lydia to get her used to inserting, removing and adjusting them for different environments.
The best part of this story is that the Nuheara IQ buds only cost $399. This shows that sometimes the best hearing aid, isn’t a hearing aid at all!
A discrete and budget solution for a busy young Dad.
Matt is a married man in his late thirties who’s second child had just arrived when he came in for his first hearing test with me. Matt has had a hearing loss since he was a boy. He told me how he immediately threw away his first pair of hearing aids. So much for early intervention! Fast forward 20+ years and Matt had learned to cope in most spheres of his life with hearing loss. His work mates knew they had to make allowances for him, but that was fine. It was at home that his hearing loss was beginning to cause strain. Arguments occurred because his wife was required to repeat herself and general misunderstandings stemmed from difficulty communicating.
Matt knew he needed to do something about his hearing and was now ready to look at options. There were some challenges however which centered around the “which hearing aid should I buy” question.
First and foremost was the stigma Matt felt was associated with hearing aids. As a result, he didn’t want his aids to be visible. Fine with me. Secondly, Matt was adjusting to the costs that come with a growing family. This made for a challenging hearing aid fitting because the two main goals are almost at cross purposes. I needed to find something that balanced these two needs but on top of that I also needed to counsel him on what to expect as a first-time hearing aid wearer.
The right hearing aid for Matt.
I recommended for Matt a Unitron T Insera 600 IIC, (the IIC stands for ‘invisible in the canal’). To begin the fitting process, I took an impression of Matt’s ear canal and requested the hearing aid be made to fit deeply within the canal. This provided him with the discreetness he was after.
IIC’s are however a little more expensive than conventional hearing aids which sit behind the ear. This cost constraint meant we had to cut back on features he would have liked, such as automatic sound classification in multiple environments or strong noise filters, which would have assisted him in his work environment. Fortunately, however the Unitron T Insera is part of the FLEX ecosystem and has an ace up its sleeve! It can be upgraded at any time allowing Matt the flexibility of improved features and performance if, and when he can afford to do so.
” It was at home that his hearing loss was beginning to cause strain.”
Living with a single-sided hearing loss.
Kathy came to see me at A Better Ear having seen me at a previous employer in Cleveland. She has a single sided hearing loss; one ear is healthy, but one has a significant loss which had deteriorated since last time I saw her. She works in the Redlands in an open plan office. Her home life is reasonably busy with her husband working full time and teenaged children whom she takes to and from numerous weekly engagements; each engagement offering its own challenging listening environment.
She’s been wearing her hearing aid from morning until night for about five years. Kathy was looking to upgrade to a more sophisticated aid that would give her a more natural sound.
What was the best hearing aid?
After her assessment and a thorough discussion about her hearing needs and goals we settled on a Phonak Audeo Marvel 70. I’ve been very impressed with the feedback I’m getting when fitting this device. The hearing aid has an incredibly natural sound with intuitive speech focusing ability.
Kathy had been prepared to go for a very high-end device to get the performance she wanted but in the end it wasn’t really necessary. Having a one-sided loss meant that Kathy didn’t need to pay the next level up; features that are only relevant for two hearing aids working in unison, so the extra spending wouldn’t have resulted in any real benefit and I didn’t recommend it. Kathy was able to focus her budget on getting the hearing aid best able to deliver the results she wanted.
Kathy has since given the feedback that her new hearing aid sounds and behaves very similarly to her healthy ear. Given her good ear has almost perfect hearing, this is a great endorsement!
Technological innovation and integration.
Ron is what the marketing people refer to as an ‘early adopter’. He has a smart phone and he uses it fully. He wears a Garmin sports watch to monitor his activity, sleep and heart rate. What is unusual about Ron is that he’s in his early 70’s. He’s a self-funded retiree who worked in travel and still enjoys seeing the world. At the time of writing he’s preparing for a walking tour of Japan’s Izu Peninsula.
As I took Ron’s case history, I noticed that he was concentrating very hard on my lips when I spoke. We got to talking about what had motivated him to seek advice on his hearing. Ron knew he had to do something about his hearing and had been putting it off. He’d done his research on hearing aids and as a result Ron knew a great deal about several on the Australian market. Even though he had put off a visit to the Audiologist for some time, he’d clearly now decided to do something.
Once the consultation and testing were complete, we got to talking about technology. Ron talked about his desired features and I matched those features to what would be appropriate from a clinical perspective.
What did Ron buy?
Starkey’s flagship hearing aid, the Starkey Livio AI, is a device that has everything an early adopter of technology could want. Believe it or not, the aid itself has a heart rate monitor, a sensor which can detect falls, and can reliably track Ron’s activity – plus the sound quality is fantastic. It is also enabled for tele-audiology (hearing aid adjustments and troubleshooting via the internet, which is perfect for someone who travels) and the accompanying APP allowed him to track his health and personalise the hearing aid settings in a multitude of ways.
To be frank, a device like this isn’t suitable for everyone. Its priced at the top end of the market and unless you have an active interest in the features, you’d never make use of them. But that’s just the point, it’s not meant to be prescribed to everyone!
Your hearing rehabilitation pathway is as unique as you are.
The range of products that have been developed for sufferers of hearing loss varies enormously. I’ve only touched on hearing aids from Phonak, Unitron and Starkey as well as an ALD from NuHeara called IQ buds. There are so many other brands of hearing aids that patients have access to through an independent clinic like mine. These include ReSound, Widex, Oticon, Signia, Sonic, and Bernafon to name a few.
Getting your full range of options is one of the benefits of seeing a specialist who truly puts your needs, and the needs of your individual rehabilitation, first. Independent Audiologist’s like myself are called independent because they are not owned or affiliated with hearing aid manufacturers. This means you are more likely to get access to the full range of products on the Australian market and received the time and attention required to understand your specific circumstances and fit you accordingly.
“Which hearing aid should I buy?” It’s an excellent question which deserves appropriate consideration and respect, but it’s impossible to answer without knowing you, knowing your circumstances and knowing your hearing goals.
Anyone who tells you differently is not providing you with an informed choice.
Penelope Woods is the Founder and Principal Audiologist at A Better Ear, Cleveland’s fair priced hearing clinic.