A hearing aid is an electroacoustic device which typically fits in or behind the wearer's ear, and

is designed to amplify and modulate sound for the wearer. Earlier devices, known as ear
trumpets or ear horns,
[1][]
were passive funnel!like amplification cones designed to gather sound
energy and direct it into the ear canal. "imilar devices include the bone anchored hearing aid,
and cochlear implant.
Contents
[hide]
1 #ypes
o 1.1 $nvisible in canal aids
o 1. %ody worn aids
o 1.& %ehind the ear aids '%#E(
1.&.1 )eceiver in the *anal+Ear
'*)#+)$*+)$#E(
1.&. Earmolds
o 1., $n the ear aids '$#E(
o 1.- $nvisible in canal hearing aids '$$*(
o 1.. E/tended wear hearing aids
o 1.0 1pen!fit devices
o 1.2 3ersonal, user, self, or consumer
programmable
o 1.4 5isposable hearing aids
o 1.16 %one anchored hearing aids '%A7A(
o 1.11 Eyeglass aids
#echnology
o .1 *ompatibility with telephones
o . 8ireless hearing aids
o .& 5irectional microphones
o ., #elecoil
.,.1 9egislation affecting use
o .- 5irect audio input
o .. 3rocessing
& $ndications
, Ad:ustment
- Evaluation
. )egulation
o ..1 $reland
o .. ;nited "tates
0 3urchase costs
o 0.1 Australia
o 0. *anada
o 0.& $celand
o 0., $ndia
o 0.- ;<
o 0.. ;"
2 %atteries
4 "ee also
16 )eferences
11 E/ternal links
[edit]#ypes
#here are many types of hearing aids 'also known as hearing instruments(, which vary in
si=e, power and circuitry. Among the different si=es and models are>
?$7 illustration of different hearing aid types.
[edit]Invisible in canal aids
#his style of hearing aids fits inside the ear canal completely, leaving little to no trace of an
installed hearing aid visible.
[edit]Body worn aids
#his was the first type of hearing aid invented by 7arvey @letcher while working at %ell
9aboratories.
[&]
%ody aids consist of a case and an earmold, attached by a wire. #he case
contains the electronic amplifier components, controls and battery while the earmold typically
contains a miniature loudspeaker. #he case is typically about the si=e of a pack ofplaying
cards and is carried in a pocket or on a belt.
[,]
8ithout the si=e constraints of smaller hearing
devices body worn aid designs can provide large amplification and long battery life at a lower
cost. %ody aids are still marketed in emerging markets because of their lower cost.
[,]
[edit]Behind the ear aids (BTE)
A pair of %#E hearing aids
%#E aids consist of a case, an earmold or dome and a connection between them. #he case
contains the electronics, controls, battery, microphone's( and often the loudspeaker. Aenerally,
the case sits behind the pinna with the connection from the case coming down the front into the
ear. #he sound from the instrument can be routed acoustically or electrically to the ear. $f the
sound is routed electrically, the speaker 'receiver( is located in the earmold or an open!fit dome,
while acoustically coupled instruments use a plastic tube to deliver the sound from the caseBs
loudspeaker to the earmold.
[-]
%#Es can be used for mild to profound hearing loss. As the electrical components are located
outside the ear, the chance of moisture and earwa/ damaging the components is reduced,
which can increase the durability of the instrument. %#Es are also easily connected to assistive
listening devices, such as @C systems, to directly integrate sound sources with the instrument.
%#E aids are commonly worn by children who need a durable type of hearing aid.
[,]
"Mini" BTE (or "on-the-ear") aids> A new type of %#E aid called the mini %#E 'or Don!
the!earD( aid. $t also fits behind+on the ear, but is smaller. A very thin, almost invisible
tube is used to connect the aid to the ear canal. Cini %#Es may have a comfortable ear
piece for insertion 'Dopen fitD(, but may also use a traditional earmold. Cini %#Es allow
not only reduced occlusion or Dplugged upD sensations in the ear canal, but also increase
comfort, reduce feedback and address cosmetic concerns for many users.
[.]
[edit]Receiver in the Canal/Ear (CRT/RIC/RITE)
%#E hearing instruments that place the loudspeaker directly in the ear without a fitted
earmold are often referred to as E)eceiver in the *analF instruments. #hese instruments use
soft ear inserts, typically of silicone, to position the loudspeaker in the patientBs ear.
"ome of the advantages with this approach include improved sound Guality, reduced case
si=e, Eopen!fitF technology, and immediate patient fitting.
[citation needed]
[edit]Earmolds
An earmold is created from an impression taken of the individual's outer ear. #his usually
ensures a comfortable fit and reduces the possibility of feedback.
[,]
Earmolds are made from
a variety of hard 'firm( and soft 'pliable( materials. #he color of the case and earmold of a
%#E aid can be modified and optional decorations can be added.
[citation needed]
[edit]In the ear aids (ITE)
#hese devices fit in the outer ear bowl 'called the concha(H they are sometimes visible when
standing face to face with someone. $#E hearing aids are custom made to fit each
individual's ear. #hey can be used in mild to some severe hearing losses. @eedback, a
sGuealing+whistling caused by sound 'particularly high freGuency sound( leaking and being
amplified again, may be a problem for severe hearing losses.
[citation needed]
"ome modern
circuits are able to provide feedback regulation or cancellation to assist with this. Ienting
may also cause feedback. A vent is a tube primarily placed to offer pressure eGuali=ation.
7owever, different vent styles and si=es can be used to influence and prevent feedback.
[0]
#raditionally, $#Es have not been recommended for young children because their fit could
not be as easily modified as the earmold for a %#E, and thus the aid had to be replaced
freGuently as the child grew.
[citation needed]
7owever, there are new $#Es made from
a silicone type material that mitigates the need for costly replacements. $#E hearing aids
can be connected wirelessly to @C systems, for instance with a body!worn @C receiver with
induction neck!loop which transmits the audio signal from the @C transmitter inductively to
the telecoil inside the hearing instrument.
$#* aids are smaller, filling only the bottom half of the e/ternal ear. #he aid cannot be seen
when face to face with the wearer. C$* and *$* aids are generally not visible unless the
viewer looks directly into the wearer's ear.
[2][4]
#hese aids are intended for mild to
moderately!severe losses. *$*s are usually not recommended for people with good low
freGuency hearing, as the occlusion effect is much more noticeable.
[16]
$n!the!ear hearing aids are typically more e/pensive than behind!the!ear counterparts of
eGual functionality, because they are custom fitted to the patient's ear. $n fitting, an
audiologist takes a physical impression 'mold( of the ear. #he mold is scanned by a
speciali=ed*A5 system, resulting in a &5 model of the outer ear. 5uring modeling, the
venting tube is inserted. #he digitally modeled shell is printed using a rapid
prototyping techniGue such as stereolithography. @inally, the aid is assembled and shipped
to the audiologist after a Guality check.
[11]
[edit]Invisible in canal hearing aids (IIC)
#his type of hearing aid fitting is not visible when worn. #his is because it fits deeper in the
canal than other types, so that it is out of view even when looking directly into the ear bowl
'concha(. A comfortable fit is achieved because the shell of the aid is custom!made to the
individual ear canal after taking a mould. $nvisible hearing aid types use venting and their
deep placement in the ear canal to give a more natural e/perience of hearing. ;nlike other
hearing aid types, with the $$* aid the ma:ority of the ear is not blocked 'occluded( by a large
plastic shell. #his means that sound can be collected more naturally by the shape of the ear,
and can travel down into the ear canal as it would with unassisted hearing. "ome models
allow the wearer to use a mobile phone as a remote control to alter memory and volume
settings, instead of taking the $$* out to do this. $$* types are most suitable for users up to
middle age, but are not suitable for more elderly people.
[edit]Etended wear hearing aids
Main article: Extended wear hearing aid
E/tended wear hearing aids are hearing devices that are non!surgically placed in the ear
canal by a hearing professional. #he e/tended wear hearing aid represents the first
DinvisibleD hearing device. #hese devices are worn for 1J& months at a time without
removal. #hey are made of soft material designed to contour to each user and can be used
by people with mild to moderately severe hearing loss. #heir close pro/imity to the ear drum
results in improved sound directionality and locali=ation, reduced feedback, and improved
high freGuency gain.
[citation needed]
8hile traditional %#E or $#* hearing aids reGuire daily
insertion and removal, e/tended wear hearing aids are worn continuously and then replaced
with a new device. ;sers can change volume and settings without the aid of a hearing
professional. #he devices are very useful for active individuals because their design protects
against moisture and earwa/ and can be worn while e/ercising, showering, etc. %ecause
the deviceBs placement within the ear canal makes them invisible to observers, e/tended
wear hearing aids are popular with those who are self!conscious about the aesthetics of
%#E or $#* hearing aid models. As with other hearing devices, compatibility is based on an
individualBs hearing loss, ear si=e and shape, medical conditions, and lifestyle. #he
disadvantages include regular removal and reinsertion of the device when the battery dies,
inability to go underwater, earplugs when showering, and for some discomfort with the fit
since it is inserted deeply in the ear canal, the only part of the body where skin rests directly
on top of bone.
[edit]!"en-#it devices
D1pen!fitD or D1ver!the!EarD '1#E( hearing aids are small behind!the!ear type devices. #his
type is characteri=ed by a minimal amount of effect on the ear canal resonances, as it
traditionally leaves the ear canal as open as possible, often only being plugged up by a
small speaker resting in the middle of the ear canal space. #raditionally, these hearing aids
have a small plastic case behind the ear and a small clear tube running into the ear canal.
$nside the ear canal, a small soft silicone dome or a molded, highly vented acrylic tip holds
the tube in place. #his design is intended to reduce the occlusion effect. *onversely,
because of the increased possibility of feedback, and because an open fit allows low
freGuency sounds to leak out of the ear canal, they are limited to moderately severe high!
freGuency losses. 8hile the design approach is attractive to a general hearing aid user,
open!fit devices can by their design have problems when connected to Assistive 9istening
5evices 'A95's(. #his problem has been addressed by manufacturers, who provide
assistive listening devices that can be paired with the hearing aid.
[edit]$ersonal% &ser% sel#% or cons&mer "rogrammable
#he personal programmable, consumer programmable, consumer ad:ustable, or self
programmable hearing aid allows the consumer to ad:ust their own hearing aid settings to
their own preference using their own 3*. 3ersonal programmable hearing aid
manufacturers or dealers can also remotely ad:ust these types of hearing aids for the
customer. Available in all hearing aid styles, these hearing aids differ from traditional hearing
aids only in that they are ad:ustable by the consumer.
[edit]'is"osable hearing aids
5isposable hearing aids are hearing aids that have a non!replaceable battery. #hese aids
are designed to use power sparingly, so that the battery lasts longer than batteries used in
traditional hearing aids. 5isposable hearing aids are meant to remove the task of battery
replacement and other maintenance chores 'ad:ustment or cleanings(. #o date, two
companies have brought disposable hearing aids to market> "ongbird 7earing, and 9yric.
[citation needed]
"ongbird is a %#E hearing aid that is bought online and worn like any other %#E
device. 8hen it runs out, the user replaces it with a new one. 9yric is implanted deep in the
ear canal by a professional. 8hen it runs out, it must be removed and replaced with a new
one by a professional.
[edit]Bone anchored hearing aids (B()()
Main article: Bone anchored hearing aid
#he %A7A is an auditory prosthetic based on bone conduction which can
be surgically implanted. $t is an option for patients without e/ternal ear canals, when
conventional hearing aids with a mould in the ear cannot be used. #he %A7A uses
the skull as a pathway for sound to travel to the inner ear. @or people with conductive
hearing loss, the %A7A bypasses the e/ternal auditory canal and middle ear, stimulating the
functioning cochlea. @or people with unilateral hearing loss, the %A7A uses the skull to
conduct the sound from the deaf side to the side with the functioning cochlea.
$ndividuals under the age of two 'five in the ;"A( typically wear the %A7A device on a
"oftband. #his can be worn from the age of one month as babies tend to tolerate this
arrangement very well. 8hen the child's skull bone is sufficiently thick, a titanium DpostD can
be surgically embedded into the skull with a small abutment e/posed outside the skin. #he
%A7A sound processor sits on this abutment and transmits sound vibrations to the e/ternal
abutment of the titanium implant. #he implant vibrates the skull and inner ear, which
stimulate the nerve fibers of the inner ear, allowing hearing.
#he surgical procedure is simple both for the surgeon, involving very few risks for the
e/perienced ear surgeon. @or the patient, minimal discomfort and pain is reported. 3atients
may e/perience numbness of the area around the implant as small superficial nerves in the
skin are sectioned during the procedure. #his often disappears after some time. #here is no
risk of further hearing loss due to the surgery. 1ne important feature of the %aha is that, if a
patient for whatever reason does not want to continue with the arrangement, it takes the
surgeon less than a minute to remove it. #he %aha does not restrict the wearer from any
activities such as outdoor life, sporting activities etc.
A %A7A can be connected to an @C system by attaching a miniaturi=ed @C receiver to it.
#wo main brands manufacture %A7As today ! the original inventors *ochlear, and the
hearing aid company 1ticon.
[edit]Eyeglass aids
5uring the late 14-6s through 1406s, before in!the!ear aids became common 'and in an era
when thick!rimmed eyeglasses were popular(, people who wore both glasses and hearing
aids freGuently chose a type of hearing aid that was built into the temple pieces of the
spectacles.
[citation needed]
7owever, the combination of glasses and hearing aids was infle/ible>
the range of frame styles was limited, and the user had to wear both hearing aids and
glasses at once or wear neither. #oday, people who use both glasses and hearing aids can
use in!the!ear types, or rest a %#E neatly alongside the arm of the glasses. #here are still
some speciali=ed situations where hearing aids built into the frame of eyeglasses can be
useful, such as when a person has hearing loss mainly in one ear> sound from a
microphone on the DbadD side can be sent through the frame to the side with better hearing.
#his can also be achieved by using *)1" or bi!*)1" style hearing aids, which are
now wireless in sending sound to the better side.
*"ectacle hearing aids are generally worn by people with a hearing loss who either prefer
a more cosmetic appeal of their hearing aids by being attached to their glasses or where
sound cannot be passed in the normal way, via a hearing aids, perhaps due to a blockage in
the ear canal. pathway or if the client suffers from continual infections in the ear. "pectacle
aids come in two forms, bone conduction spectacles and air conduction spectacles.
Bone Cond&ction *"ectacles "ounds are transmitted via a receiver attached from the arm
of the spectacles which are fitted firmly behind the boney portion of the skull at the back of
the ear, 'mastoid process( by means of pressure, applied on the arm of the spectacles. #he
sound is passed from the receiver on the arm of the spectacles to the inner ear 'cochlea(,
via the bony portion. #he process of transmitting the sound through the bone reGuires a
great amount of power. %one conduction aids generally have a poorer high pitch response
and are therefore best used for conductive hearing losses or where it is impractical to fit
standard hearing aids. (ir Cond&ction *"ectacles ;nlike the bone conduction spectacles
the sound is transmitted via hearing aids which are attached to the arm or arms of the
spectacles. 8hen removing your glasses for cleaning, the hearing aids are detached at the
same time. 8hilst there are genuine instances where spectacle aids are a preferred choice,
they may not always be the most practical option.
)ecently, a new type of eyeglass aid was introduced. #hese 'hearing glasses' feature
directional sensitivity> four microphones on each side of the frame effectively work as two
directional microphones, which are able to discern between sound coming from the front
and sound coming from the sides or back of the user.
[1]
#his improves the signal!to!noise
ratio by allowing for amplification of the sound coming from the front, the direction in which
the user is looking, and active noise control for sounds coming from the sides or behind.
1nly very recently has the technology reGuired become small enough to be fitted in the
frame of the glasses. As a recent addition to the market, this new hearing aid is currently
available only in the ?etherlands and %elgium.
[1&]
[edit]#echnology
See also: History of hearing aids
[edit]Com"atibility with tele"hones
A sign in a train station e/plains that the public announcement system uses a D7earing $nduction 9oopD
'Audio induction loop(. 7earing aid users can use a telecoil '#( switch to hear announcements directly
through their hearing aid receiver.
A hearing aid and a telephone are DcompatibleD when they can connect to each other in a
way that produces clear, easily!understood sound. #he term DcompatibilityD is applied to all
three types of telephones 'wired, cordless, and mobile(. #here are two ways telephones and
hearing aids can connect with each other>
(co&stically+ the sound from the phone's speaker is picked up by the hearing aid's
microphone.
Electromagnetically+ the signal inside the phone's speaker is picked up by the hearing
aid's DtelecoilD or D#!coilD, a special loop of wire inside the hearing aid.
?ote that telecoil coupling has nothing to do with the radio signal in a cellular or cordless
phone> the audio signal picked up by the telecoil is the weak electromagnetic field that is
generated by the voice coil in the phone's speaker as it pushes the speaker cone back and
forth.
#he electromagnetic 'telecoil( mode is usually more effective than the acoustic method. #his
is mainly because the microphone is automatically switched off when the hearing aid is
operating in telecoil mode, so background noise is not amplified. "ince there is an electronic
connection to the phone, the sound is clearer and distortion is less likely. %ut in order for this
to work, the phone has to be hearing!aid compatible. Core technically, the phone's speaker
has to have a voice coil that generates a relatively strong electromagnetic field. "peakers
with strong voice coils are more e/pensive and reGuire more energy than the tiny ones used
in many modern telephonesH phones with the small low!power speakers cannot couple
electromagnetically with the telecoil in the hearing aid, so the hearing aid must then switch
to acoustic mode. Also, many mobile phones emit high levels of electromagnetic noise that
creates audible static in the hearing aid when the telecoil is used. A workaround that
resolves this issue on many mobile phones is to plug a wired 'not %luetooth( headset into
the mobile phoneH with the headset placed near the hearing aid the phone can be held far
enough away to attenuate the static.
1n Carch 1, 660, the #elecommunications $ndustry Association issued the #$A!
162& standard, which gives manufacturers of cordless telephones the ability to test their
products for compatibility with most hearing aids that have a #!*oil magnetic coupling mode.
8ith this testing, digital cordless phone manufacturers will be able to inform consumers
about which products will work with their hearing aids.
[1,]
#he American ?ational "tandards $nstitute 'A?"$( has a ratings scale for compatibility
between hearing aids and phones>
8hen operating in acoustic 'Microphone( mode, the ratings are from C1 'worst( to C,
'best(.
8hen operating in electromagnetic 'Telecoil( mode, the ratings are from #1 'worst( to #,
'best(.
#he best possible rating is C,+#, meaning that the phone works well in both modes.
5evices rated below C& are unsatisfactory for people with hearing aids.
Iarious ;" mobile phone providers have special pages on their websites where they list
hearing!aid compatible models>
A#K#
Areat*all
"print
#!Cobile
;" *ellular
Ieri=on
[edit],ireless hearing aids
)ecent hearing aids include wireless hearing aids. 1ne hearing aid can transmit to the other
side so that pressing one aid's program button simultaneously changes the other aid, so
that both aids change background settings simultaneously. @C listening systems are now
emerging with wireless receivers integrated with the use of hearing aids. A separate wireless
microphone can be given to a partner to wear in a restaurant, in the car, during leisure time,
in the shopping mall, at lectures, or during religious services. #he voice is transmitted
wirelessly to the hearing aids eliminating the effects of distance and background noise. @C
systems have shown to give the best speech understanding in noise of all available
technologies. @C systems can also be hooked up to a #I or a stereo.
[citation needed]
., gigahert= %luetooth connectivity is the most recent innovation in wireless interfacing for
hearing instruments to audio sources such as #I streamers or %luetooth enabled mobile
phones. *urrent hearing aids generally do not stream directly via %luetooth but rather do so
through a secondary streaming device 'usually worn around the neck or in a pocket(, this
bluetooth enabled secondary device then streams wirelessly to the hearing aid but can only
do so over a short distance. #his technology can be applied to ready!to!wear devices '%#E,
Cini %#E, )$E, etc.( or to custom made devices that fit directly into the ear.
[citation needed]

1ticon hearing aids for use with %luetoothwireless devices.

3honak wireless @C system

)e"ound Alera 7earing Aid

)e"ound Alera ;nite 8ireless Accessories

$n developed countries @C systems are considered a cornerstone in the treatment of
hearing loss in children. Core and more adults discover the benefits of wireless @C systems
as well, especially since transmitters with different microphone settings and %luetooth for
wireless cell phone communication have become available.
[1-]
Cany theatres and lecture halls are now eGuipped with assistive listening systems that
transmit the sound directly from the stageHaudience members can borrow suitable receivers
and hear the program without background noise. $n some theatres and churches @C
transmitters are available that work with the personal @C receivers of hearing instruments.
[1.]
[edit]'irectional micro"hones
Cost older hearing aids have only an omnidirectional microphone. An omnidirectional
microphone amplifies sounds eGually from all directions. $n contrast, a directional
microphone amplifies sounds from in front more than sounds from other directions. #his
means that sounds originating from the direction the listener is facing are amplified more
than sounds coming from behind or other directions. $f the speech is in front of the listener
and the noise is from a different direction, then compared to an omnidirectional microphone,
a directional microphone provides a better signal to noise ratio. $mproving the signal to
noise ratio improves speech understanding in noise. 5irectional microphones are the
second best method to improve the signal to noise ratio 'the best method is an @C system(.
[10]
Cany hearing aids now have both an omnidirectional and a directional microphone. #his is
because speech often comes from directions other than in front of the listener. ;sually, the
omnidirectional microphone mode is used in Guiet listening situations 'e.g. living room(
whereas the directional microphone is used in noisy listening situations 'e.g. restaurant(.
#he microphone mode is typically selected by using a switch. "ome hearing aids
automatically switch the microphone mode.
Adaptive directional microphones vary the direction of ma/imum amplification. #he direction
of amplification is varied by the hearing aid processor. #he processor attempts to provide
ma/imum amplification in the direction of the speech signal. ;nless the user manually
temporarily switches to a Drestaurant program, forward only modeD adaptive directional
microphones have a disadvantage of amplifying speech of other talkers in a restaurant. #his
makes it difficult for the processor to select the desired speech signal. Another disadvantage
is that noise often mimics speech characteristics, making it difficult to separate the speech
from the noise. 5espite the disadvantages, adaptive directional microphones can provide
improved speech recognition in noise
[12]
5irectional microphones only provide benefit when the distance to the talker is small. $n
contrast, an @C system continues to provide a better signal to noise ratio even at larger
speaker to talker distances.
[14]
[edit]Telecoil
Audio induction loops, sometimes referred to as telecoils or #!coils 'from D#elephone *oilsD(,
allow audio sources to be directly connected to a hearing aid, which is intended to help the
wearer filter out background noise. #hey can be used with telephones, @C systems 'with
neck loops(, and induction loop systems 'also called Dhearing loopsD( that transmit sound to
hearing aids from public address systems and #Is. $n the ;< and the ?ordic countries,
hearing loops are widely used in churches, shops, railway stations, and other public places.
$n the ;.".A., telecoils and hearing loops are gradually becoming more common. Audio
induction loops, telecoils and hearing loops are gradually becoming more common also
in "lovenia.
A #!coil consists of a metal core 'or rod( around which ultra!fine wire is coiled. #!coils are
also called induction coils because when the coil is placed in a magnetic field, an alternating
electrical current is induced in the wire ')oss, 66bH )oss, 66,(. #he #!coil detects
magnetic energy and transduces 'converts( it to electrical energy. $n the ;nited "tates,
the #elecommunications $ndustry Association's #$A!162& standard, specifies how analog
handsets can interact with telecoil devices, to ensure the optimal performance.
[6]
Although #!coils are effectively a wide!band receiver, interference is unusual in most hearing
loop situations. $nterference can manifest as a bu==ing sound, which varies in volume
depending on the distance the wearer is from the source. "ources are electromagnetic
fields, such as *)# computer monitors, older fluorescent lighting, some dimmer switches,
many household electrical appliances and airplanes.
#he states of @lorida and Ari=ona have passed legislation that reGuires hearing
professionals to inform patients about the usefulness of telecoils.
[edit]-egislation a##ecting &se
$n the ;nited "tates, the 7earing Aid *ompatibility Act of 1422 '7A* Act( reGuires that
the @ederal *ommunications *ommission'@**( ensure that all telephones manufactured or
imported for use in the ;nited "tates after August 1424, and all EessentialF telephones, be
hearing aid!compatible 'through the use of a telecoil(.
DEssentialD phones are defined as Dcoin!operated telephones, telephones provided for
emergency use, and other telephones freGuently needed for use by persons using such
hearing aids.D #hese might include workplace telephones, telephones in confined settings
'like hospitals and nursing homes(, and telephones in hotel and motel rooms. "ecure
telephones, as well as telephones used with public mobile and private radio services, are
e/empt from the 7A* Act. D"ecureD phones are defined as Dtelephones that are approved
by the ;.". Aovernment for the transmission of classified or sensitive voice
communications.D
$n 66&, the @** adopted rules to make digital wireless telephones compatible with hearing
aids and cochlear implants. Although analog wireless phones do not usually cause
interference with hearing aids or cochlear implants, digital wireless phones often do
because of electromagnetic energy emitted by the phone's antenna, backlight, or other
components. #he @** has set a timetable for the development and sale of digital wireless
telephones that are compatible with hearing aids. #his effort promises to increase the
number of digital wireless telephones that are hearing aid!compatible.
[edit]'irect a&dio in"&t
A 5A$ plug on the end of a cable.
5irect audio input '5A$( allows the hearing aid to be directly connected to an e/ternal audio
source like a *5 player or an assistive listening device 'A95(. %y its very nature, 5A$ is
susceptible to far less electromagnetic interference, and yields a better Guality audio signal
as opposed to using a #!coil with standard headphones.
[edit]$rocessing
Every electronic hearing aid has at minimum a microphone, a loudspeaker 'commonly
called a receiver(, a battery, and electronic circuitry. #he electronic circuitry varies among
devices, even if they are the same style. #he circuitry falls into three categories based on
the type of audio processing 'analog or digital( and the type of control circuitry 'ad:ustable or
programmable(.
Analog audio
Ad:ustable control> #he audio circuit is analog with electronic components that
can be ad:usted. #he hearing professional determines the gain and other
specifications reGuired for the wearer, and then ad:usts the analog components
either with small controls on the hearing aid itself or by having a laboratory build the
hearing aid to meet those specifications. After the ad:ustment the resulting the audio
does not change any further, other than overall loudness that the wearer ad:usts
with a volume control. #his type of circuitry is generally the least fle/ible. #he first
practical electronic hearing aid with ad:ustable analog audio circuitry was based on
;" 3atent ,610,&-2, D7earing Aid Apparatus and AmplifierD by "amual Aordon
#aylor, filed in 14&.
3rogrammable control> #he audio circuit is analog but with additional electronic
control circuitry that can be programmed by an audiologist, oftentimes with more
than one program.
[1]
#he electronic control circuitry can be fi/ed during
manufacturing or in some cases, the hearing professional can use an e/ternal
computer temporarily connected to the hearing aid to program the additional control
circuitry. #he wearer can change the program for different listening environments by
pressing buttons either on the device itself or on a remote control or in some cases
the additional control circuitry operates automatically. #his type of circuitry is
generally more fle/ible than simple ad:ustable controls. #he first hearing aid with
analog audio circuitry and automatic digital electronic control circuitry was based on
;" 3atent ,,6-,01, DCethod of and means for adaptively filtering near!stationary
noise from speechD by 5 Araupe, A5 *ausey, filed in 140-. #his digital electronic
control circuitry was used to identify and automatically reduce noise in individual
freGuency channels of the analog audio circuits and was known as the Leta ?oise
%locker.
5igital audio, programmable control> %oth the audio circuit and the additional control
circuits are fully digital. #he hearing professional programs the hearing aid with an
e/ternal computer temporarily connected to the device and can ad:ust all processing
characteristics on an individual basis. @ully digital circuitry allows implementation of
many additional features not possible with analog circuitry, can be used in all styles of
hearing aids and is the most fle/ibleH for e/ample, digital hearing aids can be
programmed to amplify certain freGuencies more than others, and can provide better
sound Guality than analog hearing aids.
[]
@ully digital hearing aids can be programmed
with multiple programs that can be invoked by the wearer, or that operate automatically
and adaptively. #hese programs reduce acoustic feedback 'whistling(, reduce
background noise, detect and automatically accommodate different listening
environments 'loud vs soft, speech vs music, Guiet vs noisy, etc.(, control additional
components such as multiple microphones to improve spatial hearing, transpose
freGuencies 'shift high freGuencies that a wearer may not hear to lower freGuency
regions where hearing may be better(, and implement many other features. @ully digital
circuitry also allows control over wireless transmission capability for both the audio and
the control circuitry. *ontrol signals in a hearing aid on one ear can be sent wirelessly to
the control circuitry in the hearing aid on the opposite ear to ensure that the audio in
both ears is either matched directly or that the audio contains intentional differences that
mimic the differences in normal binaural hearing to preserve spatial hearing ability.
Audio signals can be sent wirelessly to and from e/ternal devices through a separate
module, often a small device worn like a pendant and commonly called a EstreamerF,
that allows wireless connection to yet other e/ternal devices. #his capability allows
optimal use of mobile telephones, personal music players, remote microphones and
other devices. 8ith the addition of speech recognition and internet capability in the
mobile phone, the wearer has optimal communication ability in many more situations
than with hearing aids alone. #his growing list includes voice activated dialing, voice
activated software applications either on the phone or on the internet, receipt of audio
signals from databases on the phone or on internet, or audio signals from television sets
or from global positioning systems. #he first practical, wearable, fully digital hearing aid
was invented by Caynard Engebretson, )obert E Corley, Mr. and Aerald ) 3opelka.
[&]
#heir work resulted in ;" 3atent ,,-,2,62, D7earing aids, signal supplying
apparatus, systems for compensating hearing deficiencies, and methodsD by A Caynard
Engebretson, )obert E Corley, Mr. and Aerald ) 3opelka, filed in 142,. #his patent
formed the basis of all subseGuent fully digital hearing aids from all manufacturers,
including those produced currently.
[edit]$ndications
7earing aids are incapable of truly correcting a hearing lossH they are an aid to make
sounds more accessible. #wo primary issues minimi=e the effectiveness of hearing aids>
8hen the primary auditory corte/ does not receive regular stimulation, this part of
the brain loses cells which process sound. *ell loss increases as the degree of hearing
loss increases.
5amage to the hair cells of the inner ear results in sensorineural hearing loss, which
affects the ability to discriminate between sounds. #his often manifests as a decreased
ability to understand speech, and simply amplifying speech 'as a hearing aid does( is
often insufficient to improve speech perception.
[edit]Ad:ustment
7earing aids are incapable of truly correcting a hearing lossH they are an aid to make
sounds more accessible. #hree primary issues minimi=e the effectiveness of hearing aids>
#he occlusion effect is a common complaint, especially for new users. #hough if the aids
are worn regularly, most people will become acclimated after a few weeks. $f the effect
persists, an audiologist or 7earing $nstrument "pecialist can sometimes further tune the
hearing aid's(.
#he compression effect> #he amplification needed to make Guiet sounds audible, if
applied to loud sounds would damage the inner ear 'cochlear(. 9ouder sounds are
therefore reduced giving a smaller audible volume range and hence inherent distortion.
#he initial fitting appointment is rarely sufficient, and multiple follow!up visits are often
necessary. Cost audiologists or 7earing $nstrument "pecialists will recommend an up!
to!date audiogram at the time of purchase and at subseGuent fittings.
[edit]Evaluation
#here are several ways of evaluating how well a hearing aid compensates for hearing loss.
1ne approach is audiometry which measures a sub:ect's hearing levels in laboratory
conditions. #he threshold of audibility for various sounds and intensities is measured in a
variety of conditions. Although audiometric tests may attempt to mimic real!world conditions,
the patient's own every day e/periences may differ. An alternative approach is self!report
assessment, where the patient reports their e/perience with the hearing aid.
[,][-]
7earing aid outcome can be represented by three dimensions>
[.]
1. hearing aid usage
. aided speech recognition
&. benefit+satisfaction
[edit])egulation
[edit]Ireland
9ike much of the $rish health care system, hearing aid provision is a mi/ture of public and
private.
7earing aids are provided by the "tate to children, 1A3s and to people whose income is at
or below that of the "tate 3ension. #he $rish "tate hearing aid provision is e/tremely poorH
people often have to wait for two years for an appointment.
$t is estimated that the total cost to the "tate, of supplying one hearing aid, e/ceeds N,666.
[citation needed]
7earing aids are also available privately, and there is grant assistance available for insured
workers.
[0]
$rish ta/payers can also claim ta/ relief, at the standard rate, as hearing aids are recognised
as a medical device.
7earing aids in the )epublic of $reland are e/empt from IA#.
7earing aid providers in $reland, mostly belong to the $rish "ociety of 7earing Aid
Audiologists.
[edit].nited *tates
1rdinary hearing aids are *lass $ regulated medical devices under @ederal @ood and 5rug
Administration '@5A( rules.
[2]
A 140. statute e/plicitly prohibits any state reGuirement that is
Ddifferent from, or in addition to, any reGuirement applicableD to regulated medical devices
'which includes hearing aids( which relates Dto the safety and effectiveness of the
device.D
[4]
$nconsistent state regulation is preempted under the federal law.
[&6]
$n the late
1406s, the @5A established federal rules governing hearing aid sales,
[&1]
and addressed
various reGuests by state authorities for e/emptions from federal preemption, granting some
and denying others.
[&]
[edit]3urchase costs
7earing aid shop, 5ublin, $reland.
"everal industriali=ed countries supply free or heavily!discounted hearing aids through
theirpublicly funded health care system.
[edit](&stralia
#he Australian 5epartment of 7ealth and Ageing provides eligible Australian citi=ens and
residents with a basic hearing aid free!of!charge, though recipients can pay a Dtop upD
charge if they wish to upgrade to a hearing aid with more or better features. Caintenance of
these hearing aids and a regular supply of batteries is also provided, on payment of a small
annual maintenance fee.
[&&]
[edit]Canada
$n *anada, health care is a responsibility of the provinces. $n the province of 1ntario, the
price of hearing aids is partially reimbursed through the Assistive 5evices 3rogram of
the Cinistry of 7ealth and 9ong!#erm *are, up to O-66 for each hearing aid, every three
years. 9ike eye appointments, audiological appointments are no longer covered through the
provincial public health plan. Audiometric testing can still easily be obtained, often free of
charge, in private sector hearing aid clinics and some ear, nose and throat doctors offices.
7earing aids may be covered to some e/tent by private insurance or in some cases through
government programs such as 5epartment of Ieteran Affairs or 8orkplace "afety K
$nsurance %oard.
[edit]Iceland
"ocial $nsurance pays a one time fee of $"< &6,666 for any kind of hearing aid. 7owever,
the rules are complicated and reGuire that both ears have a significant hearing loss in order
to Gualify for reimbursement. %#E hearing aids range from $"< .6,666 to $"< &66,666.
[&,]
[edit]India
$n $ndia hearing aids of all kinds are easily available. ;nder *entral and state government
health services, the poor can often avail of free hearing devices. 7owever, market prices
vary for others and can range from )s 1,666 to )s 1-,666.
[edit]./
8ithin the ;<, the ?7" provides %#E hearing aids to ?7" patients, on long!term loan, free
of charge. %#Es are often the only style available, and private purchases may be necessary
if a user desires a different style. %atteries are free. 3rivate hearing aid purchases can cost
from P.66 to P&,-66.
[&-]
[edit].*
Cost private ;" health care providers do not provide coverage for hearing aids, so all costs
are usually borne by the recipient. #he cost for a single hearing aid can vary between O-66
to O.,666 or more, depending on the level of technology and whether the clinician bundles
fitting fees into the cost of the hearing aid. #hough if an adult has a hearing loss which
substantially limits ma:or life activities, some state!run vocational rehabilitation programs
can provide upwards of full financial assistance. "evere and profound hearing loss often
falls within the Dsubstantially limitingD category.
[&.]
9ess e/pensive hearing aids can be found
on the internet or mail order catalogs, but some in the O66 range tend to amplify the low
freGuencies of background noise, making it harder to hear the human voice.
[&0]
#he cost of hearing aids is a ta/!deductible medical e/pense for those who itemi=e medical
deductions.
[&2]
[edit]%atteries
8hile there are some rare instances that a hearing aid uses a rechargeable battery or a
long!life disposable battery, the ma:ority of modern hearing aids use one of five
standard %utton *ell Linc!air batteries. '1lder hearing aids often used mercury battery cells,
but these cells have become banned in most countries today.( Codern hearing aid button
cell types are typically referred to by their common number name or the color of their
packaging.
#hey are typically loaded into the hearing aid via a rotating battery door, with the flat side
'case( as the positive terminal 'cathode( and the rounded side as the negative terminal
'anode(.
#hese batteries all operate from 1.&- to 1.,-Iolts.
#he type of battery a specific hearing aid utili=es depends on the physical si=e allowable
and the desired lifetime of the battery, which is in turn determined by the power draw of the
hearing aid device. #ypical battery lifetimes run between 1 and 1, days 'assuming 1. hour
days(.
)earing (id Battery Ty"es
[&4]
Ty"e/
Color
Code
'imensions
('iameter0)eight)
Common .ses
*tandard
1ames
Misc 1ames
234 11.. mm Q -., mm
7igh!3ower %#E
s,*ochlear $mplants
$E*>
3),,,A?"$>
066&L5
.0-, .0-A, .0-AE, .0-A3, .0-*A, .0-*3, .0-73, .0-73R, .0-
$mplant 3lus, .0-3 '73(, .0-3A, .0-"A, .0-"3, A.0-, A.0-3,
A*.0-, A*.0-E, A*.0-E+EL, A*.0-EL, A*!.0-E, A3.0-,
%.0-3A, %.0-,, %4663A, *.0-, 5A.0-, 5A.0-7, 5A.0-7+?,
5A.0-?, 5A.0-R, 7.0-AE, 9.0-LA, CE4L, 3.0-, 3.0-iS,
3),,, 3),,3, 3).0-, 3).0-7, 3).0-3, 3)!.0-3A, 3L.0-,
3LA.0-, ).0-LA, ".0-A, I.0-, I.0-A, I.0-A#, I#.0-,
R9.0-, L.0-3R, LA.0-, LA.0-73
56 0.4 mm Q -., mm %#Es, $#Es
$E*>
3),2,A?"$>
0666L5
1&, 1&A, 1&AE, 1&A3, 1&73, 1&73R, 1&3, 1&3A, 1&"A, 1&LA,
A1&, A*1&, A*1&E, A*1&E+EL, A*1&EL, A*!1&E, A31&,
%1&%A, %61&,, %.3A, *3,2, 5A1&, 5A1&7, 5A1&7+?,
5A1&?, 5A1&R, E1&E, 91&LA, CE2L, 31&, 3)1&, 3)1&7,3)!
1&3A, 3L1&, 3LA1&, )1&LA, "1&A, I1&A, I#1&, I1&A#,
81&LA, R91&, LA1&
657 0.4 mm Q &.. mm mini%#Es, )$*s,$#*s
$E*>
3),1,A?"$>
066L5
&1, &1A, &1AE, &1A3, &173, &173R, &13, &13A,
&1"A, &1LA, A*&1, A*&1E, A*&1E+EL, A*&1EL, A*!
&1E, A3&1, %&1%A, %&1,, %&,03A, *3,1, 5A&1,
5A&17, 5A&17+?, 5A&1?, 5A&1R, E&1E, 7&1AE,
9&1LA, CE0L, 3&1, 3)&1, 3)&17, 3)!&13A, 3L&1,
3LA&1, )&1LA, "&1A, I&1A, I&1A#, I#&1, 8&1LA,
R9&1, LA&1
58 -.2 mm Q &.. mm *$*s, )$*s $E*>
3)06,A?"$>
066-L5
16, 16A, 16AE, 16A3, 165", 1673, 1673R, 16"A, 16;3, 63A,
&6, &6E, &6EL, &673R, A*16, A*16EL, A*16+&6,
A*16+&6E, A*16+&6EL, A*&6, A*&6E, A*&6E+EL,
A*&6EL, A*!&6E, A316, %616,, %6%A, %63A, *3&-,
5A16, 5A167, 5A167+?, 5A16?, 5A&6, 5A&6+16, 916LA,
CE16L, 316, 3)16, 3)167, 3)&67, 3)-&., 3)!163A,3)!
&63A, 3LA&6, )16LA, "16A, I16, I#16, I16A#, I1673,
I&6A#, 816LA, R916, LA16
4 -.2 mm Q .1 mm *$*s
$E*>
3).&,A?"$>
061L5
-A, -AE, -73R, -"A, A*-, A*-E, A3-, %03A, *3.&, *3-1,
9-LA, CE-L, 3-, 3)-7, 3)!-3A, 3)-1, )-LA, "-A, I-A#,
I#-, R9-, LA-