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So, you know you need a hearing aid. What now?

Adults who experience hearing loss let an average of seven years go by from the time they realize they’re missing things to doing something about it.

If you’re one of those in hearing loss limbo, don’t wait! Think of all the important information, jokes, and whispers you’d miss in seven years. Additionally, recent research shows that untreated hearing loss can increase risk for cognitive decline.

If you’re considering hearing aids, don’t wait any longer. Here’s a Q&A with one of New York City’s top audiologists, Ellen Lafargue, AuD, CCC-A.

Dr. Lafargue, what are the questions new clients ask most?

Almost always, the first questions are: What’s it going to look like? And then, how much will it cost?

How do you answer?

That depends. Generally, smaller means pricier, but higher-priced doesn’t necessarily mean better for you. Every client has choices as far as size, cost, and features.

What’s most important to know to make good decisions about hearing aids?

First, understand your own hearing loss. The majority of adult-onset hearing losses primarily affect the higher frequencies (high pitches). You may still hear low frequency sounds normally, but high frequencies are crucial to understanding speech. Give some thought to what situations give you the most trouble, and ask loved ones or colleagues what situations they see you struggling in most. Be ready to convey this information to your audiologist.

New hearing aid technology

What are some recent technology advances?

Over the past 10 years, “receiver in the ear(RIC) technology has become extremely popular.

An RIC hearing aid sits behind the ear and a tiny wire connects it to the “receiver” inside the ear. Before RICs, all hearing aids had their receivers in the hearing aid case itself, and a clear plastic tube connected it to a tight -fitting ear mold inside the ear.

What is the “receiver”?

Think of it as a miniature loudspeaker. When the receiver is moved into the ear, the hearing aid case just has to house the microphone (which collects the sound) and the computer chip (which processes the sound).

Did the RIC style become so popular because it’s less noticeable?

It’s a big reason. Since the receiver is in the ear, the hearing aid case is smaller, and the RIC’s wire is subtler than the standard style’s plastic tube.

Interestingly though, cosmetic appeal is not why RICs were developed. They’re meant to manage “feedback,” whistling sounds from the hearing aid’s microphone that plague some wearers of traditional hearing aids.

RICs often don’t require a tight fitting ear mold, so the trend has been toward “open fit.” Open fit receivers sit in the canal without closing it off. This is good for people who have mostly high-frequency hearing loss. When the canal isn’t filled with an ear mold, you use your natural hearing in the lower ranges while the aids make higher sounds louder. “Open fit,” RIC hearings aren’t right for everyone, but for many age-related hearing losses, it’s one of the best choices.

More hearing aid styles

What about the hearing aids that don’t rest behind your ear, but are in the ear itself?

There are a few types. Standard “in-the-ear(ITE) hearing aids fill the ear canal and the area around it. “In the canal(ITC) and “completely in the canal(CIC) hearing aids are smaller, and you only see a small part of it at the entrance of the canal. “Invisible in the canal(ITC) hearing aids are placed deep into the canal and are practically unnoticeable.

There’s another type called “extended wear,” which users can’t put in or remove by themselves. A professional inserts and replaces it when the battery dies about every three months. They aren’t visible from the outside, but they’re the only ones we’ve discussed so far that aren’t digital.

What’s the difference between digital and not digital?

If they’re not digital, they’re analog. Digital hearing aids enable much finer tuning to match the hearing loss.

Assuming people want the least conspicuous hearing aids, can anyone get the smallest ones?

For some people, the smallest hearing aids give them everything they need. But the smallest ones may not be powerful enough for some severe hearing losses. Furthermore, some ears aren’t large enough to accommodate the hearing aids that go deep into the canal, while other people just find it easier to handle a device that isn’t so tiny. Lastly, the user may want certain features that can’t be provided in a very small aid.

Fully loaded: important hearing aid features

What types of features can’t fit in the smallest hearing aids?

One is a telecoil, or t-coil, which gives you advantages in two situations: on the telephone, as most phones are telecoil compatible; and in “looped” environments. Some places like theaters, classrooms, ticket booths in the subway, and even taxicabs are “looped.” When you find you’re in a looped space (there are usually signs) and you switch to telecoil mode, you’ll just get the sound coming from the loop’s microphone.

Five or six years ago, Bluetooth-enabled hearing aids were introduced. If you wear one in each ear, they “communicate” with each other to improve your listening experience. For example, if there’s background noise on your left side, that aid may turn down its volume a bit, and signal this information to the right. The right aid then may zero in on a person talking to you. This connectivity improves your directional hearing, too.

Bluetooth hearing aids can give users the option for connectivity with their cell phones, music players, television, and more via an additional device that looks like a small remote control. The device “streams” the sound from the phone, TV, etc. right into both ears.

What to expect as a first-time hearing aid user

What are some surprises for first-time wearers?

I want clients to be prepared for the adjustment period. It isn’t like putting on a new pair of glasses and instantly seeing clearly. The first few days or weeks can be a little tough as your brain literally learns to process new digital sounds. You should visit the audiologist a few times to get the settings just right. Sometimes, a particular brand of hearing aid just isn’t best for one person, while it works perfectly for someone else with a similar hearing loss. Remember that you have time to decide on a new aid. (New York State law requires a 45-day trial period; other states have a 30-day trial; the law does stipulate dispensers’ right to a cancellation fee.)

Your audiologist may offer classes to help you get the most out of your hearing aids. Classes can also provide a mutually supportive environment for people who have hearing loss.

For me, the worst possible scenario is when someone purchases hearing aids that wind up sitting in a drawer. That can happen if the wearer isn’t prepared for the initial process and adjustment period, if the audiologist doesn’t have the right experience for a particular hearing loss, or if the audiologist and client aren’t communicating effectively.

For those who stick with it and work closely with an experienced audiologist, the quality-of-life payoff is huge.

About the Author: Ellen Lafargue, Au.D., CCC-A, is the Director of the Shelley and Steven Einhorn Audiology Center at the Center for Hearing and Communication (CHC) in Lower Manhattan. CHC is a 103-year-old nonprofit institution with a mission to keep people with hearing loss connected. A multidisciplinary hearing health practice, CHC offers audiological, communication therapy (speech and language) and emotional health and wellness services. Dr. Lafargue is a 30-year veteran at CHC and recognized as a top NYC audiologist.


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