Hearing Aids

Treatment options for hearing loss. Introduction to hearing aids.

Hearing Loss

Hearing loss is usually gradual and sometimes it takes a family member to notice the hearing problem before you do. If you are older than 60, there is about one in three chance that you may suffer from some amount of hearing loss–and that rate climbs steadily as you age.

Hearing is an important sense which is an integral part of the human experience. If one cannot hear well, the person invariably reduces engagement with people and the world around him/her. It is frustrating not to be able to understand a conversation fully the likely cause of action is to reduce interaction with people. Hearing disability also makes one less aware of the surroundings increasing safety risks. Recent research has shown that untreated hearing loss has been linked to a higher risk of developing dementia.

While some types of hearing loss involving the outer and middle ear can be medically or surgically treated, most cases of hearing loss in adults stem from damage to the inner ear, where tiny hair cells turn sound vibrations into impulses that nerve cells then carry to the brain. Hearing loss resulting from hair cell damage (such as age-related hearing loss or noise induced hearing loss) cannot be resolved medically. This is where hearing aids become a possible option.


Hearing Aids Explained

In the past, we often associate inner ear related hearing loss as a part of ageing where one just lives with the condition. There is also a perception that hearing aids are for the very deaf and that they don’t work very well. However, over the past decade or so, digital signal processing has helped hearing aid technology progressed by leaps and bounds. Hearing Aids has helped people around the world with various degrees of hearing loss improve their communication ability, reduce the stress associated with trying to listen and help people continue to live productive and connected lives.

A hearing aid is electronic device that is worn inside or behind the ear. It works by amplifying sounds from the environment to the degree that compensates the hearing loss of the wearer. A hearing aid will not be able to restore ones hearing to normal but modern hearing aids are like miniature computers with advanced technology to help wearers make the most of ones residual hearing.


Hearing Aid Styles

Hearing aids comes in four main styles as follows:

  1. Behind‐the‐ear (BTE) aids. These are aids that are resting behind the ear connected and to an ear mould. They are relatively sturdy and easy to handle. Good for people with poor dexterity.
  2. Receiver in the canal / Mini-BTE aids. These are characterised by a very thin tube connects the aid to the ear canal. Often they can come in an open ear mould which reduces the “plugged up“ sensation hence may be a comfortable option. They are also relatively less visible than BTEs.
  3. In‐the‐ear  (ITE) / In‐the‐canal  (ITC) aids. These are custom type aids where all  parts  contained  in  a  shell,  which fills  in  the  ear  canal. They are relatively easier to  handle  than CICs.
  4. Completely‐in‐the‐canal  (CIC)   are the smallest  custom type hearing aid where all  parts  contained  in  tiny  cases, which  fits  completely  in the  ear  canal. Some users are attracted to the discrete form.


BTE                                     CIC2                                   ITC2                                   RIC


Hearing Aid Technology

The price of digital hearing aids can range from hundreds to thousands of dollars. Contrary to what some may believe, it is not so much the style but the technological features that determines the price. These features make a significant difference to benefit and comfort level each person receives from the hearing aid. Some of the more common features are:

Multiple channel Technology

Digital Hearing Aids divide the incoming sound to more than one frequency channel, processing the channels independently of one another, each channel capable to being adjusted as part of the fine-tuning process to match the particularities of each person’s hearing ability based on the hearing test results and requirements. Usually the more number of channels, the more expensive the hearing aids as they offer greater precision in matching the persons hearing loss.

Automatic Volume Adjustment

Digital technology allows has situation awareness to allow for the hearing aid volume to be automatically adjusted. It monitors the sound level to ensure that soft sounds are audible but loud sounds are not discomforting for the user.

Multiple Microphones

The most effective way to improve hearing of speech in noise is to select a hearing aid with at least two microphones. With inputs from a second microphone, the hearing aid can intelligently pick up sounds coming from a certain direction and provides the capacity to zoom towards a dominant voice.

Multiple Listening Programs

The listening needs of a user when he/she is using the phone may quite different compared to when he is communicating with a group of friends in a busy restaurant. With this, feature hearing aids come with different programs which he/she can choose from. The program can be activated with a button press or with a remote control.

Feedback management

This is a very important feature which reduces the tendency of the hearing aid to feedback (make a loud audible noise) and allows the wearer to have a more comfortable ear mould.

Digital Noise Reduction

People with hearing loss have a reduced ability to cope with background noise. Most digital hearing aids will have some way of intelligently distinguishing speech from noise and to selectively filter out unwanted noise.

Tinnitus Management

It is common for people with hearing loss to also suffer from ringing in their ears. Some hearing aids offer tinnitus management programmes such as musical tones and white noise and can be used therapeutically to lessen this disturbing perception.

Compatibility with mobile devices / telephones / Television

Many Hearing Aids today provides capability to connect with external audio inputs wirelessly. Sometimes additional add-on interfaces are required.


How do we choose a Hearing Aid?

You should first consult an Audiologist who specialises in diagnosing hearing loss and helping patients manage their condition. Based on the severity of your hearing condition, your listening needs and your lifestyle, the Audiologist will make several recommendations to help you to select a suitable hearing aid to meet your needs. It is important to know that this is just a beginning of your journey to better hearing. Just like buying a pair of new shoes is just the first part in training for a marathon, you only get maximum benefit from your hearing aids when you start training your brain to listen.


Better Adjustment to Hearing Aids.

Many people do not know that you need time to adjust to the new hearing aids. This is because the brain takes time to accustom to the sounds which you have missed for many years. Your new hearing aids will amplify all the sounds of your life. When your hearing was normal, all the extra noises you could hear were placed into your background so that they do not distract you. Until you have become accustomed to the sounds of life again you will have difficulty tuning them out. The time for the brain to fully adjust may take from 2 weeks to 3 months. It is therefore important to preserve in wearing your hearing aids even though they may seem too loud or harsh at first. Below are some tips that can help a new hearing aid user adapt to the new device.


  1. Start out slowly. For a start, it may be a good idea to begin to use the hearing aids in your own home for at least four hours a day when you have control of the environment. Allow your ears to rest and then put them on again.
  2. Find a conversation partner. Practise listening with your new hearing aids with one person by discussing about familiar topics in the absence of other distracting sounds. Once you are more comfortable, you can start introducing some background noise from the TV or radio. It may also be helpful to have your communication partner read aloud from a newspaper while to read along silently.
  3. Practise speech sound discrimination. Prepare a list of words that differ by a single sound (eg night / knife, top / pop, sell / tell) and get your conversation partner to say them. Watch the lip movement to observe the visual aspects of the sound production. Then repeat the task without watching and listen for the subtle sound differences.
  4. Extending listening situations. Once you have become more experienced with your new hearing aids, gradually include different listening environments and situations. Certainly group conversations will be significantly more difficult than one-on-one situations. Practise on lietening for the idea of what is being said rather than individual words.
  5. Work towards higher volume setting. Most new hearing aid users have been programmed with an initial volume setting that is less than optimal for comfort. For subsequent visits to your Audiologist, you should gradually have your hearing aids adjusted to actual prescribed amplification setting which would give you maximum benefit.


Finally and most importantly, persevere and do not give up. Remember that you did not loose your hearing overnight. Do not be discouraged and your hearing will continue to improve. Soon you will find that your hearing aids will soon become part of your everyday life and you begin to wonder why it took so long before you actually decided to get one!

About the Author: Gary Lee is Principal Audiologist in a public hospital in Singapore and the current president for the Society of Audiology Professsionals Singapore. For enquiries, please email audiologysingapore@gmail.com