Hearing aids or prostheses

In general, hearing aids (or prostheses) are the therapy of choice for mild or moderate hearing loss (hypakusis).

It must be borne in mind that the typology of hearing aid varies depending on the severity of the disorder, which can range from hearing loss to deafness. It can affect one or both ears.

There are different types of hearing loss.
Often people with impaired hearing only have difficulty in perceiving certain sounds:

• high notes (like children’s voices),
• weak tones (such as S and F),
• Voice of a person talking to other people.

Some people see a doctor because they don’t understand the people talking, even though they can hear them.
Therefore, an amplifier that increases the volume of the sounds is not always sufficient.
The difference between hearing aid and amplifier:

• The hearing aid detects and processes the sound quality depending on the frequency.
• The amplifier only increases the volume.

Digital and analog technologies of hearing aids

Hearing aid technology has long since overtaken the various traditional options.
Digital hearing aids are also called programmable hearing aids.
In these devices, both the audio circuits and additional control circuits are completely electronic.
The device is programmed externally via a connected computer.
The model therefore has fully personalized sound processing properties.
They can be programmed through various settings to improve the sound quality.
These hearing aids automatically reduce:

• the sound distortion,
• Background.

The latest generation devices are able to analyze and distinguish the sounds:

• Tune
• Background.

They can then increase the vocal volume and reduce the background noise.
They can also detect if the environment is particularly noisy to reduce the volume.
They can also be programmed to better hear:

• Television set
• Music.

These devices are manufactured, for example, by the company MAICO.
The latest generation of digital devices is tiny and almost invisible.
Of these prostheses, some have a Bluetooth device.
There are some digital hearing aids that reduce tinnitus (noise in the ear).
The use of batteries is recommended.

How to choose between a cochlear implant and a hearing aid

Hearing aids are often used by people who have moderate hearing loss. People affected by mild to moderate hearing loss have difficulty perceiving sounds and voices.
This is where the advantages of using hearing aids lie.
As technology advances, it is possible to:

• select different frequencies,
• amplify some sounds depending on the intensity of the hearing loss.

Hearing aids:

• do not need to be implanted surgically;
• are easy to store;
• the repair costs are low.

You can change the devices if a better technology has been developed.

It is important to wear the device all day because the ear has to get used to hearing with a device that amplifies the sounds.
If it is only used for a few hours a day, there is a risk that the sounds will then be perceived excessively loud.

Cochlear implants

Cochlear implants are recommended for people with profound sensorineural hearing loss, but are only considered after testing with hearing aids.

It is a neuroprosthesis, i.e. a prosthesis that replaces the transmission system of sensory information.
It replaces the cochlea and has the following components:

1. A computer with an antenna that receives the voices and sounds, converts them into electrical signals and sends them to an internal receiver.
2. An internal receiver with electrodes that processes the received information and transmits it to the auditory nerve.

The benefit of an implant depends on a few factors:

Of course, the duration and severity of the hearing loss can influence the result.
It might take some time to regulate the sound frequencies.
It is important that an experienced acoustician:

• Assignment
• Performs speech processor adjustment.

It can help affected children hear conversations and other ambient sounds.
It can also make telephone calls possible.

Some of the factors influencing the outcome are:

• Opportunity to learn and communicate,
• the depth at which the implant is inserted into the cochlea,
• the cause of hearing loss,
• duration of hearing loss (must not be too long),
• Heaviness of degeneration of nerves in the ear.

Why not have a cochlear implant?

Since cochlear implants require surgery, this could lead to complications such as:

• loss of taste,
• Convulsions
• facial contractures,
• partial numbness of the face,
• tinnitus,
• infections caused by staphylococcus,
• Paralysis.

If a person receives an implant at an advanced age, it is possible that the brain has problems converting the electrical signals into understandable speech.

Contraindications for hearing aids:

• Ossified cochlea, possible in case of meningitis (meningitis)
• Tympanic membrane perforation or recurrent ear infections
• Lesion of the eighth cranial nerve (auditory nerve)

Many people think that there may be problems with hearing aids when traveling by plane, but in fact this is not the case.

Bone conduction hearing aid

Bone conduction hearing aids are positioned on the skull bone. The device is programmed in such a way that electrical signals are converted into desired mechanical vibrations. The sound is transmitted through the skull bone to the inner ear, it runs parallel to the outer and middle ear.

This type of prosthesis is indicated in case of dysfunction of the outer or inner ear.
These products are better than traditional hearing aids.
Not only are they more durable and safe to use, they also guarantee the clarity of sound even in very noisy environments. They enable the perception of stereo sound.

This is usually observed in marine biologists who wear equipment that does not allow normal hearing of sounds, professional divers and passionate swimmers.

A device anchored to the bone is used to transmit or control the received sound.
These implants are inserted surgically.
The sound conduction bypasses the external auditory canal and reaches directly into the inner ear.

The advantage of this prosthesis is that there are no foreign bodies in the ear that can irritate the skin.

The operation consists in the implantation of a titanium device in the bones under the scalp.
It contains an audio processor to transmit sound vibrations that stimulate the nerve fibers in the inner ear.
This procedure supports hearing.
Through the bone integration process, the tissue of the surrounding skull bone connects to the external titanium housing.

Open-ear hearing aids

These devices consist of:

• a receiver behind the earpiece,
• a tube that guides the sound into the ear canal.

The open-ear hearing aids do not close the ear canal and allow people to hear the voices naturally.
The most common inconvenience of hearing aids is the occlusion effect.
The occlusion effect is the feeling of blocked ears.
Users hear the voice with a sound as if it were sounding in a barrel.
The reason for the occlusion effect is that these devices block the ear canal.
This changes:

• the natural resonance in the ear,
• the ability to capture an individual’s voice.

The open-ear hearing aids are small implanted devices above or behind the ear.
They do not obstruct the ear canal because the tubes are very fine.
They are so light that users don’t feel any weight.

What are the best hearing aids? How to make the right choice?

Hearing aid types suitable for mild to moderate hearing loss

Smaller devices that disappear completely in the ear canal and hollow of the auricle are helpful for mild hearing loss, but they are unable to amplify the sounds sufficiently if someone suffers from severe hearing loss

In front of the eardrum and devices completely in the ear canal (CIC – “Completely In the Canal”)
As the name suggests, this type of hearing aid is designed for the ear canal. The hearing aids, which sit directly in front of the eardrum (in the ear canal), are individually developed for people for whom aesthetic aspects play a role.
The CIC device is less noticeable in the ear. The device cannot perceive wind noise because it is protected by the ear.

It is not suitable for children, because their ear canal is subject to constant growth. The device is often criticized because the battery is very small and thus has a shorter lifespan compared to larger batteries.
In addition, no control functions are available on this device for:

• Volume
• Directional microphones.

Feedback could be an issue due to the small distance between microphone and speaker. The high price could also be a disadvantage.

Devices in the ear canal (ITC – “In The Canal”)
There are two subtypes of in-the-ear canal devices: ITC devices and CIC devices. The ITC devices are designed to be inserted into the ear canal, while the CIC devices are designed to hide almost completely in the ear.
These hearing aids are among the most expensive on the market, costing between 1,300 and 2,750 euros. Hearing aids and hearing aids can be claimed for tax purposes.

Types of hearing aids that work for mild or profound hearing loss

Devices in the ear (ITE – “In The Ear”)

There are two types of ITE devices:

1. Half Shell – the device is completely contained in the hollow of the auricle;
2. Full Shell – the device covers the conch cavity and enters the cymba of the outer ear.

Full shell hearing aid
It has larger sound amplifiers and switches and is also easy to use.
The ITE hearing aid has digital and conventional technology. There are also programmable hearing aids.
This device is suitable for adult hearing loss and is not recommended for children.
The device is visible and detects wind noise.

The prices of these hearing aids vary between 1,500 and 3000 euros.

Hearing aid types for almost all types of hearing loss

Behind-the-ear devices (BTE)
The BTE hearing aid is positioned above the ear and the electronics housing remains hidden behind it.
The speaker is inserted into the ear canal.
This device is one of the less expensive.
The device is recommended for people of all ages. Due to large batteries and strong amplifier, the BTE hearing aid provides more amplification than the other devices.
The cost of the BTE is between 1,200 and 2,700 euros.

Types of hearing aids for mild and moderate hearing loss of high-frequency sounds
There are some devices that are incorporated into the frame and transmit the sounds:

• by air, with an earplug connected to the temple, inserted into the ear canal.
• via the bone pathway over the mastoid (part of the temporal bone) behind the ear.

Open fitting hearing aids
An open-fitting hearing aid leaves the ear canal open and provides more comfort than the traditional hearing aid worn behind the ear. In addition, it is less visible and does not clog the ear canal, like other models. This device is able to eliminate the hollow sound often caused by standard hearing aids.

The open-fitting hearing aids amplify the sounds or frequencies that are difficult to perceive. The device is not damaged by earwax and moisture and is worn outside the ear.

How to find cost-effective hearing aids?

One must be careful when buying cheap hearing aids; the device must adapt to the ear and be appropriate to the hearing problems.

On the Internet you can also find used hearing aids, but you have to check the reliability of the seller well.

Marches
Some of the most popular brands are:

• Resound
• Oticon
• Rexton

• Hearing loss or hearing loss
• Ear canal inflammation or otitis externa: symptoms and causes
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