Month: September 2014

Current Types Of Hearing Aids

Hearing aids have come a long way since the creation of the first electric hearing aid in 1898. It was the invention of the carbon microphone, transmitters, the digital signal processing chip (DSP), and the rapid development of computer technology that really helped transform the hearing aid to it’s present form. By the late 20th century, digital hearing aids became the standard.

There are a wide variety of types and styles of hearing aids (also referred to as hearing instruments) and they vary in size, power and circuitry. There are about a half dozen hearing aid manufacturers whose products are sold under many, many brand names, some of which you’ve probably heard of on television commercials or seen in big box stores or full service department stores.

According to the FDA (Food and Drug Administration) there is a difference between hearing aids and sound amplifiers. Hearing aids are meant to compensate for hearing loss and are considered a medical device and, thus, regulated by the FDA. Sound amplifiers are for amplifying environmental sounds for consumers with no hearing loss. The FDA does not consider these to be medical devices when labeled for recreational use only. However, certain safety regulations related to sound output levels still apply to these products.

There is no single style of hearing instrument(s) in today’s market place which is the perfect solution for each individual person. Differing degrees and types of hearing loss, lifestyles, associated symptoms, budgets, current technologies, color and other personal preferences all combine to have a significant influence on which hearing instruments offer the best personalized solution for each individual. For that reason, hearing instruments are made in many technological styles and sleek ergonomic designs to address the individual needs of every person. ihearingaids will help narrow down your search to find the hearing instrument which is best for you. The most common styles of hearing instruments include:

Completely-in-the-canal (CIC)

A completely-in-the-canal hearing aid is molded to fit inside your ear canal. It improves mild to moderate hearing loss in adults.

A completely-in-the-canal hearing aid:

  • is the smallest and least visible type

  • is less likely to pick up wind noise

  • uses very small batteries which have a shorter life and can be difficult to handle

  • doesn’t contain extra features such as volume control or a directional microphone

  • is susceptible to earwax clogging

In-the-canal (ITC)

An in-the-canal (ITC) hearing aid is custom molded and fits partly in the ear canal. This style can improve mild to moderate hearing loss in adults.

An in-the-canal hearing aid:

  • is less visible in the ear than larger styles

  • includes features that won’t fit on completely-in-the-canal aids, but may be difficult to adjust due to it’s small size

  • is susceptible to earwax clogging

In-the-ear (ITE)

An in-the-ear (ITE) hearing aid is custom made in two styles — one that fills most of the bowl-shaped area of your outer ear (full shell) and one that fills only the lower part (half shell). Both are helpful for people with mild to severe hearing loss.

An in-the-ear hearing aid:

  • includes features such as volume control and directional microphones that are easier to adjust

  • is generally easier to insert

  • uses larger batteries, which are easier to handle and last longer

  • is susceptible to earwax clogging

  • may pick up more wind noise than smaller devices

  • is more visible in the ear than smaller devices

Behind-the-ear (BTE)

A behind-the-ear (BTE) traditionally consists of a form fitting, colorized, plastic case, with an attached custom fit ear mold. BTE’s have historically been effective in addressing the larger range of hearing loss. The various sizes and stylized cases are typically moisture resistant and enclose the electronics, controls, battery, microphone and speaker. Generally, the case sits securely and weightlessly behind the ear with a short silicone tube extending from the case and discretely traveling down the front fold of the ear and into your custom ear mold which sits comfortably within your ear. The sound from the hearing instrument is then routed acoustically through this tube and delivered to and through the ear mold.

Recommended for the broadest range of hearing loss, BTE’s typically provide improved hearing and improved communicative capabilities.

Battery size is generally larger resulting in longer battery life. These hearing instruments often yield a sustained period of reasonably stable performance with a useful life expectancy of 5-7 years assuming no significant change in hearing acuity or hearing instrument abuse.


  • Easy to operate and manipulate

  • Good durability and longevity

  • Broadest hearing loss application and best range of pricing

  • Most trouble free, least expensive to service and maintain

There is a thin tube (or narrow tube) variation of the BTE, which is fit more typically only for specific types of hearing loss (typically extreme high frequency losses). As such, they are not recommended for everyone. Often such hearing instruments are merely masquerading as the more highly desired and effective RITE (Receiver-in-the-ear) styles.

Receiver-in-canal (RIC) or Receiver-in-the-ear (RITE)

(Receiver-in-the-Ear), also referred to as RIC (Receiver-in-the-Canal) – Initially seemingly similar to BTE hearing instruments in that there are choices of sleek highly ergonomic stylized cases of various colors and sizes that sit securely and unobtrusively above and behind the ear.

However, it is there that the similarities to BTE’s end. This newest state-of-the-art technological hearing instrument uses a cosmetically miniature, discreet wired receiver which attaches at the case and travels down and sits comfortably within the ear canal. There the micro receiver is protected with a soft comfortable open-fit flexible silicone dome or a miniature inconspicuous customized earmold. This means that the in-the-canal micro receiver is more efficiently amplifying directly within your ear canal, as opposed to having to be further away within the case.

This newest technological advancement allows for a more practical open fit in-the-ear-canal receiver which provides the wearer with superior clarity through delicate, discrete amplification.

The “open ear fitting” also provides for the natural “inclusion of sound” by including the desired natural sounds and speech that exist in your world. This inclusive technology results in a more brilliant reproduction of sounds that you have lost, and seek to regain as you remember them. Earlier hearing instruments all “exclude” the natural sounds and speech you want to hear by limiting you to only the sounds that come through its amplifier.

These are currently the most popular instruments for both patient and hearing professional alike. Their smaller ergonomic styles, shapes, sizes and technological capabilities make them typically the easiest and most effective hearing instrument products to fit, operate and maintain. As a result the wearer quickly experiences this revitalized real world sound connectivity, and can expect more trouble free use and longevity.

Battery size is sufficiently large resulting in longer battery life. These hearing instruments often yield a sustained period of reasonably stable performance with a useful life expectancy of 5-7 years assuming no significant change in hearing acuity, hearing instrument abuse, or continued technological advancements.

Recommended for the broadest range of hearing loss and typically provides the most beneficial improved hearing and communicative capabilities for the greatest longevity.

  • Benefits:

  • Reduced feedback

  • Better integrated and less distorted, softer amplification delivered more directly to the eardrum

  • More acceptable, cosmetically suitable and more discrete than traditional BTEs

  • Smaller cosmetically discreet miniature colorized sizes

  • Best technological digital application across a broader range of hearing loss

To determine the best hearing instrument for you, contact ihearingaids for a consultation….we’re here to help!

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Cochlear Implants versus Hearing Aids

There are three main components of the human ear: the outer ear, the middle ear, and the inner ear.

The basic anatomy of the human ear.

The basic anatomy of the human ear.

The outer ear includes the pinna, the visible part of the ear, as well as the ear canal which terminates at the eardrum, also called the tympanic membrane. The pinna serves to focus sound waves through the ear canal toward the eardrum. The eardrum is an airtight membrane, and when sound waves arrive there, they cause it to vibrate following the waveform of the sound.

The middle ear consists of a small air-filled chamber that is located medial to the eardrum. Within this chamber are the three smallest bones in the body, known collectively as the ossicles (incus, malleus, and stapes). They aid in the transmission of the vibrations from the eardrum to the inner ear. While the middle ear may seem unnecessarily complex, the purpose of its unique construction is to overcome the impedance mismatch between air and water, by providing impedance matching.

Also located in the middle ear are the stapedius and tensor tympani muscles which protect the hearing

Four types of wave forms

Four types of wave forms

mechanism through a stiffening reflex. The stapes transmits sound waves to the inner ear through the oval window, a flexible membrane separating the air-filled middle ear from the fluid-filled inner ear. The round window, another flexible membrane, allows for the smooth displacement of the inner ear fluid caused by the entering sound waves.

The inner ear consists of the cochlea, which is a spiral-shaped, fluid-filled tube. It is divided lengthwise by the organ of Corti, which is the main organ of mechanical to neural transduction. Inside the organ of Corti is the basilar membrane, a structure that vibrates when waves from the middle ear spread out through the cochlear fluid. The basilar membrane is tonotopic, so that each frequency has a characteristic place of

A brief diagram of the function of the basilar membrane.

A brief diagram of the function of the Basilar membrane.

resonance along it. Characteristic frequencies are high at the basal entrance to the cochlea, and low at the apex. Basilar membrane motion causes depolarization of the hair cells, specialized auditory receptors located within the organ of Corti. While the hair cells do not produce action potentials themselves, they release neurotransmitter at synapses with the fibers of the auditory nerve, which does produce action potentials. In this way, the patterns of oscillations on the basilar membrane are converted to spatio-temporal patterns of firings which transmit information about the sound to the brain stem.

As you can see, hearing is a complex process originating in the cochlea. The cochlea, a tiny snail shell shaped organ, is comprised of thousands of microscopic sensory cells. These sensory cells work like keys on a piano. Each sensory cell is organized and tuned to match a certain pitch. In a person with normal hearing, these cells respond to acoustic information in the environment and translate it into a neurological code that the brain can interpret. Understanding of sound happens in the brain; the ears are just the way in. The sensory cells have a very important role in this translation of acoustic information to a neurological code. If any of the sensory cells do not work properly, the information that arrives in the brain will be distorted and/or incomplete. The listener may have difficulty understanding what is said.

Speech is a complex acoustic signal. When a speech signal arrives at the cochlea, many sensory cells respond. Think of a sonata being played on a piano. Many keys are being played at once to make rich, full music. With hearing, many sounds are being “heard” at once to make sense of conversation, music, background noises, etc. When sensory cells are damaged and/or missing, incomplete and distorted sound arrives at the brain. Think about how a piece of music would sound when played on an out of tune instrument. This is comparative to speech coming through a cochlea with damaged and missing sensory cells. When the signal arrives at the brain, the music isn’t rich, full, or even recognizable. The listener has to work even harder to understand what he or she is listening to.
A cochlear implant is not a hearing aid. Rather, it is a neural prosthesis that may help to provide hearing to

A complex prosthesis surgically placed inside the skull.

A complex prosthesis surgically placed inside the skull.

people with severe to profound hearing loss by bypassing the damaged sensory cells of the cochlea. It is a procedure whereas a prosthetic electronic sensory device is utilized by surgical intervention. These implants normally consist of two components:

  1. the sound processor and transmitter microphone, worn externally, normally behind the ear lobe (or is magnetically attached through the skull next to the implant); and

  2. 2) the implanted component is the impulse receiver, intercepting the impulses from the external component and conveying these electrical impulses onto the the cochlear

This acts as a receiver of sound waves to the interpreting area of the brain. The patient’s traditional means of hearing, “acoustic hearing,” is then replaced with “electric hearing” through the cochlear implant.

Receiving a cochlear implant is a surgery and, as with any surgical procedure, the decision to have surgery should be after all other avenues of remediation have been thoroughly examined and exhausted. Every surgery comes with risk and those risks should be weighed with concern, care, and sensitivity; never should the decision to have surgery be based on fear or unrealistic expectations.

Externally worn hearing aids amplify sound. In a person with damaged sensory nerves in the cochlea, a hearing aid would provide an amplified sound which would arrive at a damaged cochlea. The amplified sounds don’t overcome the damage of the sensory cells, however, property diagnosed hearing loss (even from damaged nerve cells) may be improved with the use of the proper hearing instrument designed and programmed for one’s specific hearing loss. Unlike a surgical procedure, the wearing of an external hearing instrument does not come with the same risks as a cochlear implant; in fact, the risk factors for negative effects of hearing aids are practically non-existent.

As with any health or medical question, seek the advice of one or more qualified professionals and make your decisions after seriously weighing all possible procedures along with their respective risks and benefits.


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