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What did you say? . . . Hearing Aids Deciphered . . .

tobedetermined

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I started posting about hearing aids in the totally random thread but I thought that it might have a wider audience. Many of us have hearing problems and since the solutions are often crazy expensive some research is required. I did a deep dive into HAs (hearing aids) some months back so I thought I should share some of what I learned.

The first thing you need is a hearing test. Forget the online tests – they will just give you a very fuzzy idea of your problem. Only a test by a professional in a controlled environment is worthwhile. For this you must visit an ENT or a hearing aid store. The test will produce an audiogram - a graph displaying the bad news about your own hearing. They put you in a soundproof booth with headphones and play test tones for frequency response and they run through some word recognition tests. The end result will look like this:

costco-audiogram-stripped.jpg

I went to Costco - who will test you for free at one of their Hearing Centers. Any decent hearing aid store can do the same but they might not let you walk away with a copy of it for free because you can use it to shop around.

Here is what it means:

myloss.jpg


This is a simple graph of my hearing ability at different frequencies. The loudness level is measured in dB and for reference, 1 dB is the lowest level where the human ear can just hear a difference. As you can see, my hearing is normal until 1K (1000 Hertz) and then it dives abruptly down into the severe-profound loss area. The severity of your loss determines what type of HA is suitable. If your loss is mild-moderate you may get away with an OTC (over the counter) hearing aid, but only if you live in the US because most countries’ medical boards have not approved them for use – yet. The US allowed sales of OTC HAs starting in 2022 but they have had a huge return ratio at over 30% so something ain’t right.

Another option for the mild-moderate crowd is the new Apple AirPods Pro 2 which can work for the same type of loss, but you must have a recent Apple phone for them to work and you have to like the feel of earbuds constantly in your ear.

However, if your loss is severe or profound, you will need a real HA which requires a personalized setup – which is called ‘fitting’ where your audi (audiologist) dives into the software to tune your HA to your individual loss. Expensive? You bet!

More to follow . . .
 

tobedetermined

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Excluding the OTC HAs, the hearing aid business is controlled by a handful of big companies. Each of these corporations has gobbled up numerous brands which they have in their stable and which - more often than not – share the same technology. Most of these corporate giants – 3 Danish (Demant, GN Group, WS), 1 Swiss (Sonova) and 1 US based (Starkey) – also own their own retail hearing aid stores or their own chain of franchises around the world. So when you walk into a local hearing aid store it may be owned by or affiliated with one of these HA monsters. So this means that even though they may handle several brands, they will inevitably try to steer you towards their corporate brand which is the most profitable for them.

hearing-industry-map-sm.jpg


This industry map is available on the Hearing Tracker site. They are the best resource for hearing aid information that I have found. They also have a busy online forum which is invaluable if you want to learn as much as you can about hearing solutions.
 
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armedoldhippy

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i wish you had done this a year ago. it would, at the very least, have slowed me down in my search for an appropriate HA. my wife steered me to Beltone, a grievous error which i won''t let her forget. my Beltones (better than nothing :shucks: ) cost me out of pocket over $1500, and are no better (possibly worse) than a set of hearing aids i used to wear turkey hunting, which were $17 apiece. sure, i can hear lots of stuff that i couldn't before, but i am still unable to tell what is being said unless up close and personal. music is just jumbled noise since EVERYTHING is amplified. to enjoy music, i take the HAs out and crank that shit up...
 

tobedetermined

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Sorry about that, aoh. That said, while I don't know your loss or anything about Beltone, they should work better than what you have. I would lay the blame completely on the store and the fitter. Go back and demand a new fitting. I have jumped into the software of my hearing aid and this shit ain't rocket science. While the software is unique to every brand, it all seems to work the same. You plunk in the numbers and it will generate a solution for the patient. Since these companies all sell worldwide, the fitting software was designed to be easy to use by any idiot in any hearing aid store anywhere and it should provide a reasonably acceptable generic solution. After that, the audi is supposed to do their damn job and listen to you and make small adjustments to suit your needs.

And speaking of stores, you will typically find 2 levels of expertise - not to say one is better than the other. An audiologist - masters or PhD grad or a hearing instrument specialist - HIS - a 2 year program. Despite the education the HIS might be better at fitting but that will vary person by person. The biggest complaints that I have seen in the forums are aimed at the audi rather than the HA.
 

tobedetermined

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Types of Hearing Aids

While there are numerous different types of hearing aids, stores are reporting that the majority of new customers seemingly are walking out of the store with a RIC because of their versatility and convenience, so I will concentrate on these. RIC stands for Receiver In Canal which are also called Receiver In The Ear (RITE). These are known as open-fit HAs and they sit behind your ear and a wire connects it to a receiver which sits in the ear canal with a soft plastic dome partially or fully sealing the cavity. All the new tech seems to appear in RICs, so the manufacturers are obviously pouring their R&D dollars into that form factor. The other major type of HA is a Behind The Ear (BTE) which looks similar but has a clear plastic tube that connects to a molded insert that sits in the ear canal.

myric.jpg


In the pic above, the red thing is the receiver which connects to the HA with a stiff wire. Receivers are tiny balanced armature speakers and they come in various power levels for different losses. The white circle is an easily replaceable wax filter to keep debris out of the receiver. The body of the HA has various microphone openings – aimed front and back – and a push button switch for changing programs or volume. I removed the dome for clarity, but it clips onto the receiver. Domes come in various sizes for different size canals and various styles of different types of hearing loss.

While historically, everything was battery operated, now rechargeable HAs are becoming increasingly common. Their rechargeable batteries will last about 5 years and they can often be replaced relatively cheaply and often under warranty if you time it right. That said, the industry seems to expect only a 5 – 6 year life cycle on the HA. Yeah, only 5 or 6 years . . .

The guts of an HA . . .

guts.jpg
 

tobedetermined

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Where to Buy a Hearing Aid

The first thing to remember about hearing aids is that they are a health product and they are regulated to some degree in almost every country. That’s the FDA in the US, a provincial Regulated Health Professions Act here in Ontario, Health and Care Professions Council in the UK etc etc. These regulations determine who can sell you hearing aids.

Since I retired out of the Consumer Electronics industry, the corporate structure, distribution model and retail environment of hearing devices is all very familiar to me. The manufacturer’s develop the HA with the latest tech and sell it through their distributors worldwide. These distributors are often corporately owned in major markets. Storefront retail stores – also sometimes corporately owned or franchised – buy from them and sell to you. So they pass through at least 3 hands – and that means 3 levels of profit. The stores reap the highest profit but they are also supposed to do the legwork. i.e. the hearing test, the fitting(s),the day to day service etc. You will note that I said ‘supposed to’ because as I mentioned above, the biggest complaints from consumers is the quality of the fitting. At the profit level they enjoy, they should spend sufficient time during the original fitting to get it close to right and then subsequent fittings should just be for fine tuning. Obviously, this varies. Most stores also extend the manufacturer’s warranty and they offer free replacement of each aid one time – for damage or loss – as long as you are within the warranty period. The other thing that most stores offer is free trials of HAs. You pay a refundable deposit and they will loan you a demo HA that you can wear for a week or so to see if it works for you. In home HiFi stores, loudspeakers are considered high margin at 50 points (that’s double their cost btw) but hearing aid stores sneer at these low margins fwiw . . . and that may be why you see so many hearing aid stores in major markets. Here in Toronto, I have at least a dozen stores within a mile or two.

Oddly, the cheapest place to buy HAs is Paris, France. I don’t know why, but I priced a top tier aid and I could have flown to Paris, bought an HA, stayed for a few days and flown home for the same $s that a local store quoted me on the same Phonak HA. Here is some comparative pricing (in CAN $s so 1.5x euro or usd) for a pair of Phonak i90 Spheres around the world. Many consider this the best HA on the market at the moment:

compare.jpg

Crazy money for a hearing aid but many people are willing to pay the price because their hearing is so important for their work or just their quality of life. As an aside, I trialled a pair of these from a local Connect Hearing store (a Sonova franchise store btw) and I thought they sounded very odd and at $8190, they were something that I would never buy.

Due to health regulations, online stores are only available in some countries. For example: the US and the UK allow it but not Canada. Since HAs must be fitted, the online shops will sell you the aid and they will refer you to local store for the original fitting and then do subsequent fittings online via WiFi.

And that brings us to the disrupter in the HA business: Costco.

I say disrupter because with their buying volume and relatively low prices Costco has captured 15% of the US market in the past decade. They keep it simple and only offer 3 aids. These 3 are from secondary brands of the majors but they are literally the same HAs as some top flight models. For example . . . the Phillips 9050 is the Oticon Intent 1, the Jabra is the Resound Nexia, the Rexton Reach is an ix 7 Signia and the new Sennheiser unit (only @ 100 US stores) is the Phonak Lumity. So you can buy the best (or near best tech) for 1/3 of the price or less offered by a dedicated HA store. While you can’t trial the HA like you usually can from an HA store, Costco has a 6 month money-back return policy and they give you free wax guards and free domes as needed, as well as a warranty that is as good as any other store. It is no wonder that their hearing device business is increasing at 20% per year.
 
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tobedetermined

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One thing I have not touched on is the connectivity of HAs. They have come a long way from their analogue great-grandparents and they are like mini-computer now with teeny circuit boards featuring state of the art DSP chips with AI weaving its magic to try to solve a hearing aid’s hardest task – allowing the wearer to distinguish voices from a mass of noise like a busy restaurant or a convention floor. Each year, new aids are released that try to further this goal. As I mentioned, this year’s golden child is the Phonak Sphere, with a Starkey and the Oticon Intent as runners-ups. Next year it will be someone else in the top spot as they all vie for the top sales bracket.

Every digital HA comes with an app that you can use on your smart phone for volume control, program switching and Bluetooth connectivity which gives you music streaming and phone connectivity. Yes, with the right phone-hearing aid combo, you can answer calls via your HAs leaving your phone in your pocket. Apple phones seem to be winning this war at the moment with Androids giving sound only and still requiring a handset for talking. Music streaming is possible with either format, although the sound quality really sucks with no bass response whatsoever unless you plug (occlude) your ears which many people don’t like – me included. It is only a single tiny speaker after all. For many users, these 2 functions – phone and streaming – appear to be as necessary as the aids ability to suppress noise.

Since HAs are digital devices, most aids can hold several different sound profiles – programs – that the user can switch to and from with the app or the buttons on the aids. This allows the user to have custom sound profiles optimised for different situations: one for speech in noise, a stripped one for music listening, a general one for everyday use etc etc. These can all be setup in the fitting stage.

And speaking of fitting, there is no magic involved. To program a new HA, you need to have a Noahlink Wireless 2 which is a small $200 USB device that you plug into a Windows computer. It wirelessly connects to your hearing aids via your HA’s fitting software.

noah.jpg


The fitting software – the Phillip’s version is called HearSuite – allows your audi to input data from your audiogram and idealize the gain for frequencies where you have deficiencies. Noise suppression, compression, microphone directionality and feedback control all come to play as well. I set mine up using presets within the software – just like any audi would do in any store.

Here are the insertion gain graphs in the programming software:

fitting data.jpg


And here are the custom noise reduction settings for my custom music listening program:

9050-music-menu.jpg


It looks a lot more difficult than it is but you do need some basic knowledge of sound to program an HA.
 

tobedetermined

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Resources:

The best all round info on hearing devices. Hearing Tracker site

Hearing Tracker Forum This is the ICMag of Hearing.

Hearing Aid review sites are not really that critical. Think of them as sites that compare features and benefits of HAs.

Hearing Tracker’s YouTube Channel A popular review site from a super smooth London-based HA store owner. Even though he talks with both hands, you know he is still capable of emptying your wallet while he is doing it.

Dr. Cliff’s YouTube Channel A popular review site from the kind of guy you want to shoot with a tranquillizer gun.

The Hearing Club YouTube Channel A review site about all things Costco.
 
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tobedetermined

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That may be life changing for kids and young adults with hearing deficiencies. We're old and we earned our hearing loss with a big ass smile on our face. :cool:

Something I should have mentioned is that the Costco aids are $1599.99 per pair in the US stores. All of them afaik. So when I poke around for an Oticon Intent 1 (an awesome top HA btw), I see prices like $4445 from Merit, $5650 from Yes, $4898 from Zip and a whole lot more at the storefronts. But the same damn thing with a different name - Phillips 9050 - is $1599 at Costco. So even if you don't have a Costco Hearing Center in town, it might be worth a drive to a town that does have one.
 
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4maggio

Active member
Great thread, TBD... I have used PHONAC for 12 years or so (prescribed and installed by the VA). They put you in a booth listen, hear the tone, push the button, for an hour+and 2 weeks later put them in.. I LOVE THEM.
Many are to vain (age/ ascetics) to go for them..
 

tobedetermined

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I LOVE THEM.
Many are to vain (age/ ascetics) to go for them..
Likewise. Every morning I want to put them on so I can hear again. The first couple of weeks were bizarre as my ears and brain adjusted to the sensory overload but they really work.

And you are right; Veterans Affairs in any country will usually have a program for HAs and you can often get a new set every 5 years or so. Outside of that, there is health insurance for some and subsidies in other places – e.g. the UK has NHS for free aids but they aren’t top tier. The province of Quebec has something similar but also not top tier and they don’t allow Costco Hearing Centers in the province. I get $500 per ear every 5 years in a grant here in Ontario and the store applies for it so I only paid $1K out of pocket for my Phillips.
 

tobedetermined

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are there any that can be volume controlled individually?
Screenshot_20250202-061410.HearLink 2.png


Yes, they can. This is a screenshot of my app showing the dual volume controls.

The audi can program them with a completely different sound profiles in each ear. Look at my audiogram above and then the insertion graph. My right ear (red is R, blue is L) has more loss so it has been programmed with more gain (volume) to balance my hearing. I blame a guitar petal manufacturer that was beside our booth at Summer NAMM in Nashville one year. Their booth was on my right for 3 days and they were often LOUD!

I can also adjust the volume individually with the buttons. While it will take some getting used to, you can control the volume and change programs with the buttons. All of these actions are programmable in the software and they can be personalized for what you want.

Here is the selection screen in the fitting software of my Phillips.

buttosettings.jpg
 

tobedetermined

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So now that I have gone on and on with the who/what/where, it is time to mention a few practicalities.

You don’t need a smart phone but one is useful.

All better HAs have an app that connects to them via Bluetooth. The app can give you the ability to change volume, change programs, use music streaming & an EQ for it, cell phone features (sometimes tap to answer, handsfree etc) and it often has a Find My Hearing Aid feature. It seems if you have the latest Apple, Google or Samsung cell, you can have all of these features along with the much anticipated Auracast – which is sound streaming that venues can use to send the venue’s music-soundtrack-lecture-whatever feed directly to your HAs, so the hard of hearing aren’t left out. Some venues have a Telecoil feed which is similar but this is quicker-neater-better. But, but but . . . be aware that everybody has problems staying connected. Proximity matters with BT and once you drift away – or for a literal multitude of other reasons – you lose the connection. And tech being tech, it sometimes reconnects and sometimes it doesn’t. And HAs often want to hog the connection so if you wear HAs AND want to stream music to your car radio, you will probably be disappointed. And if you have an older phone – or even a cheap new one – your app’s feature set slims down a bit and some of the above will not work. I will admit that in the first 10 days of ownership, I did lose a HA in my house and the app was good enough to come to the rescue and find the damn thing – in our utility room under a corner of the washing machine where I would have never, ever found it without the app.

And . . . HAs are water-resistant and cold-resistant but only so far. I have worn them into the shower 4 times and the last 2 times one went dead. I revived them both times with a bit of compressed air one time and by simply blowing in the mic vents the second. But I have altered my morning rituals so my HAs only go on AFTER my shower. They also don’t like heavy sweat from what the forums say. And the forums also say that extremely low temps can make them stop as well because the battery can freeze. I have a trapper hat and I haven’t experienced this, but my hat does like to dislodge the damn things so I had to buy some socks from Ear Gear that clip to my shirt so I am not paranoid about losing them during my daily dog walks.

I should also mention that some HAs are locked - just like cell phones can be. This means that you can only go back to the seller for adjustments. Most better aids are now unlocked so you can get them serviced anywhere and you can even self-program if you are so inclined. Sam's Club aids are locked but Costco's are not locked btw.

And also btw, you can get a free hearing test at Costco and not be a member - just tell them at the door that you are going to the Hearing Center. To buy however, you need to join.
 
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tobedetermined

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I am glad that it is helpful. I knew nothing about HAs six months ago and after I dove in, I realized that a lot of people were in the same situation, with the same need. And once I made the leap and got HAs, I wondered what took me so long. ;)
 
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