Hearing aid
A hearing aid is a device designed to improve hearing by making sound audible to a person with hearing loss. Hearing aids are classified as medical devices in most countries, and regulated by the respective regulations. Small audio amplifiers such as PSAPs or other plain sound reinforcing systems cannot be sold as "hearing aids".
Early devices, such as ear trumpets or ear horns, were passive amplification cones designed to gather sound energy and direct it into the ear canal. Modern devices are computerised electroacoustic systems that transform environmental sound to make it audible, according to audiometrical and cognitive rules. Modern devices also utilize sophisticated digital signal processing to try and improve speech intelligibility and comfort for the user. Such signal processing includes feedback management, wide dynamic range compression, directionality, frequency lowering, and noise reduction.
Modern hearing aids require configuration to match the hearing loss, physical features, and lifestyle of the wearer. The hearing aid is fit to the most recent audiogram and is programmed by frequency. This process is called "fitting" and is performed by a Doctor of Audiology, also called an audiologist, or by a Hearing Instrument Specialist. The amount of benefit a hearing aid delivers depends in large part on the quality of its fitting. Almost all hearing aids in use in the US are digital hearing aids. Devices similar to hearing aids include the osseointegrated auditory prosthesis and cochlear implant.
Uses
Hearing aids are used for a variety of pathologies including sensorineural hearing loss, conductive hearing loss, and single-sided deafness. Hearing aid candidacy is typically determined by a Doctor of Audiology, who will also fit the device based on the nature and degree of the hearing loss being treated. The amount of benefit experienced by the user of the hearing aid is multi-factorial, depending on the type, severity, and etiology of the hearing loss, the technology and fitting of the device, and on the motivation, personality, lifestyle, and overall health of the user.Hearing aids are incapable of truly correcting a hearing loss; they are an aid to make sounds more audible. The most common form of hearing loss for which hearing aids are sought is sensorineural, resulting from damage to the hair cells and synapses of the cochlea and auditory nerve. Sensorineural hearing loss reduces the sensitivity to sound, which a hearing aid can partially accommodate by making sound louder. Other decrements in auditory perception caused by sensorineural hearing loss, such as abnormal spectral and temporal processing, and which may negatively affect speech perception, are more difficult to compensate for using digital signal processing and in some cases may be exacerbated by the use of amplification. Conductive hearing losses, which do not involve damage to the cochlea, tend to be better treated by hearing aids; the hearing aid is able to sufficiently amplify sound to account for the attenuation caused by the conductive component. Once the sound is able to reach the cochlea at normal or near-normal levels, the cochlea and auditory nerve are able to transmit signals to the brain normally.
Common issues with hearing aid fitting and use are the occlusion effect, loudness recruitment, and understanding speech in noise. Once a common problem, feedback is generally now well-controlled through the use of feedback management algorithms.
Candidacy and acquisition
There are several ways of evaluating how well a hearing aid compensates for hearing loss. One approach is audiometry which measures a subject's hearing levels in laboratory conditions. The threshold of audibility for various sounds and intensities is measured in a variety of conditions. Although audiometric tests may attempt to mimic real-world conditions, the patient's own every day experiences may differ. An alternative approach is self-report assessment, where the patient reports their experience with the hearing aid.Hearing aid outcome can be represented by three dimensions:
- hearing aid usage
- aided speech recognition
- benefit/satisfaction
Current research is also pointing towards hearing aids and proper amplification as a treatment for tinnitus, a medical condition which manifests itself as a ringing or buzzing in the ears.
Types
There are many types of hearing aids, which vary in size, power and circuitry.Among the different sizes and models are:
Body-worn
Body worn aids were the first portable electronic hearing aids, and were invented by Harvey Fletcher while working at Bell Laboratories. Body aids consist of a case and an earmold, attached by a wire. The case contains the electronic amplifier components, controls and battery, while the earmold typically contains a miniature loudspeaker. The case is typically about the size of a pack of playing cards and is carried in a pocket or on a belt.Without the size constraints of smaller hearing devices, body worn aid designs can provide large amplification and long battery life at a lower cost. Body aids are still used in emerging markets because of their relatively low cost.
Behind the ear
Behind the ear hearing aids are one of two major classes of hearing aids – Behind the ear and In the ear. These two classes are distinguished by where the hearing aid is worn. [|BTE] hearing aids consist of a case which hangs behind the pinna. The case is attached to an earmold or dome tip by a traditional tube, slim tube, or wire. The tube or wire courses from the superior-ventral portion of the pinna to the concha, where the ear mold or dome tip inserts into the external auditory canal. The case contains the electronics, controls, battery, and microphone.The loudspeaker, or receiver, may be housed in the case or in the earmold or dome tip. The [|RIC] style of BTE hearing aid is often smaller than a traditional BTE and more commonly used in more active populations.BTEs are generally capable of providing more output and may therefore be indicated for more severe degrees of hearing loss. However, BTEs are very versatile and can be used for nearly any kind of hearing loss. BTEs come in a variety of sizes, ranging from a small, "mini BTE," to larger, ultra-power devices. Size typically depends on the output level needed, the location of the receiver, and the presence or absence of a telecoil. BTEs are durable, easy to repair, and often have controls and battery doors that are easier to manipulate. BTEs are also easily connected to assistive listening devices, such as FM systems and induction loops. BTEs are commonly worn by children who need a durable type of hearing aid.
In the ear
In the ear aids devices fit in the outer ear bowl. Being larger, these are easier to insert and can hold extra features. They are sometimes visible when standing face to face with someone. ITE hearing aids are custom made to fit each individual's ear. They can be used in mild to some severe hearing losses. Feedback, a squealing/whistling caused by sound leaking and being amplified again, may be a problem for severe hearing losses. Some modern circuits are able to provide feedback regulation or cancellation to assist with this.Venting may also cause feedback. A is a tube primarily placed to offer pressure equalization. However, different vent styles and sizes can be used to influence and prevent feedback.
Traditionally, ITEs have not been recommended for young children because their fit could not be as easily modified as the earmold for a BTE, and thus the aid had to be replaced frequently as the child grew. However, there are new ITEs made from a silicone type material that mitigates the need for costly replacements.
ITE hearing aids can be connected wirelessly to FM systems, for instance with a body-worn FM receiver with induction neck-loop which transmits the audio signal from the FM transmitter inductively to the telecoil inside the hearing instrument.
Mini in canal or completely in canal aids are generally not visible unless the viewer looks directly into the wearer's ear. These aids are intended for mild to moderately severe losses. CICs are usually not recommended for people with good low-frequency hearing, as the occlusion effect is much more noticeable. Completely-in-the-canal hearing aids fit tightly deep in the ear. It is barely visible. Being small, it will not have a directional microphone, and its small batteries will have a short life, and the batteries and controls may be difficult to manage. Its position in the ear prevents wind noise and makes it easier to use phones without feedback. In-the-canal hearing aids are placed deep in the ear canal. They are barely visible. Larger versions of these can have directional microphones. Being in the canal, they are less likely to cause a plugged feeling. These models are easier to manipulate than the smaller completely in-the-canal models but still have the drawbacks of being rather small.
In-the-ear hearing aids are typically more expensive than behind-the-ear counterparts of equal functionality, because they are custom fitted to the patient's ear.
In fitting, the audiologist takes a physical impression of the ear.
The mold is scanned by a specialized CAD system, resulting in a 3D model of the outer ear.
During modeling, the venting tube is inserted.
The digitally modeled shell is printed using a rapid prototyping technique such as stereolithography.
Finally, the aid is assembled and shipped to the audiologist after a quality check.
Invisible in-canal hearing aids
Invisible in canal hearing aids style of hearing aids fits inside the ear canal completely, leaving little to no trace of an installed hearing aid visible. This is because it fits deeper in the canal than other types, so that it is out of view even when looking directly into the ear bowl. A comfortable fit is achieved because the shell of the aid is custom-made to the individual ear canal after taking a mold.Invisible hearing aid types use venting and their deep placement in the ear canal to give a more natural experience of hearing. Unlike other hearing aid types, with the IIC aid the majority of the ear is not blocked by a large plastic shell. This means that sound can be collected more naturally by the shape of the ear, and can travel down into the ear canal as it would with unassisted hearing. Depending on their size, some models allow the wearer to use a mobile phone as a remote control to alter memory and volume settings, instead of taking the IIC out to do this. IIC types are most suitable for users up to middle age, but are not suitable for more elderly people.
Extended wear hearing aids
Extended wear hearing aids are hearing devices that are non-surgically placed in the ear canal by a hearing professional. The extended wear hearing aid represents the first "invisible" hearing device. These devices are worn for 1–3 months at a time without removal. They are made of soft material designed to contour to each user and can be used by people with mild to moderately severe hearing loss. Their close proximity to the ear drum results in improved sound directionality and localization, reduced feedback, and improved high frequency gain. While traditional BTE or [|ITC] hearing aids require daily insertion and removal, extended wear hearing aids are worn continuously and then replaced with a new device. Users can change volume and settings without the aid of a hearing professional. The devices are very useful for active individuals because their design protects against moisture and earwax and can be worn while exercising, showering, etc. Because the device's placement within the ear canal makes them invisible to observers, extended wear hearing aids are popular with those who are self-conscious about the aesthetics of BTE or ITC hearing aid models. As with other hearing devices, compatibility is based on an individual's hearing loss, ear size and shape, medical conditions, and lifestyle. The disadvantages include regular removal and reinsertion of the device when the battery dies, inability to go underwater, earplugs when showering, and for some discomfort with the fit since it is inserted deeply in the ear canal, the only part of the body where skin rests directly on top of bone.CROS hearing aid
A CROS hearing aid is a hearing aid that transmits auditory information from one side of the head to the other side of the head. Candidates include people who have poor word understanding on one side, no hearing on one side, or who are not benefiting from a hearing aid on one side. CROS hearing aids can appear very similar to behind the ear hearing aids. The CROS system can assist the patient in sound localization and understanding auditory information on their poor side.Bone-anchored
A bone anchored hearing aid is a surgically implanted auditory prosthetic based on bone conduction. It is an option for patients without external ear canals, when conventional hearing aids with a mold in the ear cannot be used. The BAHA uses the skull as a pathway for sound to travel to the inner ear. For people with conductive hearing loss, the BAHA bypasses the external auditory canal and middle ear, stimulating the functioning cochlea. For people with unilateral hearing loss, the BAHA uses the skull to conduct the sound from the deaf side to the side with the functioning cochlea.Individuals under the age of two typically wear the BAHA device on a Softband. This can be worn from the age of one month as babies tend to tolerate this arrangement very well. When the child's skull bone is sufficiently thick, a titanium "post" can be surgically embedded into the skull with a small abutment exposed outside the skin. The BAHA sound processor sits on this abutment and transmits sound vibrations to the external abutment of the titanium implant. The implant vibrates the skull and inner ear, which stimulate the nerve fibers of the inner ear, allowing hearing.
The surgical procedure is simple both for the surgeon, involving very few risks for the experienced ear surgeon. For the patient, minimal discomfort and pain is reported. Patients may experience numbness of the area around the implant as small superficial nerves in the skin are sectioned during the procedure. This often disappears after some time. There is no risk of further hearing loss due to the surgery. One important feature of the Baha is that, if a patient for whatever reason does not want to continue with the arrangement, it takes the surgeon less than a minute to remove it. The Baha does not restrict the wearer from any activities such as outdoor life, sporting activities etc.
A BAHA can be connected to an FM system by attaching a miniaturized FM receiver to it.
Two main brands manufacture BAHAs today – the original inventors Cochlear, and the hearing aid company Oticon.
Eyeglass aids
During the late 1950s through 1970s, before in-the-ear aids became common, people who wore both glasses and hearing aids frequently chose a type of hearing aid that was built into thetemple pieces of the spectacles. However, the combination of glasses and hearing aids was inflexible: the range of frame styles was limited, and the user had to wear both hearing aids and glasses at once or wear neither. Today, people who use both glasses and hearing aids can use in-the-ear types, or rest a BTE neatly alongside the arm of the glasses. There are still some specialized situations where hearing aids built into the frame of eyeglasses can be useful, such as when a person has hearing loss mainly in one ear: sound from a microphone on the "bad" side can be sent through the frame to the side with better hearing.
This can also be achieved by using CROS or bi-CROS style hearing aids, which are now wireless in sending sound to the better side.
Spectacle hearing aids
These are generally worn by people with a hearing loss who either prefer a more cosmetic appeal of their hearing aids by being attached to their glasses or where sound cannot be passed in the normal way, via a hearing aids, perhaps due to a blockage in the ear canal. pathway or if the client suffers from continual infections in the ear.Spectacle aids come in two forms, bone conduction spectacles and air conduction spectacles.
Bone conduction spectacles
Sounds are transmitted via a receiver attached from the arm of the spectacles which are fitted firmly behind the boney portion of the skull at the back of the ear, by means of pressure, applied on the arm of the spectacles. The sound is passed from the receiver on the arm of the spectacles to the inner ear, via the bony portion. The process of transmitting the sound through the bone requires a great amount of power. Bone conduction aids generally have a poorer high pitch response and are therefore best used for conductive hearing losses or where it is impractical to fit standard hearing aids.Air conduction spectacles
Unlike the bone conduction spectacles the sound is transmitted via hearing aids which are attached to the arm or arms of the spectacles. When removing your glasses for cleaning, the hearing aids are detached at the same time. Whilst there are genuine instances where spectacle aids are a preferred choice, they may not always be the most practical option.Directional spectacles
These 'hearing glasses' incorporate a directional microphone capability: four microphones on each side of the frame effectively work as two directional microphones, which are able to discern between sound coming from the front and sound coming from the sides or back of the user. This improves the signal-to-noise ratio by allowing for amplification of the sound coming from the front, the direction in which the user is looking, and active noise control for sounds coming from the sides or behind.Only very recently has the technology required become small enough to be fitted in the frame of the glasses. As a recent addition to the market, this new hearing aid is currently available only in the Netherlands and Belgium.
Stethoscope
These hearing aids are designed for medical practitioners with hearing loss who use stethoscopes. The hearing aid is built into the speaker of the stethoscope, which amplifies the sound.Hearing aid application
is a software which, being installed on a mobile computational platform, transforms it into a hearing aid.The principle of HAA operation corresponds to the basic principles of operation of traditional hearing aids: the microphone receives an acoustic signal and converts it into a digital form. Sound amplification is achieved by the means of a mobile computational platform, in accordance with the degree and type of users hearing loss. The processed audio signal is transformed into audio signal and output to the user into the headphones/headset. Signal processing is implemented in real time.
Constructional features of mobile computational platforms imply preferred use of stereo headsets with two speakers, which allows carrying out binaural hearing correction for the left and right ear separately. HAA can work with both wired and wireless headsets and headphones.
As a rule, HAA have several operation modes: setup mode and hearing aid mode. Setup mode involves the user passing an in situ-audiometry procedure, which determines the user's hearing characteristics. Hearing aid mode is a hearing correction system that corrects the user's hearing in accordance with user's hearing thresholds. HAA also incorporates background noise suppression and acoustic feedback suppression.
The user can independently choose a formula to enhance the sound, as well as adjust the level of the desired amplification according to his subjective feelings.
HAA have several advantages :
- the large distance between the microphone and the speaker prevents the occurrence of acoustic feedback;
- possibility to implement more convenient application control functions for people with poor motor skills;
- using of various types of headphones and headsets;
- it is possible to achieve the highest sound pressure level and get high sound quality ;
- resistant to ingress of earwax and moisture;
- it is possible to use more complex audio signal processing algorithms and a higher sampling rate ;
- software flexibility;
- the set up HAA in simple cases does not require special equipment and qualifications;
- HAA does not cause any psychological inconvenience;
- the user does not need to purchase and carry any separate device.
- more noticeable and not so comfortable to wear;
- because of the microphone is not located in the ear, it does not use the functional advantages of the auricle and the natural acoustics of the outer ear.
Technology
Compatibility with telephones
A hearing aid and a telephone are "compatible" when they can connect to each other in a way that produces clear, easily understood sound. The term "compatibility" is applied to all three types of telephones. There are two ways telephones and hearing aids can connect with each other:- Acoustically: the sound from the phone's speaker is picked up by the hearing aid's microphone.
- Electromagnetically: the signal inside the phone's speaker is picked up by the hearing aid's "telecoil" or "T-coil", a special loop of wire inside the hearing aid.
The electromagnetic mode is usually more effective than the acoustic method. This is mainly because the microphone is often automatically switched off when the hearing aid is operating in telecoil mode, so background noise is not amplified. Since there is an electronic connection to the phone, the sound is clearer and distortion is less likely. But in order for this to work, the phone has to be hearing-aid compatible. More technically, the phone's speaker has to have a voice coil that generates a relatively strong electromagnetic field. Speakers with strong voice coils are more expensive and require more energy than the tiny ones used in many modern telephones; phones with the small low-power speakers cannot couple electromagnetically with the telecoil in the hearing aid, so the hearing aid must then switch to acoustic mode. Also, many mobile phones emit high levels of electromagnetic noise that creates audible static in the hearing aid when the telecoil is used. A workaround that resolves this issue on many mobile phones is to plug a wired headset into the mobile phone; with the headset placed near the hearing aid the phone can be held far enough away to attenuate the static. Another method is to use a "neckloop", and plug the neckloop directly into the standard audio jack of a smartphone. Then, with the hearing aids' telecoil turned on, the sound will travel directly from the phone, through the neckloop and into the hearing aids' telecoils.
On 21 March 2007, the Telecommunications Industry Association issued the TIA-1083 standard, which gives manufacturers of cordless telephones the ability to test their products for compatibility with most hearing aids that have a T-Coil magnetic coupling mode. With this testing, digital cordless phone manufacturers will be able to inform consumers about which products will work with their hearing aids.
The American National Standards Institute has a ratings scale for compatibility between hearing aids and phones:
- When operating in acoustic mode, the ratings are from M1 to M4.
- When operating in electromagnetic mode, the ratings are from T1 to T4.
Computer programs that allow the creation of a hearing aid using a PC, tablet or smartphone are currently gaining in popularity. Modern mobile devices have all the necessary components to implement this: hardware and a high-performance microprocessor that carries digital sound processing according to a given algorithm.
Application configuration is carried out by the user himself in accordance with the individual features of his hearing ability. The computational power of modern mobile devices is sufficient to produce the best sound quality. This, coupled with software application settings provides for high comfort and convenience of use.
In comparison with the digital hearing aid, mobile applications have the following advantages:
- ease of use ;
- high wearing comfort;
- complete invisibility ;
- user-friendly interface of software settings;
- high sampling frequency providing for excellent sound quality;
- Fast switching between the external headset and phone microphone;
- acoustic gain is up to 30 dB ;
- low delay in audio processing ;
- No need to get used to it, when changing mobile devices;
- No loss of settings when switching from one gadget to another and back again;
- High duration of the battery;
- free distribution of applications.
- is a medical device ;
- is designed for use by doctor's prescription;
- is adjusted using audiometry procedures.
- Apps such as Oticon ON for certain iOS and Android devices can assist in locating a lost/misplaced hearing aid.
Wireless
FM systems can also be hooked up to a TV or a stereo.
2.4 gigahertz Bluetooth connectivity is the most recent innovation in wireless interfacing for hearing instruments to audio sources such as TV streamers or Bluetooth enabled mobile phones. Current hearing aids generally do not stream directly via Bluetooth but rather do so through a secondary streaming device, this bluetooth enabled secondary device then streams wirelessly to the hearing aid but can only do so over a short distance. This technology can be applied to ready-to-wear devices or to custom made devices that fit directly into the ear.
In developed countries FM systems are considered a cornerstone in the treatment of hearing loss in children. More and more adults discover the benefits of wireless FM systems as well, especially since transmitters with different microphone settings and Bluetooth for wireless cell phone communication have become available.
Many theatres and lecture halls are now equipped with assistive listening systems that transmit the sound directly from the stage; audience members can borrow suitable receivers and hear the program without background noise. In some theatres and churches FM transmitters are available that work with the personal FM receivers of hearing instruments.
Directional microphones
Most older hearing aids have only an omnidirectional microphone. An omnidirectional microphone amplifies sounds equally from all directions. In contrast, a directional microphone amplifies sounds from one direction more than sounds from other directions. This means that sounds originating from the direction the system is steered toward are amplified more than sounds coming from other directions. If the desired speech arrives from the direction of steering and the noise is from a different direction, then compared to an omnidirectional microphone, a directional microphone provides a better signal to noise ratio. Improving the signal-to-noise ratio improves speech understanding in noise. Directional microphones have been found to be the second best method to improve the signal-to-noise ratio.Many hearing aids now have both an omnidirectional and a directional microphone mode. This is because the wearer may not need or desire the noise-reducing properties of the directional microphone in a given situation. Typically, the omnidirectional microphone mode is used in quiet listening situations whereas the directional microphone is used in noisy listening situations. The microphone mode is typically selected manually by the wearer. Some hearing aids automatically switch the microphone mode.
Adaptive directional microphones automatically vary the direction of maximum amplification or rejection. The direction of amplification or rejection is varied by the hearing aid processor. The processor attempts to provide maximum amplification in the direction of the desired speech signal source or rejection in the direction of the interfering signal source. Unless the user manually temporarily switches to a "restaurant program, forward only mode" adaptive directional microphones frequently amplify the speech of other talkers in a cocktail party type environments, such as restaurants or coffee shops. The presence of multiple speech signals makes it difficult for the processor to correctly select the desired speech signal. Another disadvantage is that some noises often contain characteristics similar to speech, making it difficult for the hearing aid processor to distinguish the speech from the noise. Despite the disadvantages, adaptive directional microphones can provide improved speech recognition in noise
FM systems have been found to provide a better signal to noise ratio even at larger speaker-to-talker distances in simulated testing conditions.
Telecoil
Telecoils or T-coils are small devices installed in hearing aids or cochlear implants. An Audio induction loop generates an electromagnetic field that can be detected by T-coils, allowing audio sources to be directly connected to a hearing aid. The T-coil is intended to help the wearer filter out background noise. They can be used with telephones, FM systems, and induction loop systems that transmit sound to hearing aids from public address systems and TVs. In the UK and the Nordic countries, hearing loops are widely used in churches, shops, railway stations, and other public places. In the US, telecoils and hearing loops are gradually becoming more common. Audio induction loops, telecoils and hearing loops are gradually becoming more common also in Slovenia.A T-coil consists of a metal core around which ultra-fine wire is coiled. T-coils are also called induction coils because when the coil is placed in a magnetic field, an alternating electric current is induced in the wire. The T-coil detects magnetic energy and transduces it to electrical energy. In the United States, the Telecommunications Industry Association's TIA-1083 standard, specifies how analog handsets can interact with telecoil devices, to ensure the optimal performance.
Although T-coils are effectively a wide-band receiver, interference is unusual in most hearing loop situations. Interference can manifest as a buzzing sound, which varies in volume depending on the distance the wearer is from the source. Sources are electromagnetic fields, such as CRT computer monitors, older fluorescent lighting, some dimmer switches, many household electrical appliances and airplanes.
The states of Florida and Arizona have passed legislation that requires hearing professionals to inform patients about the usefulness of telecoils.
Legislation affecting use
In the United States, the Hearing Aid Compatibility Act of 1988 requires that the Federal Communications Commission ensure that all telephones manufactured or imported for use in the United States after August 1989, and all "essential" telephones, be hearing aid-compatible."Essential" phones are defined as "coin-operated telephones, telephones provided for emergency use, and other telephones frequently needed for use by persons using such hearing aids." These might include workplace telephones, telephones in confined settings, and telephones in hotel and motel rooms. Secure telephones, as well as telephones used with public mobile and private radio services, are exempt from the HAC Act. "Secure" phones are defined as "telephones that are approved by the U.S. Government for the transmission of classified or sensitive voice communications."
In 2003, the FCC adopted rules to make digital wireless telephones compatible with hearing aids and cochlear implants. Although analog wireless phones do not usually cause interference with hearing aids or cochlear implants, digital wireless phones often do because of electromagnetic energy emitted by the phone's antenna, backlight, or other components. The FCC has set a timetable for the development and sale of digital wireless telephones that are compatible with hearing aids. This effort promises to increase the number of digital wireless telephones that are hearing aid-compatible. Older generations of both cordless and mobile phones used analog technology.
Audio boot
An audio boot or audio shoe is an electronic device used with hearing aids; hearing aids often come with a special set of metal contacts for audio input. Typically the audio boot will fit around the end of the hearing aid link these with another device, like an FM system or a cellphone or even a digital audio player.Direct audio input
Direct audio input allows the hearing aid to be directly connected to an external audio source like a CD player or an assistive listening device. By its very nature, DAI is susceptible to far less electromagnetic interference, and yields a better quality audio signal as opposed to using a T-coil with standard headphones. An audio boot is a type of device that may be used to facilitate DAI.Processing
Every electronic hearing aid has at minimum a microphone, a loudspeaker, a battery, and electronic circuitry. The electronic circuitry varies among devices, even if they are the same style. The circuitry falls into three categories based on the type of audio processing and the type of control circuitry. Hearing aid devices generally do not contain processors strong enough to process complex signal algorithms for sound source localization.Analog
audio may have:- Adjustable control: The audio circuit is analog with electronic components that can be adjusted. The hearing professional determines the gain and other specifications required for the wearer, and then adjusts the analog components either with small controls on the hearing aid itself or by having a laboratory build the hearing aid to meet those specifications. After the adjustment the resulting audio does not change any further, other than overall loudness that the wearer adjusts with a volume control. This type of circuitry is generally the least flexible. The first practical electronic hearing aid with adjustable analog audio circuitry was based on US Patent 2,017,358, "Hearing Aid Apparatus and Amplifier" by Samual Gordon Taylor, filed in 1932.
- Programmable control: The audio circuit is analog but with additional electronic control circuitry that can be programmed by an audiologist, often with more than one program. The electronic control circuitry can be fixed during manufacturing or in some cases, the hearing professional can use an external computer temporarily connected to the hearing aid to program the additional control circuitry. The wearer can change the program for different listening environments by pressing buttons either on the device itself or on a remote control or in some cases the additional control circuitry operates automatically. This type of circuitry is generally more flexible than simple adjustable controls. The first hearing aid with analog audio circuitry and automatic digital electronic control circuitry was based on US Patent 4,025,721, "Method of and means for adaptively filtering near-stationary noise from speech" by D Graupe, GD Causey, filed in 1975. This digital electronic control circuitry was used to identify and automatically reduce noise in individual frequency channels of the analog audio circuits and was known as the Zeta Noise Blocker.
Digital
The signal processing is performed by the microprocessor in real time and taking into account the individual preferences of the user. The microprocessor automatically analyzes the nature of the external background noise and adapts the signal processing to the specific conditions.
Difference between digital and analog hearing aids
Analogue hearing aids make louder all the sounds picked up by the microphone. For example, speech and ambient noise will be made louder together. On the other hand, digital hearing aid technology processes the sound using digital technology. Before transmitting the sound to the speaker, the DHA microprocessor processes the digital signal received by the microphone according to a mathematical algorithm. This allows just making louder the sounds of certain frequency according to the individual user settings, and automatically adjusting the work of DHA to various environments.For users with varying degrees of hearing loss it is difficult to perceive the entire frequency range of external sounds. DHA with multi-channel digital processing allows a user to "compose" the output sound by fitting a whole spectrum of the input signal into it. This gives users with limited hearing abilities the opportunity to perceive the whole range of ambient sounds, despite the personal difficulties of perception of certain frequencies. Moreover, even in this "narrow" range the DHA microprocessor is able to emphasize the desired sounds, weakening the unwanted loud, high etc. sounds at the same time.
Advantages of digital aids include:
According to researches DHA have a number of significant advantages :
- Speech recognition. Can distinguish the speech signal from the overall spectrum of sounds which facilitates speech perception.
- Noise reduction. Can reduce the background noise level to increase user comfort in noisy environments.
- Flexibility in selective amplification. Can provide more flexibility in frequency specific amplification to match the individual hearing characteristics of the user.
- Effective acoustic feedback reduction. The acoustic whistling common to all hearing aids can be adaptively controlled.
- Effective use of directional microphones. Directional microphones can be adaptively controlled.
- Extended frequency range. A larger range of frequencies can be implemented with frequency shifting.
- "Self-learning" and adaptive adjustment. Can implement adaptive selection of amplification parameters and processing.
- Improved connection to other devices. Connection to other devices such as smartphones, televisions, internet etc are possible.
Difference between digital hearing aid and hearing aid application
s have all the necessary hardware facilities for performing the functions of a digital hearing aid: microphone, AD converter, digital processor, DA converter, amplifier, and speakers. External microphone and speakers can also be connected as a special headset.The operational principles of hearing aid application correspond to general operational principles of digital hearing aid
Taking into account the structural features of mobile computational platforms, stereo headsets with two speakers can be used, which allows to perform binaural hearing correction for the left and right ear separately.
Unlike digital hearing aid, adjustment of hearing aid applications an integral part of the application itself. Hearing aid application adjusted in accordance with the user's audiogram. The whole adjustment process in hearing aid application automated so that the user can perform audiometry on their own.
The hearing correction application has two modes: audiometry and correction. In the audiometry mode, hearing thresholds are measured. In the correction mode, the signal is processed with respect to the obtained thresholds.
Hearing aid applications also provides for using different computational formulas for calculation of sound amplification based on the audiometry data. These formulas are intended for maximum comfortable speech amplification and best sound intelligibility.
Hearing aid application allows saving the adjustment as different user profiles for different acoustic environments. Thus, in contrast to static settings of digital hearing aid
One of the most important characteristics of the hearing aid is acoustic feedback. In hearing aid application the duration of unavoidable hardware delay is rather great, so hearing aid application uses a signal processing scheme with minimum possible algorithmic delay to make it as short as possible.
Difference between PSAP and digital hearing aids
are classified by the FDA as "personal sound amplification devices." These compact electronic devices are designed for people without hearing loss. Unlike hearing aids use of PSAP does not require medical prescription. Such devices are used by hunters, naturalists, ordinary people, etc.PSAP models differ significantly in price and functionality. Some devices simply amplify sound. Others contain directional microphones, equalizers to adjust the audio signal gain and filter noise.
Evolution of hearing aid applications
There are audio players designed specifically for the hard-of-hearing. These applications amplify the volume of the reproduced audio signal in accordance with user's hearing characteristics and acts as music volume amplifier and assistive hearing aid. The amplification algorithm works on the frequencies that the user hears worse, thus restoring natural hearing perception of the sound of music.Just as in hearing aid application, the player adjustment is based on the user's audiogram
There are also applications that do not only adapt the sound of music to the user's hearing but also include some hearing aid functions. Such types of applications include sound amplification mode in accordance with the user's hearing characteristics as well as noise suppression mode and the mode allowing to hear the surrounding sounds without pausing the music.
Also, some applications allow the hard-of-hearing watching the video and listening to the radio with comfort. Operational principles of these applications are similar to hearing aid application operational principles: the audio signal is amplified on the frequencies that the user hears worse.
Hearing aid adaptation
It often happens that a person using a hearing aid for the first time cannot quickly make use of all its advantages. Structure and characteristics of hearing aids are thoroughly devised by specialists in order to make the period of adaptation to the hearing aid as simple and quick as possible. However, despite this, a beginning hearing aid user certainly needs time to get used to it.The process of hearing prostheses consists of the following steps:
- Initial adjustment of the device;
- Adaptation to new sounding;
- Fine adjustment.
Feeling the hearing aid in the user's ear may seem unusual. It also takes time to adapt to the new way of hearing perception. The ear has to be gradually adjusted to the new sounding.
The sound may seem unnatural, metallic, too loud or too quiet. Whistling sound may also appear, which is a rather unpleasant irritant.
Hearing aid does not provide immediate improvement. The adaptation period can last from several hours to several months.
A patient is offered a schedule of wearing their hearing aid ensuring gradual adaptation to it. If the patient starts permanently wearing the hearing aid, unfamiliar sound may cause a headache, and as a result the user refuses to wear a hearing aid despite the fact that it helps. Surdo-teachers often run a quick preparation course for the patients. As a rule, users have inflated expectations of using hearing aid
Hearing aid application, in contrast to a traditional hearing aid, allows implementing nonspecific options, such as a built-in adaptation course.
The functions of the course may include:
- control over the sequence of performed exercises according to the calendar;
- control of the amount of time spent on learning ;
- reminders of daily exercises and so on.
The adaptation course includes a certain number of stages, starting from listening to a set of low everyday sounds in a quiet environment, getting accustomed to one's own speech and other people's speech, getting accustomed to speech in the noise, etc.
History
The first hearing aids were ear trumpets, and were created in the 17th century. Some of the first hearing aids were external hearing aids. External hearing aids directed sounds in front of the ear and blocked all other noises. The apparatus would fit behind or in the ear.The movement toward modern hearing aids began with the creation of the telephone, and the first electric hearing aid, the "akouphone," was created about 1895 by Miller Reese Hutchison. By the late 20th century, digital hearing aids were commercially available.
The invention of the carbon microphone, transmitters, digital signal processing chip or DSP, and the development of computer technology helped transform the hearing aid to its present form.
History of digital aids
The history of DHA can be divided into three stages. The first stage began in the 1960s with the widespread use of digital computers for simulation of audio processing for the analysis of systems and algorithms. The work was conducted with the help of the very large digital computers of that era. These efforts were not actual digital hearing aids because the computers were not fast enough for audio processing in real time and the size prevented them from being described as wearable but hey allowed successful studies of the various hardware circuits and algorithms for digital processing of audio signals. The software package Block of Compiled Diagrams developed by Kelly, Lockbaum and Vysotskiy in 1961 allowed simulation of any sound system that could be characterized in the form of a block diagram. A special phone was created so that a person with a hearing impairment could listen to the digitally processed signals, but not in real time. In 1967, Harry Levitt used BLODI to simulate a hearing aid on a digital computer.Almost ten years later the second stage began with the creation of the hybrid hearing aid, in which the analog components of a conventional hearing aid consisting of amplifiers, filters and signal limiting were combined with a separate digital programmable component into a conventional hearing aid case. The audio processing remained analog but was able to be controlled by the digital programmable component. The digital component could be programmed by connecting the device to an external computer in the laboratory then disconnected to allow the hybrid device to function as a conventional wearable hearing aid.
The hybrid device was effective from a practical point of view because of the low power consumption and compact size. At that time, low-power analog amplifier technology was well developed in contrast to the available semiconductor chips able to process audio in real time. The combination of high performance analog components for real time audio processing and a separate low power digital programmable component only for controlling the analog signal led to the creation several low power digital programmable components able to implement different types of control.
A hybrid earing aid was developed by Etymotic Design. A little later, Mangold and Lane created a programmable multi-channel hybrid hearing aid. Graupe with co-authors developed a digital programmable component that implemented an adaptive noise filter.
The third stage began in the early 1980s by a research group at Central Institute for the Deaf headed up by faculty members at Washington University in St. Louis MO. This group created the first full digital wearable hearing aid. They first conceived a complete, comprehensive full digital hearing aid, then designed and fabricated, miniaturized full digital computer chips using custom digital signal processing chips with low power and very large scale integrated chip technology able to process both the audio signal in real time and the control signals yet able to be powered by a battery and be fully wearable as a full digital wearable hearing aid able to be actually used by individuals with hearing loss. Engebretson, Morley and Popelka were the inventors of the first full digital hearing aid. Their work resulted in US Patent 4,548,082, "Hearing aids, signal supplying apparatus, systems for compensating hearing deficiencies, and methods" by A Maynard Engebretson, Robert E Morley, Jr. and Gerald R Popelka, filed in 1984 and issued in 1985. This full digital wearable hearing aid also included many additional features now used in all contemporary full digital hearing aids including a bidirectional interface with an external computer, self-calibration, self-adjustment, wide bandwidth, digital programmability, a fitting algorithm based on audibility, internal storage of digital programs, and fully digital multichannel amplitude compression and output limiting. This group created several of these full digital hearing aids and used them for research on hearing impaired people as they wore them in the same manner as conventional hearing aids in real-world situations. In this first full DHA all stages of sound processing and control were carried out in binary form. The external sound from microphones positioned in an ear module identical to a BTE was first converted into binary code, then digitally processed and digitally controlled in real time, then converted back to an analog signal sent to miniature loudspeakers positioned in the same BTE ear module. These specialized hearing aid chips continued to become smaller, increase in computational ability and require even less power. Now, virtually all commercial hearing aids are fully digital and their digital signal processing capability has significantly increased. Very small and very low power specialized digital hearing aid chips are now used in all hearing aids manufactured world wide. Many additional new features also have been added with various on-board advanced wireless technology.
Regulation
Ireland
Like much of the Irish health care system, hearing aid provision is a mixture of public and private.Hearing aids are provided by the State to children, OAPs and to people whose income is at or below that of the State Pension. The Irish State hearing aid provision is extremely poor; people often have to wait for two years for an appointment.
It is estimated that the total cost to the State, of supplying one hearing aid, exceeds €2,000.
Hearing aids are also available privately, and there is grant assistance available for insured workers. Currently for the fiscal year ending 2016, the grant stands at a maximum of €500 per ear.
Irish taxpayers can also claim tax relief, at the standard rate, as hearing aids are recognised as a medical device.
Hearing aids in the Republic of Ireland are exempt from VAT.
Hearing aid providers in Ireland mostly belong to the Irish Society of Hearing Aid Audiologists.
United States
Ordinary hearing aids are regulated medical devices under Federal Food and Drug Administration rules. A 1976 statute explicitly prohibits any state requirement that is "different from, or in addition to, any requirement applicable" to regulated medical devices which relates "to the safety and effectiveness of the device." Inconsistent state regulation is preempted under the federal law. In the late 1970s, the FDA established federal rules governing hearing aid sales, and addressed various requests by state authorities for exemptions from federal preemption, granting some and denying others. The Over-the-Counter Hearing Aid Act was passed under the FDA Reauthorization Act of 2017, creating a class of hearing aids regulated by the FDA available directly to consumers without involvement from a licensed professional. This law's provisions are expected to go into effect in 2020.Cost
Several industrialized countries supply free or heavily discounted hearing aids through their publicly funded health care system.Australia
The Australian Department of Health and Ageing provides eligible Australian citizens and residents with a basic hearing aid free-of-charge, though recipients can pay a "top up" charge if they wish to upgrade to a hearing aid with more or better features. Maintenance of these hearing aids and a regular supply of batteries is also provided, on payment of a small annual maintenance fee.Canada
In Canada, health care is a responsibility of the provinces. In the province of Ontario, the price of hearing aids is partially reimbursed through the Assistive Devices Program of the Ministry of Health and Long-Term Care, up to $500 for each hearing aid. Like eye appointments, audiological appointments are no longer covered through the provincial public health plan. Audiometric testing can still easily be obtained, often free of charge, in private sector hearing aid clinics and some ear, nose and throat doctors offices. Hearing aids may be covered to some extent by private insurance or in some cases through government programs such as Veterans Affairs Canada or Workplace Safety & Insurance Board.Iceland
Social Insurance pays a one time fee of ISK 30,000 for any kind of hearing aid. However, the rules are complicated and require that both ears have a significant hearing loss in order to qualify for reimbursement. BTE hearing aids range from ISK 60,000 to ISK 300,000.India
In India hearing aids of all kinds are easily available. Under Central and state government health services, the poor can often avail themselves of free hearing devices. However, market prices vary for others and can range from Rs 10,000 to Rs 275,000 per ear.United Kingdom
From 2000 to 2005 the Department of Health worked with Action on Hearing Loss to improve the quality of NHS hearing aids so every NHS audiology department in England was fitting digital hearing aids by March 2005. By 2003 Over 175,000 NHS digital hearing aids had been fitted to 125,000 people. Private companies were recruited to enhance the capacity, and two were appointed – David Ormerod Hearing Centres, partly owned by Alliance Boots and Ultravox Group, a subsidiary of Amplifon.Within the UK, the NHS provides digital BTE hearing aids to NHS patients, on long-term loan, free of charge. Other than BAHAs, where specifically required, BTEs are usually the only style available. Private purchases may be necessary if a user desires a different style. Batteries are free.
In 2014 the Clinical Commissioning Group in North Staffordshire considered proposals to end provision of free hearing aids for adults with mild to moderate age related hearing loss, which currently cost them £1.2m a year. Action on Hearing Loss mobilised a campaign against the proposal.
In June 2018 the National Institute for Health and Care Excellence produced new guidance saying that hearing aids should be offered at the first opportunity after hearing loss is detected rather than waiting for arbitrary thresholds of hearing loss to be reached.
United States
Most private healthcare providers in the United States do not provide coverage for hearing aids, so all costs are usually borne by the recipient. The cost for a single hearing aid can vary between $500 and $6,000 or more, depending on the level of technology and whether the clinician bundles fitting fees into the cost of the hearing aid. Though if an adult has a hearing loss which substantially limits major life activities, some state-run vocational rehabilitation programs can provide upwards of full financial assistance. Severe and profound hearing loss often falls within the "substantially limiting" category. Less expensive hearing aids can be found on the internet or mail order catalogs, but most in the under-$200 range tend to amplify the low frequencies of background noise, making it harder to hear the human voice.Military Veterans receiving VA medical care are eligible for hearing aids based on medical need. The Veterans Administration pays the full cost of testing and hearing aids to qualified military Veterans. Major VA medical facilities provide complete diagnostic and audiology services.
The cost of hearing aids is a tax-deductible medical expense for those who itemize medical deductions.
Research involving more than 40,000 US households showed a convincing correlation between the degree of hearing loss and the reduction of personal income. According to the same research the tendency was not observed in almost 100% of households using DHA.
Batteries
While there are some instances that a hearing aid uses a rechargeable battery or a long-life disposable battery, the majority of modern hearing aids use one of five standard button cell zinc–air batteries. Modern hearing aid button cell types are typically referred to by their common number name or the color of their packaging.They are typically loaded into the hearing aid via a rotating battery door, with the flat side as the positive terminal and the rounded side as the negative terminal.
These batteries all operate from 1.35 to 1.45 volts.
The type of battery a specific hearing aid utilizes depends on the physical size allowable and the desired lifetime of the battery, which is in turn determined by the power draw of the hearing aid device. Typical battery lifetimes run between 1 and 14 days.
| Type/ Color Code | Dimensions | Common Uses | Standard Names | Misc Names |
| 675 | 11.6 mm × 5.4 mm | High-Power BTEs, Cochlear Implants | IEC: PR44, ANSI: 7003ZD | 675, 675A, 675AE, 675AP, 675CA, 675CP, 675HP, 675HPX, 675 Implant Plus, 675P, 675PA, 675SA, 675SP, A675, A675P, AC675, AC675E, AC675E/EZ, AC675EZ, AC-675E, AP675, B675PA, B6754, B900PA, C675, DA675, DA675H, DA675H/N, DA675N, DA675X, H675AE, L675ZA, ME9Z, P675, P675i+, PR44, PR44P, PR675, PR675H, PR675P, PR-675PA, PZ675, PZA675, R675ZA, S675A, V675, V675A, V675AT, VT675, XL675, Z675PX, ZA675, ZA675HP |
| 13 | 7.9 mm × 5.4 mm | BTEs, ITEs | IEC: PR48, ANSI: 7000ZD | 13, 13A, 13AE, 13AP, 13HP, 13HPX, 13P, 13PA, 13SA, 13ZA, A13, AC13, AC13E, AC13E/EZ, AC13EZ, AC-13E, AP13, B13BA, B0134, B26PA, CP48, DA13, DA13H, DA13H/N, DA13N, DA13X, E13E, L13ZA, ME8Z, P13, PR13, PR13H, PR-13PA, PZ13, PZA13, R13ZA, S13A, V13A, VT13, V13AT, W13ZA, XL13, ZA13 |
| 312 | 7.9 mm × 3.6 mm | miniBTEs, RICs, ITCs | IEC: PR41, ANSI: 7002ZD | 312, 312A, 312AE, 312AP, 312HP, 312HPX, 312P, 312PA, 312SA, 312ZA, AC312, AC312E, AC312E/EZ, AC312EZ, AC-312E, AP312, B312BA, B3124, B347PA, CP41, DA312, DA312H, DA312H/N, DA312N, DA312X, E312E, H312AE, L312ZA, ME7Z, P312, PR312, PR312H, PR-312PA, PZ312, PZA312, R312ZA, S312A, V312A, V312AT, VT312, W312ZA, XL312, ZA312 |
| 10 | 5.8 mm × 3.6 mm | CICs, RICs | IEC: PR70, ANSI: 7005ZD | 10, 10A, 10AE, 10AP, 10DS, 10HP, 10HPX, 10SA, 10UP, 20PA, 230, 230E, 230EZ, 230HPX, AC10, AC10EZ, AC10/230, AC10/230E, AC10/230EZ, AC230, AC230E, AC230E/EZ, AC230EZ, AC-230E, AP10, B0104, B20BA, B20PA, CP35, DA10, DA10H, DA10H/N, DA10N, DA230, DA230/10, L10ZA, ME10Z, P10, PR10, PR10H, PR230H, PR536, PR-10PA, PR-230PA, PZA230, R10ZA, S10A, V10, VT10, V10AT, V10HP, V230AT, W10ZA, XL10, ZA10 |
| 5 | 5.8 mm × 2.1 mm | CICs | IEC: PR63, ANSI: 7012ZD | 5A, 5AE, 5HPX, 5SA, AC5, AC5E, AP5, B7PA, CP63, CP521, L5ZA, ME5Z, P5, PR5H, PR-5PA, PR521, R5ZA, S5A, V5AT, VT5, XL5, ZA5 |