My Experience With Hearing Aids
Ludwik Kowalski, Ph.D. (see Wikipedia)
Montclair State University, NJ USA
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This diary-like essay is a continuation of what I wrote about inexpensive personal sound amplifiers (PSA) in an earlier online post:
Both essays, written for myself, will hopefully be of some interest to other people. Unfortunately, my hearing problem, described in the PSA essay(use the link above), remains unsolved. The only solution is to purchase a pair of more effective devices, called hearing aids (HAs). As usual, I am learning and writing at the same time.
What is sound?
Sound, as one learns in science, consists of invisible waves, propagating through air, or through another medium. The loudness of sound, often expressed in units called decibels (dB) depends on the amount of energy it carries; the pitch of the sound depends on the frequency of waves vibrations, usually expressed in units called Hertz (Hz), The range of frequencies a human can hear is between approximately 50 Hz and 10,000Hz. A speaking or singing person sends into air waves of different frequencies, at the same time. Some waves carry more energy than others. The purpose of listening is to receive sound and to understand information it carries.
Analog versus Programable HAs.
The HAs that I have been wearing for the last seven years are said to be of the analog kind; the much better HAs that I am going to buy soon are said to be of the digital kind. What is the difference between these two kinds?
Each analog hearing aid consists of at least three electrical components: a microphone, an amplifier and a speaker, like a typical PSA. But these components are tiny, in comparison with those in PSAs. The microphone turns sonic vibrations into an electric signal; that signal is amplified in the amplifier and the speaker produces sonic vibrations (sound) that my ears hear. Higher frequencies of vibrations are magnified more than lower, because my ability to hear high frequencies is limited, as determined
by my audiologist.
The essential electrical components of my old hearing aids are located in a small rounded container that I wear above the ear. Thin plastic air-filled tubes deliver the amplified sound into each of my ear canals. The tubes, in analog HAs, are the carriers of amplified sound waves.
My modern (digital) HAs will look like the old ones.Their microphones and amplifiers will also be located in two above-the-ear containers. But the amplified sound will be digitized and computer-processed. This is possible because a tiny computer is located in each digital HA. The quality of the sound produced by digital HAs will depend not only on how they will be set by the audiologist (as in my analog HAs) but also on which computer program will be used at any given time. Programs are said to be written to make sound easier to understand (by the brain of the wearer). The audiologist told me that new HAs will allow me to change the volume of the sound, and its quality (by programs), when needed.
The HAs assigned to me are of the Receiver-In-the-Canal (RIC) type. The microphone and the amplifier, as in my analog HAs, will be located inside the above-the ear containers, but the loudspeaker in my digital HAs will be located inside my ear canals, closer to the endings of my brain’s hearing cells. The receiver, in each hearing aid, will be covered with a thin filter, protecting it from wax released inside the canal. Periodic removal of accumulated wax is unavoidable, no matter what kind of HAs is used. But the method of doing this in the RIC type HAs is not the same as in my analog HAs.The audiologist will show me how to remove wax.
What percentage of the total cost of HAs is due to design and manufacture of hardware, writing programs (software), maintenance services, and marketing? Unfortunately, I do not know how to answer such questions. Here is how they were answered by a more knowledgeable teacher, on an Internet discussion list. "I guess that the noisy [HAs] cost 15 cents to make and the quieter [HAs] cost 16 cents to make, or perhaps 10 times that much." Three other teachers also responded. One of them wrote:
"This is a physics list so I do not expect many to understand much about economics. The markup is an example of wealth transfer to those who make us all better off ... the inventors, the proselytizers of the invention, those who support the invention in the field, those who invest in bringing the technology to the market, to make it widely available. Otherwise we would have nothing new in this market since forever. Why would anyone invent, invest in manufacturing, sales, and support of that technology if there was no profit to be made?
And the initial comment about the 'cost' is wrong-headed to begin with. High-end hearing aids typically come with lifetime service in terms of periodic adjustment. Professional fitting takes time and equipment. Just those two easily account for a few hundred dollars. Add the R&D cost that went into it, add the cost of setting up the manufacturing line -- not just the incremental cost of the chip inside -- and the cost of inventory.
If the prices were unreasonably high, cheaper competitors would have entered the market long ago. ... But the market supports both. And then there is the question of what's a 'reasonable' profit margin that would make A and B happy .... 'Capitalism is inherently evil'? Only in the eyes of know-nothings. Capitalism pulled out of poverty over billion of people in just the last 20 years. In contrast, communism was responsible for tens of millions starving to death in Soviet Union and China, and another tens of millions living in semi-starvation for decades in their socialist satellites."
Things worth knowing
According to the Internet, a pair of modern HA may cost beween two and eight thousand dollars, depending on the instruments’ sophistication and on where they are purchased. Purchasing HAs and associated services at university teaching clinics is often less expensive than at other places, because some tasks are performed by doctoral students, who are supervised by certified professionals. Typical discounts are said to be close to 20 percent. In fact, my university is very liberal; its audiology clinic services are also available to relatives and friends of faculty and staff.
A pair of Siemens HAs which I subsequently purchased, on October 13, 2015, at Montclair State University, cost me $2960 This includes the cost of all future follow-up visits and adjustments, described below. The model of my HAs is: Binax-RIC; the level of its sophistication is 5BX. Why did I select Siemens, rather than Resound, costing $1800, at Costco? Because I have never heard of a company named Resound; the company named Siemens, by contrast, is a well known producer of high quality equipment.
After tentatively selecting the recommended kind of Siemens HA I came home and started browsing the Internet, to educate myself, and to examine other options. This was very useful. I soon recognized that, unfortunately, a “Hearing Aids for Dummies” book does not exist. A good book of that kind would probably be very popular. I am certainly not the only one who wants to be an educated consumer, as one can verify, for example, at:
The reference below is worth reading, especially by those interested in costs of repairs, and other unavoidable hidden expenses.
Referring to a question about the most common HA problems, the author of the above post wrote:
90% of Hearing Aids go bad due to Earwax - Earwax is compacted into the receiver...because the hearing aid owner does not clean it out or replace the wax guard wax filters enough. Earwax...is natural, everyone creates it, for some folks much much more, for other folks less ... But thankfully, it's just temporary. If ear wax gets into a hearing aid, you can clean it out; all HA manufacturers have created tools to protect hearing aids from hearing aid earwax. If you don't change out the wax guards or wax filters ... I mean once per week or more often ... you are going to be paying someone for repairs.
Debris, Moisture and Body Chemicals - oils etc. Debris is the microscopic stuff - hard to avoid that when you are out in the open but smoke ashes can create issues with hearing aids. Other airborne stuff like pollution too. Also, Moisture - Here is a hard and fast irrefutable rule: Minimize moisture in your hearing aids. Moisture inside a hearing aid creates corrosion. Corrosion creates faulty circuits. Hearing aids will not last very long if you do not minimize the moisture. What you could do is to buy a hearing aid dryer ... A hearing aid dryer will eliminate all the moisture out of the hearing aids and will lengthen their life. ... Be sure to take the batteries out of the hearing aid before placing them in the hearing aid dryer. Lastly, Body Chemicals, Skin Oils - same thing applies - Oils - inside a hearing aid creates corrosion. Corrosion creates faulty circuits. Try to keep the hearing aid dry and clean - brush your hearing aid at least once per week.
The Microphone Dies. The microphone in the hearing aids can - should - last at least 2 to 5 years. Because the receiver is exposed to earwax, moisture, debris, body oils .. the microphones go out ... which is just about the time your warranty expires. Replacing a receiver-in-the-canal receiver can run you $150 to $500 depending on make and model. Wax guards are a lot cheaper. There is one other issue with hearing aids you might want to be aware of ... with most of the new hearing aids coming out today ... the microphone is not replaceable because it’s all on the same circuit board with the rest of the brains of the hearing aid. That means, if the microphones goes out ... sorry, we cannot replace it ... you are going to have to buy a new hearing aid."
Technical problems resulting from wax and humidity are understandable. But normal use of microphones and receivers, for two or three years, should not cause problems, in my opinion. Was placing microphones on the circuit boards occupied by tiny computers a mistake or was it deliberate, to maximize profits? Who knows? Only individual designers know the answers.
Trial period and warranties
At the first meeting the dispenser informed me that the process of buying HAs will start when I pay $400, the initial down payment for ordering the two HAs. I will pay the remaining amount when I receive the ready-to-use new devices. My initial deposit will be non-returnable; I will lose it if I decide to cancel the order.
The one-month-long trial period will begin on the day I receive the HAs. During that month I will use the HAs in different listening situations, and will visit the clinic for free adjustments, as often as needed. And what if a HA fails during the trial period? In that case I would receive another new HA immediately and another trial period would begin at once.
The factory's warranty period (two years in my case) will begin at the end of the trial month. During that limited warranty period the HA company will pay for repair (or replacement) of my broken devices, if this becomes necessary. Subsequent repairs, after the two year warranty period expires, may be covered (if I choose this option) by an extended protection plan offered by the manufacturer or by an independent insurer. This additional insurance (after the expiration of the company's warranty) may or may not be worth buying, as described in:
Here is a link to a description of a typical factory warranty:
Costs of subsequent adjustments (as opposed to repairs per se), during the warranty period, if needed, will depend upon the agreement with the dispenser, i.e. whether or not there will be a charge.
First use of my digital hearing aids
The appointment to receive my new HAs had to be canceled, two weeks ago, because one of my ears was found to be partially blocked by wax. The obstacle was removed by a medical doctor, whom I visited a week ago. That is why my digital HAs were installed only today, on 11/10/2015, after I paid the remaining sum. The impression is positive; I do hear much better with them than with my analog HAs. The audiologist showed me how to change the loudness of sound and how to change the sound quality (by pressing a button on top of each HA). That was not complicated. But I decided to use a more convenient way of controlling sound parameters; I purchased a Siemens remote control, named "Easy Pocket,” for $220. A very similar remote, from Rexton, another HAs manufacturer, would cost me $245 +shipping).
Manufacturers often sell optional accessories, devices which simplify, or add functions, to their digital HAs. The Easy Pocket, mentioned above, is one of these accessories. I like it because control buttons are large, and because it has a screen, displaying chosen options-- the sound loudness (volume) and the sound quality (the program). Unlike some other models of remote control, the Easy Pocket does not depend on the use of a smart phone. It is powered by two common AAA batteries, lasting "at least one year," I was told.
My new HAs can be powered by the same kind of ordinary non-rechargeable batteries (each costing only about $0.50 and lasting typically one week), as my old HAs. But each of my new HAs will actualy be powered by a small rechargeable battery. This is possible because I purchased an appliance called “battery charger,” costing $177. A practically identical device, from Rexton, would cost me $195 +shipping.
Rechargeable batteries cost $50 each, and they must be replaced once every ten months, approximately. This will be done by the audiologist, but I must pay for new batteries. The rechargeable batteries will permanently reside inside of my HAs. My task will be to place the HAs (with batteries inside) into the charger, before going to sleep, each evening, and to remove them from the charger each morning. Charged in this way the HAs can be used for about 10 hours. The battery charger is a small easy-to-operate device. Why did I choose this option (instead of traditional disposable batteries)? Because charging of the batteries will take place in the humidity-free air, inside the charger. Accumulation of moisture inside dry air is said to be minimal.
The Siemens items I bought come with short user’s guides; unfortunately, two of these manuals --I will read the third one later-- are poorly written, in my opinion. The audiologist also thinks that some information they contain is for experts only, not for people like myself. Here is the link to a slightly better manual,
found by Googling.
Using Different programs. Controling Sound Quaqlity
My trial month period started today; when I received the Easy Pocket remote control, and learned how to use it. Programs controlling sound quality were also inserted into my HAs today.The maximum number of such programs, for my kind of HAs is six. But the audiologist decided that, in my situation, only two will be needed, to begin with. Other programs might be inserted later, if necessary, at no additional cost. Naturally, I accepted her advice. I do not plan to use sophisticated devices based on blue tooth technology.
My Program #1 is called “Universal;” my Program #2 is called ”Noise.” I was advised to select (with my remote control) the second program only in very noisy environments. Otherwise I should select the first program. That program, actually a collection of many sub-programs, is able to monitor the sound environment and select the subprogram most appropriate for eliminating potential problems, i.e. by suppressing certain non-speech sounds.
The “Easy Pocket” remote control accessory, mentioned above, allows me to control only two sound parameters:
a) volume (in ten steps, between the minimum and the maximum, as set by the audiologist) and
b) program (either #1 or #2).
The number of options for programs would be larger if more than two programs were actually installed.
The maximum loudness, unfortunately, is much lower that I sometimes need. I will signal this to the audiologist, at the next meeting. Will she be able to double or triple the maximum loudness? Probably not; the size of the speaker is probably too small for this.
My Clarity telephone has two independent sound control dials, one for volume and one for tone (pitch). A pair of expensive HAs should also allow me to change the volume and the pitch, either simultaneousely, or separately, when I want. I know that this does improve speech comprehension, sometimes.
Motivation for this Essay
Writing about what I do and think is a pleasant and useful activity; I have been doing this since I was a student, at Warsaw Polytechnic Institute, first in diaries, on which my online book was based:
then in over one hundred scientific and pedagogical publications. Writing is a conversation with oneself, and with potential partners in learning, such as students and colleagues. Writing helps to think critically about what one is doing, to make good decisions, and, as in this case of HAs, to share knowledge which may be useful to others.
This essay is not copyrighted; feel free to use its content, in any way you wish.