The Best Hearing Aid. Does it really exist? | Clearly Hearing
Jeffrey David

The Best Hearing Aid. Does it really exist?

Posted on March 12, 2014 by Jeffrey David | 2 Comments

What is the best hearing aid?  

This is a question voiced to hearing health providers fairly often.  

The truth is there really isn’t a hearing aid that can be labelled ‘The Best Hearing Aid’.  Dr. Catherine Palmer, Associate Professor in the Department of Communication Science and Disorders in the University of Pittsburgh’s School of Health and Rehabilitation Sciences and an Audiologist at the University of Pittsburgh Medical Centre, has been quoted: “Numerous models of high-technology hearing aids are available, but the majority of them are similar to one another”

That really is an accurate statement, in fact, many hearing aid companies own more than one brand of hearing aid and sell the same hearing aid technology, under different names and often for different prices.  Phonak Hearing Aids and Unitron Hearing Aids are owned by the same company.  Oticon Hearing Aids and Bernafon Hearing Aids are owned by the same company.  These manufacture's along with Siemens are sold at Costco under different packaging labels and often at significantly lower prices than through local hearing clinics.  

When purchasing hearing aids online at it’s no different, the SmartAid line of hearing instruments is another packaging label for the same or similar technology found packaged under many other brands.

It’s not to say all hearing aids are the same, as they certainly are not.  What makes one hearing aid better than another has several factors including, the style or design of the hearing device, the microphone technology, the power of the hearing device and the DSP or Digital Sound Processor that powers the hearing device.

Hearing Aid Wearers should make it a point to understand some of the basics about hearing aids so that they know what their options are.  There is still a lot of outdated perception about the aesthetics and technology available in modern hearing aids.  Most people are pleasantly surprised when they find out they won't have to wear grandpa's old hearing aid.  

Hearing aids are available through Audiologists and some doctors offices, as well as through online stores.  Hearing Aids are typically priced between $1000-$3000 inside of hearing clinics, with similar hearing aids sold online for $299-$599.

Hearing Aid Design

Open-Fit & Receiver-In-Canal Hearing Aids

These are by far the most popular hearing aids sold today, as they represent one of the greatest breakthroughs in hearing aid designs.  These hearing devices are far smaller than traditional Behind-The-Ear hearing aids, providing a sleek attractive design while leaving the ear canal unoccluded, except for a small ear bud connected to a thin tube or wire. 

The vast majority of people living with hearing loss have a varied degree of high frequency sensorineural hearing loss.  These people are still able to hear low frequencies at or close to the normal hearing range, but have a sloping amount of hearing loss in the middle and high frequencies.  Often taking on a pattern similar to the hearing loss plotted on the audiogram below.

For years, audiologists have taken impressions of the ear to custom make earmolds or In-The-Ear hearing aids, but these hearing aid styles would block low frequencies from being heard naturally and would often cause occlusion, which leaves a person feeling plugged up, and usually leads to over amplification of the low frequencies and a sensation of talking with their head stuck inside of a barrel.

By leaving the ear canal open, hearing aid users are able to experience a much more natural sound quality and often adjust to hearing aids in a couple of weeks instead of the several months it often takes with molded hearing aids.  Some modern Open-Fit / RIC hearing aids are pictured below.

Whether your using the SmartAid Digital Premium or Oticon Alta Open-Fit Hearing Aid or the Phonak Audeo Q or Siemens Ace RIC hearing aid your hearing device will house multiple microphones, digital circuitry, an amplifier and a battery.  The SmartAid Digital Premium and Oticon Alta will also house the speaker which transports the sound through the thin tube to the ear canal.  Where, the Phonak Audeo Q and the Siemens Ace place the speaker in the ear and connect it to the hearing aid using a wire.

The verdicts out on which design is better between Open-Fit and RIC.  Some audiologists originally thought that having the receiver in the canal (RIC) would create less feedback because the speaker is further away from the microphone, but with advances in Feedback filters we don't notice much of a difference.  

RIC models are more susceptible to damage, as the speaker has to deal with a very humid environment, being the ear canal, as well as, the damaging effects of earwax.  This is something hearing aid users should consider, especially if they live far away from their service provider or are purchasing their hearing aids online.  On the other hand, RIC devices provide more power than Open-Fit hearing aids and are therefore able to fit patients with higher degrees of hearing loss.  

When we talk about power with hearing aids, we are talking in terms of 'Gain' which is recorded in decibels.  Most Open-Fit hearing aids provide 30-50dB of Gain, where as, RIC hearing aids range in gain from 40-70dB.

Traditional Behind-The-Ear (BTE)

These hearing aids still have there place in today's product mix as they are the most powerful hearing aids available.  Usually this style of hearing aid is only recommended for people when Open-Fit & RIC hearing aids are not powerful enough or for people with dexterity or vision constraints.  

In-The-Ear Hearing Aids

ITE and ITC hearing aids have really tapered in popularity over the last several years.  The majority of patients who have worn these custom hearing aids are now better served with Open-Fit or RIC hearing aids.  With nano-technology allowing hearing aid manufacturers to make their parts smaller, people wanting custom hearing aids are often able to change to a smaller Completely-In-The-Canal hearing aid.  ITE and ITC hearing aids are mostly only recommended to people who are already used to the design and simply replacing old hearing aids.  

Completely-In-The-Canal (CIC) Hearing Aids

While other In-The-Ear hearing aids have lost there popularity, CIC hearing aids have become increasingly popular.  With the miniaturization of hearing aid components, CIC's are more powerful than in the past and capable of fitting in smaller ear canals.  For most people, the draw of the CIC is in it's small size, which makes it hardly noticeable or completely invisible depending on the size of the ear canal that it calls home.  Some CIC's are now available off the shelf, without the requirement of an ear-mold, like the SmartAid Invisible hearing aid shown below. 

SmartAid Invisible with Volume Control

Mini-CIC (IIC) & Lyric Hearing Aid

The IIC and Lyric hearing aid are both designed to be fit in the second bend of the ear canal.  This is a deep insertion fitting that begins where a standard CIC ends and ends only millimetres from the ear drum.  The IIC is a custom molded hearing aid that is removed daily, the same as all traditional hearing aids.  The Lyric is placed in the ear by a hearing professional and then left there for up to 4 months.  Lyric wearers return to their audiologist to have the expired Lyric replaced with a new one.

These devices are almost always completely invisible when worn.  Wearers of these devices appreciate the benefits of having the microphone tucked deep inside of the ear canal, which include less wind noise, or noises from clothing brushing against the microphone and less of an incidence of feedback.  

These devices are only suitable for about 10% of the people who request them, as minimal length and diameter is required of the ear canal.  Also people on blood thinners or who experience active ear movement from jaw movement are not recommended to pursue these hearing aids. 

Advances in Microphone Technology & Digital Sound Processors

The problem without hearing aids is that you don't hear enough, but the problem with hearing aids is you often hear too much.  Hearing aid manufacturers have been spending millions of dollars advancing technology that allows hearing aid users to hear more of the stuff they want to hear and less of the stuff that they don't.  

The DSP, or Digital Sound Processors that control modern advanced hearing aids filters sound before it's amplified.  This allows the hearing aid to adapt the amplification applied to a quiet voice vs. a loud voice, increase filters applied to ambient noise and even change the focus of it's microphones to target speech when communicating in noisy places.  

While all of these technologies combine to provide the best hearing experience for the client, it is the authors opinion that the most beneficial technology has been in the advancement of adaptive directional microphones.  The video below shows how mathematics has been used to develop these smarter and more effective microphones. 

Adaptive directional microphones need a minimum space between microphones to make them effective, so they are not an option on CIC, IIC or Lyric hearing aids.  

Other area's where advancements in the DSP are evident is in feedback reduction.  Feedback or whistling hearing aids has been one of the biggest, if not the biggest complaints about hearing aids, since they were first invented.  The DSP helps to find and eliminate annoying feedback before it's ever heard, this allows hearing aids to achieve more amplification before an individual is bothered by feedback.  

Optimal Hearing Aid Performance

While open-fit hearing aids are the most popular choice of hearing aids and certainly offer many benefits, they are not for everyone.  The best practice before selecting a hearing aid is to have a hearing test done by a qualified hearing healthcare provider.  The best style of hearing aid for an individual depends on hearing test results, dexterity, vision, communication needs, lifestyle and what they can afford.  

We've provided more information about the products we sell on our website below:

Learn about the SmartAid Line of Hearing Instruments

Posted in Hearing Aid Technology, Open-Fit Hearing Aids



2 Responses


April 02, 2016

I wonder if you have found a better solution since your last posting? I have phonax that does not solve the clarity problem. Oticon didnt work for me. I dont know which to choose now, thinking about having an ear mold to have the bernafon or other.

Wayne L. Vince
Wayne L. Vince

October 14, 2014

I have been wearing hearing aids for over 10 years and have found the Siemens BTE Hearing Aids interfere with my eyeglasses and had to constantly re-adjust the hearing aids. Also, when removing any kind of pull-over shirt or sweater the BTE’s would get caught in my clothing, and last but not least they “whissled”. Since then I have been wearing Oticon ITC hearing aids and they have served me relatively well, however, I have had to send them out for repair about every 2 years. October 9, 2014 I purchased a set of Phonac Q90’s and am returning them today. One of the worsed experiences I have ever had. SO AFTER 10 1/2 YEARS OF HEARING AIDS I NOW WEAR NONE.

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