Welcome to the CCENT Hearing, Otology and Balance Center. The audiology department at Central Carolina ENT offers a full range hearing instrument dispensary. Once a patient has been evaluated medically and has had their hearing evaluated, hearing instruments may be recommended. The patient will then be scheduled for a hearing aid evaluation which will help determine which level of digital technology that is needed.

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Questions about Digital Hearing Aids

Q.       Why does my hearing aid squeal ?

A.     Squealing from a hearing aid is called Feedback. It can result from sound leaking around the hearing aid and getting re-amplified. Wax in the ear can also cause feedback. With a hearing aid behind the ear instrument, cracked tubing in the ear mold can also cause feedback.

Q.     Can digital hearing aids can eliminate feedback?

A.     Yes, in many cases digital instruments can eliminate feedback. This is accomplished by comparing the returning signal to a static filter set that is stored in the hearing aid chip. If the returning signal is different from that stored image, a phase shifting of the signal occurs which stops the whistling. Different manufacturers have different methods for reducing the feedback. 

Q.     How do I know if I need a hearing aid?

A.     Make an appointment to see an ear specialist or an audiologist. Your hearing will be evaluated and then you will be told if you could benefit from a hearing aid. Then a hearing aid evaluation might be set up where you could try a hearing aid for one month to determine if it would benefit you. Several counseling sessions are needed during that adjustment period to make sure the hearing instrument is adjusted properly and that you are doing what you are supposed to do. 

Q.     Can digital hearing aids help me hear better?

A. In most cases, patients report better understanding in noise with digital hearing instruments. The main reason is that digital products have the ability to continuously analyze the incoming sound signal and try to differentiate between noise and speech signals. Also units equipped with two or more microphones can also improve the signal to noise ratio, especially in noisy environments. The result is typically clearer speech.

Q.     How much do digital hearing aids cost?

A.     There are basically two factors that affect the cost..size and level of sophistication of the circuit. The smallest in the hearing aid is called a completely in the canal (CIC) and it is designed to fit deep in the ear canal and not be noticeable. It is the most expensive style of hearing aid because it is the hardest to build. Then there are varying degrees of sizes that get little bigger. The largest in the ear size is called a full shell in the ear (ITE). It fills the entire outer ear. Then there are of course behind the ear units that can accommodate more severe losses. Price can also be driven by the type of digital circuit ordered. The top of the line digital circuit has all of the bells and whistles included to try and help the user hear better in quiet and noisy listening environments. Then as you go down to the two other classes of digital hearing instruments, certain features like directional microphones (and some programming abilities) are eliminated to help hold down costs. Bottom line, what you need is determined by your listening environments and your personal desires. The price range can be from $2900 each for the top end digital CIC unit to $850 for older style in the ear (ITE) analogue (non digital) device with volume control. 

Q.     How do I pay for my digital hearing aids?

A. We do have financing available now that will allow you to pay for your digital hearing aids in two different ways. You can pay same as cash over 90 days, or finance them over 48 months. We can see if you qualify for financing immediately when you come into our office. If you would rather pay cash, we ask that you pay half of the total price at the time the hearing instrument order is placed, and then the other half when you are fitted with the devices. You of course have a 30-day trail period to decide if you like you're new hearing instruments.

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Assistive Listening Devices

When a person won’t or can’t wear a hearing aid, assistive listening devices might be the answer.  Assistive listening devices (ALDs) are designed to improve audibility in specific listening situations.  ALDs comprise a large group of items that can be used with hearing aids, cochlear implants, or by themselves.

An example might be a frequency modulated (FM) system that can work with a hearing aid or on its own.  A hand held microphone or an attached microphone picks up the sound of the speaker more directly and then sends that signal directly to the hearing aid or receiver unit.  The effect of the noise in the listening environment is minimized by being able to pick up the sound of the speaker(s) more efficiently and directly.  The hearing aid user can then hear the speaker at a better signal to noise ratio.  The FM systems are used many times in schools to help the student hear the teacher better in a noisy classroom setting.

There are also assistive listening devices that can help you hear the television better.  A microphone placed near the television speaker picks up the sound and sends it to a receiver unit via infrared signals.  The user can then adjust the volume to a comfortable level and let other family members listen to the television at their normal levels.

Assistive listening devices also cover such products as amplified telephones, alarm and alerting devices (alarm clocks, smoke detectors, doorbell alerts).  ALDs have a primary goal of improving your ability to hear by making the desired sound stand out from the background noise.

If you are interested in ordering an assistive listening device, call one of the audiologists.  Central Carolina ENT has many different suppliers for ALD’s.

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Hearing Aid Evaluation

The hearing aid evaluation appointment takes an hour and is mainly an information sharing session.  After a brief review of your hearing test, the various styles of hearing aids will be discussed and shown to you.  Normally you will then be given an actual hearing aid demonstration with an over the ear hearing aid.  This type of aid is used because it usually can be programmed to your hearing need and fitted to the ear immediately with a stock tip that fits into the ear canal. 

This experience will give you an idea of how amplification sounds in your ear(s) and how much clearer the speech can sound.  Family members may be asked to talk to you in a normal voice so that you can experience first hand how well your hearing has been improved with hearing aids.  You can also see how the audiologist uses the computer to program your hearing aids to your specific needs.

You might be asked to tell us about your listening needs.  This information is helpful in determining which type of digital processor you might need.  The most sophisticated digital processor will be needed to handle the most difficult listening situations.  But if you are not in a lot of noise, then a less costly and less sophisticated digital aid might be recommended for you.  There are normally four different priced hearing aids and our goal is to find one that will meet your hearing needs and budget.

Once it has been determined which style and level of technology you want, an earmold impression will be taken of your ears.  The impressions will then be sent to the manufacturer or earmold lab for processing.  In about two weeks, you will be called to return to our office for the fitting of the hearing aid(s).  You will be given a copy of the hearing aid payment policy which outlines the terms of the 45 day hearing aid trial period.  It is a company policy that the hearing aids are paid for in full at the time of the fitting.  Financing options can be checked out if you think you’ll need more time to pay for your hearing aids.

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Types of Hearing Aids

CIC (Completely in the Canal)

This is the smallest type of hearing aid made and in some ears, is almost invisible.  All the components are housed in a small case that fits down into the ear canal.  People often like this style because it is less visible and “hides” in the ear canal.

The advantages of this style is that the hearing aid utilizes the ear’s own natural sound collecting design (Pinna or outer ear) to collect and  funnel the sound down to the hearing aid.  The CIC aid also allows for normal telephone use most of the time and protection from wind noise as the microphone is recessed in the ear canal.

Because of its size, the CIC devices have a limited fitting range.  They can not be fitted on all ranges of hearing loss.  The person using this type of unit must have fairly good dexterity with their hands and fingers.  The CIC hearing aid is also more fragile and prone to getting plugged up with ear wax.  It also may not be able to be fitted in some ear canals that are extremely small or have severe bends or angles. 

ITC (In the Canal)

A little bigger than the CIC, the ITC hearing aids also fit far into the ear canal. Canal hearing aids use a slightly larger battery than the CIC style. This style is used for mild to moderate hearing losses.  It has the advantage of fitting deeply into the ear canal but may be more manageable by someone with reduced hand and finger dexterity.

These sizes can also accommodate directional microphones (in most cases) which help focus the sound in front of the patient and minimize the noise along side or behind the patient.  No volume controls are necessary in the ITC unit and different noise programs can be accessed by pushing a small button on the faceplate of the device.

ITE (in the Ear, Full Shell or Half Shell)

These hearing aids can be used for a wider range of hearing losses. Due to their larger size, ITEs can accommodate larger sound amplifiers and more features such as directional microphones and a memory program button.

Directional microphones help the patient focus on the sound  in front and minimize the sound on the sides and behind the hearing aid listener. The memory button allows the hearing aid user to access multiple memories that process the incoming sound differently.   They are also easier to handle. 

BTE (Behind the Ear)

In BTE hearing aids, the electronics are housed in a case that fits behind the ear. Tubing and a custom made earmold direct the sound to the ear canal. Due to its robust design, this style is especially recommended for children.

BTE hearing aids can provide more amplification than smaller devices due to the stronger amplifier and the larger battery. This style is available in several colors for hair and skin tone matching.  The behind the ear unit can also be equipped with directional microphones to help focus the sound in front of the person and minimize the sound beside and behind the person.  The units also can have multiple memories included in the design, so that the user can go to a different noise program (via a button on the unit) that reduces background noise and makes speech easier to understand in certain listening environments.

Body Aid

Body aids are the strongest of any hearing aids.  A separate amplifier is clipped to a belt or shirt pocket and then a cord leads to a button type receiver in the ear.  The separation of the microphone and receiver allows the user to turn up the unit a lot higher before feedback (whistling noise) occurs.

 

Open Ear Technology For millions of Americans with mild to moderate high frequency hearing loss, new “open Ear” technology offers many advantages over traditional hearing aid fitting approaches. Typically older technology would block the normal hearing ranges while trying to boost the high frequency regions (2 to 6kHz).  The result left the hearing aid user with a plugged up sensation that made wearing hearing aids almost intolerable.

Thanks to advances in digital processing of sound, like the Resound Pulse hearing aid, sound can now be delivered to the ear at prescribed levels without the occlusion effect.  In the world of open fittings, true useable gain is the foundation of speech intelligibility.  A very small thin tube delivers digitally processed sound to the eardrum from a small processor located behind the ear.  This type of fitting, keeps the ear open to lower-pitched sounds that don’t need amplification.  Help can be delivered to the high frequency consonant regions because acoustic feedback can now be better controlled by digital feedback suppression routines that are the hallmark of “open fitting” technologies. The small processor and thin tubing is cosmetically appealing and the improved clarity, especially in the presence of background is a welcome benefit.  [Learn More]

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Typical Hearing aid Experiences in the Beginning

Depending upon your hearing loss, you may be hearing all sorts of sounds you have not heard for a long time.  This can be somewhat overwhelming at first until your brain “toughens up” to certain types of sounds.  Luckily digital hearing aids can be adjusted in many ways to keep loud sounds from not being too loud but keep soft sounds audible.
So it is important to report your initial hearing aid experiences (good and bad) to your audiologist so that proper adjustments can be made through the early stages of hearing aid adaptation.

Even the best digital hearing aids will not solve all of your understanding problems.  Once the sounds leave the digital processor and pass through the middle ear and then on to the inner ear, hearing problems may still exist.  This can be caused by the extent of your hearing loss.  We have no control over how your inner ear processes incoming sounds.  All the audiologist can do is to fit the hearing aids to the best possible settings for you and then review realistic expectations.  We want you to understand what the hearing aids can do but also what they can’t do.

When you speak your own voice may sound quite different with hearing aids in place.  In certain fittings, the Occlusion Effect, can cause your voice to sound like you are in an echo chamber.  The reason for this is that some parts of your voice are trapped in the ear canal which in turn can cause the cartilage to vibrate.

This sensation often goes away in a short time after your brain adjusts to amplification.  But it may persist if there are fitting issues that need to be resolved.  For example, the air vent hole in the hearing aids may need tobe enlarged to help offset the occlusion effect.  The units may need to be recased so that the tip can be shortened.  There are many things that can affect the way your own voice sounds to yourself.  Again, excellent communication with your audiologist is critical in making you a successful and happy hearing aid user.

Even after your initial trial period, it is most important to stay in touch with your audiologist.  We recommend that you are seen every three months.  These checkup appointments are very important so that your aid(s) can be cleaned and programs changed or adjusted if necessary.  Also every year the hearing aids can be reprogrammed to account for changes noted in the annual hearing test.   These type of services are free if your hearing aid is in warranty.

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Digital Hearing Aids

Digital hearing aids boast today's most advanced technology. Digital hearing aids are programmable hearing instruments with digital circuits. These digital circuits are more flexible than analog circuits.   The analog circuits increased the volume of all incoming sounds and sometimes made loud sounds too loud and soft sounds too soft.  These types of circuits were also prone to feedback (whistling noise) and distortion.  Digital circuits can be precisely programmed to match the patient's individual hearing loss, sometimes at each specific frequency/pitch. Digital circuits offer improved clarity of sound, less circuit noise, faster processing of sound, and improved listening in noise when compared to analog circuits. Digital hearing aids are easy to use because they adjust volume automatically.

	Digital hearing aids represent the most advanced technology available today allowing the most precise prescriptive fitting available. Older analog hearing aids turned everything up, but digital hearing aids focus on clarity and comfort through sophisticated control of the sound signal inside the hearing aid.
If you think about the sounds that you can hear and sounds that you cannot hear, these sounds differ in pitch (ex. keys on a piano) and they differ in volume/loudness. Digital processing can shape your amplification (volume and clarity of signal which you hear through the aid) by changing pitches and changing volumes.

Digital hearing aids also offer many other feature like directional microphones and multiple programmable memories to enhance the user’s benefit in different listening environments.  The key is the tiny computer chip that manipulates the incoming soundwaves according to logic principles supplied by the various manufacturers.  The modern digital hearing aid can provide a hearing-impaired person with an improved and more pleasant sound picture. But it cannot bring back normal hearing.  Even digital hearing aids are limited by many factors of hearing loss such as speech understanding abilities, extent of damage to the inner ear and entire auditory pathway.  Like many other high-tech devices, high expectations can accompany digital hearing aid devices.  Counseling patients as to the realistic expectations of digital amplification will continue to be most important.  But the future looks bright as technology and processing schemes continue to improve.

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How digital Hearing Aids work

In a very rough sense, the digital hearing aid has five major components: the microphone, the analog to digital converter, the core, the digital to analog converter, and the receiver. Sound waves hit the hearing instrument microphone where they are converted to an electrical signal (analog). The signal then passes through an Analog to Digital converter (A/D converter) where it is changed to a sequence of 1s and 0s. This sequence is sent to the "core" where it is filtered into bands and channels, then manipulated according to the programmed settings for the specific hearing loss. Each hearing aid manufacturer may have its own proprietary set of rules that it applies to the digital speech envelope.  The manipulated signal is then channeled through a Digital to Analog converter (D/A) where the end result is an analog signal that has been manipulated according to the hearing loss and proprietary chip logic. This signal then travels to the receiver where it is converted back to an acoustic signal that the user then hears. In other words, the digital hearing aid has a tiny computer chip in it that can manipulate the sound according to specific frequency (pitch) and specific volume level to deliver a clear sound set precisely to the user's hearing loss.  The dispenser or audiologist then has the ability to manipulate many aspects of the digital processor, like gain, compression (control the loudness of sounds), and acoustical feedback (whistling noise) through the computer interface.  The result is a more precisely fit hearing instrument and a happier hearing aid user.   

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Cost of Digital Hearing Aids

People often ask why hearing aids are so expensive.  One reason is that manufacturers put a great deal of time and money into research and development of the digital products.  Another reason is that hearing aid industry is relatively small and a great majority of their products are custom made. 

Prices for digital units can run from a low end of $750 to a high end of $3500 each.  You also must realize that the price includes the services of a highly qualified audiologist who will program and service your hearing aid(s) for the life of the warranty and beyond.  What type of digital aid you might need might be determined by your listening needs.  If you need to hear in crowds and in lots of demanding listening situations, the best noise reduction processor is what you may need.  However if you have a fairly quiet life style, then perhaps a less sophisticated processor might be all you’ll need to hear better.  Your audiologist will help determine which digital processor is best for you.

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Custom Earmold Products

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Repairs and Supplies

Hearing Aids come with standard warranties and loss and damage coverages.  The length of the warranty often is determined by the model of hearing aid that is purchased.  When your initial warranty is about to expire, you can elect to extend that warranty for a certain fee.  Sometimes you can also extend the loss and damage coverage.  Be sure and check with your audiologist regarding the details in your particular case.

When a loss occurs, you might be asked to bring in a notarized statement.  This document describes when and where the loss occurred and is submitted to the hearing aid manufacturer for processing.  Normally there will be a deductible charge that could range from $125 on up to $170.  The replacement hearing aid will continue with the warranty terms of the lost hearing aid but it will no longer have loss coverage.  You can obtain loss coverage again from a third party vendor if desired.  Earmolds are not covered by loss and damage claims.

Most hearing aids can be repaired.  However some units more than five years old, may be more expensive to repair.  A standard repair warranty is typically one year long.  With some custom in the ear aids, remakes may or may not be covered by a typical repair.  With changes in technology, it is wise to have your hearing checked yearly to see if you could be better served with a newer hearing aid. 

Central Carolina ENT sells batteries and other hearing aid supplies.  Assistive listening devices (ALD’s) can often help individuals who can’t or won’t wear hearing aids.  ALD’s, like FM systems, can often be coupled to current hearing aids and help pickup and focus in on sounds in noisy environments.  Check with the audiology staff to see if we can find certain products that will enhance your listening experience. 

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Warranty and Service

All hearing aids come with at least a one year warranty and one year loss and damage coverage.  Many of the higher priced units will have a longer warranty and loss and damage coverage.  There is never a charge to be seen in the Audiology department if your aid is under warranty.  But we ask you to call first becoming in to the office as we want to take care of your needs promptly.   

When your initial warranty is about to expire, you do have the opportunity to extend the warranty and loss coverage for a certain period of time depending upon the make of your hearing aid.  Sometimes extended warranties will only cover repair services and not remakes of in the ear hearing aids.  Check with your audiologist to find out what coverage you have on your digital unit. 

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