Hearing aid technology has made massive enhancements over the last two decades. Not only has the basic functionality for treating hearing loss advanced, but new features such as Bluetooth connectivity and rechargeability have been introduced to vastly improve the end-user experience. In today’s article, we are going to discuss digital vs analog hearing aids and how they greatly differ from each.
How Is Hearing Loss Measured?
Let’s start by taking a look at how hearing loss is quantified by audiologists. Below is an example of an audiogram that is typical for a person who has hearing loss due to aging, also known as presbycusis.
On the y-axis, you see intensity (loudness) measured in decibels (dB). On the x-axis, you see frequency (pitch) measured in hertz (Hz). An audiologist presents pure tones at each octave frequency from 250-8000 Hz and determines the softest possible level the patient is able to hear, known as threshold. These frequencies are chosen specifically because they represent the range of the sounds of speech. The red circles represent the thresholds for the right ear, and the blue X’s represent the thresholds for the left ear.
Normal hearing is considered to be thresholds of 15 dB or lower. As the sound needs to be made louder in order to detect it, the thresholds can be classified into mild, moderate, moderately severe, severe, and profound hearing loss. As you can see in the audiogram above, this patient has a normal or near-normal hearing in the lower frequencies, which slopes to a severe hearing loss in the higher frequencies. This is a very common configuration of hearing loss.
How Do Hearing Aids Treat Hearing Loss?
Analog hearing aids provide equal amplification for all sounds, which, as you can see from the example above, would be problematic for this patient who really doesn’t need low-frequency sounds to be any louder. Additionally, analog hearing aids would amplify speech and noise equally, which would not be helpful in a difficult listening environment. When you’re in a noisy restaurant, you probably want to hear the person you are dining with and not the kitchen noise or the other diners.
A digital hearing aid, on the other hand, only provides amplification at the frequencies where the hearing loss is present, and the amount of amplification would be determined by the amount of hearing loss. So, simply put, digital hearing aids are probably going to leave those low frequencies alone, provide some assistance in the mid frequencies, and then a larger boost for the high frequencies. Digital hearing aids can be continually re-programmed as hearing loss advances or changes. Additionally, digital hearing aids have complex algorithms to determine speech versus noise in the environment. They have multiple microphones which can automatically focus, known as “directionality” to provide more emphasis on a dining partner in front of you and reduce the kitchen noise or other diners sitting behind you.
Analog hearing aids have very limited ability to be tweaked with the manual controls on the devices themselves. Digital hearing aids are programmed by your audiologist using the proprietary software from the manufacturers, which has some flexibility to customize your hearing aids based on your hearing loss and individual listening needs. It is important to give your audiologist feedback about how your hearing aids are managing different listening situations. They are never going to be perfect, but specifics will help your audiologist to make informed choices about what adjustments to perform.
How Should I Choose Hearing Aids?
Analog hearing aids are unlikely to be recommended by any provider these days. Rather, digital hearing aids come in different levels of technology at a variety of price points. The advanced level hearing aids at higher price points have more sophisticated microphone technology in terms of how sensitive they are to speech versus noise, as well as other difficult listening environments such as the car or in the presence of wind noise.
Your audiologist will likely make a recommendation about the style of hearing aid (behind the ear, receiver-in-the-ear, in-the-ear, etc.) based on your type and degree of hearing loss. They may also make a recommendation about the technology level based on your lifestyle and the demands on your listening. Someone who is retired, lives only with their significant other and is largely in quiet requires a different device than a young professional who is frequently at restaurants or other social gatherings with lots of noise and competing speakers.
Increasingly, insurance companies are offering hearing aid benefits which may not cover the full cost but will certainly help to contribute. The cost of hearing aids can vary depending on the setting where they are purchased. Sometimes audiologists will bundle in the cost of the visits for fitting and adjustments for a certain period of time into the total price of the hearing aids. Other providers will charge separately for additional visits. The manufacturer warranty of the hearing aids is also a factor to consider; often, the higher-end hearing aids come with additional years of warranty.
Related Article: Does United Healthcare Cover Hearing Aids?
What If I Already Have Analog Hearing Aids?
While it may seem like the advantages of digital hearing aids are obvious, the transition to digital hearing aids from analog can be quite challenging. We hear with our ears, but more importantly, we process sound with our brains. When the brain has become accustomed to a certain kind of signal, no matter how inadequate, the adjustment to a new signal takes some time.
Often, patients who have used analog hearing aids perceive that their new digital hearing aids can never be loud enough. Others are distracted by the automatic features meant to improve listening ability in difficult environments. That said, the brain is highly plastic, meaning that with continued wear time and effort, the user can adjust to and benefit from their new hearing aids.
Traditional analog hearing aids are only available in a behind-the-ear (BTE) style with an earmold. Digital hearing aids come in a variety of fits and styles, which may make them more physically comfortable, in addition to providing superior sound quality. Additionally, digital hearing aids have sophisticated technology to manage feedback (whistling) which can be a major advantage for both the user and their loved ones.
Finally, there are a wide variety of assistive listening devices available today which can provide extra support in the most difficult listening environments, which typically involve noise and/or distance. These devices are supported by digital hearing aid platforms but do not have the ability to pair to analog aids.
Of note, personal amplifiers work similarly to analog hearing aids. Rather than right and left hearing aids worn on the ears, a personal amplifier typically utilizes a set of earphones connected to a device with a microphone. Like the analog aids, the amplifier is going to make any sound coming into the external microphone louder. There is no way to fine-tune it specifically to the individual’s hearing loss configuration. So, if you have tried a hearing amplifier and haven’t found it to be sufficient for your hearing needs, you should absolutely consider pursuing digital hearing aids.
Erin Edwards received her Doctor of Audiology degree from Towson University in 2015 and her Ph.D. in Education and Leadership from Pacific University in 2022. She has worked with patients of all ages in a variety of settings and has a specific interest in cochlear implants, the relationship of hearing loss and dementia, and interdisciplinary healthcare.