How Do I Know If I Need Hearing Aids?

Hearing loss is one of the most common disabilities worldwide. According to the National Institute of Deafness and Other Communication Disorders, in the United States, almost 25 percent of people aged 65 to 74 and 50 percent of those who are 75 and older are affected by disabling hearing loss. Despite the prevalence of hearing loss, the majority of people experiencing difficulty go undiagnosed and untreated. 

If you are noticing that you have difficulty hearing in some situations, it may be time to consider hearing aids. There is a misconception that hearing aids are only for people with a great degree of hearing loss, but this is untrue. In fact, many people who get hearing aids sooner rather than later find more success with them. Perhaps you struggle in noisy environments such as restaurants, you have difficulty understanding on the phone, or you find that your spouse is always trying to speak to you from another room and you are missing what they are saying. Whatever the situation, the best place to start is a full diagnostic hearing evaluation with an audiologist.

During a hearing evaluation, the audiologist will measure the softest levels at which you can detect sound (known as thresholds) in each ear individually at a range of frequencies (pitches). The tones will first be presented via insert earphones or over-the-ear headphones, and then via an oscillator placed on the bony portion of your head behind your ear.

These results will tell the audiologist the type and degree of your hearing loss, if any. The second portion of the evaluation will involve a test of your ability to discriminate words. They will be presented to each ear individually at a comfortable level. While this isn’t a true test of your comprehension ability (no visual cues, one ear at a time, in a soundproofed room), it can help the audiologist to determine whether your discrimination ability aligns with your hearing sensitivity and predict, to some degree, how successful you might be with hearing aids.If you are a candidate for hearing aids, there are several different brands and styles.

The purpose of this article is to compare and contrast two of the most common styles: open fit and traditional hearing aids, to help you determine which option is best suited for your needs.

What Are Open Fit Hearing Aids?

open fit hearing aids

Open fit hearing aids have a few other names: receiver-in-canal (RIC) and receiver-in-the-ear (RITE); they are synonymous. As the name implies, the goal of this style of hearing aid is to leave the ear as “open” as possible, both for comfort and for sound quality reasons. The receiver on a hearing aid is the speaker, and it is small enough to sit in the ear canal. A thin wire connects the receiver to the body of the hearing aid which sits behind the ear.

There are three main advantages of open fit hearing aids: sound quality, user comfort, and aesthetics. First, sound quality is quite natural due to the placement of the speaker in the ear because it is closer to the eardrum and therefore does not have to travel very far to reach the natural sound pathway in its amplified form.

Additionally, an open ear canal allows for low frequency sounds to enter the ear naturally; often, patients who qualify for this style of hearing aid have normal or near-normal hearing in the low frequencies and require hearing aids for the middle and high frequencies. Keeping low frequency sounds natural can improve the overall perception of sound quality with hearing aids. If you’ve ever plugged your ears and tried to talk, you notice that it changes the perception of your own voice. This is due to something called the occlusion effect. By leaving the ear mostly open, this can be avoided.

In terms of comfort, leaving the ear canal open allows air to circulate. The hearing aids are quite small and very light. More than likely you won’t even notice they are there after a few hours. Often, open fit hearing aids use plastic “domes” over the receiver to make it comfortable in the ear and protect the receiver from wax and moisture. These domes come in different shapes and sizes which can be selected based on degree of hearing loss and patient comfort. They are easy for the patient to change at home as needed.

Finally, this style of hearing aid is probably the least noticeable, which is a desirable attribute for many hearing aid users. The hearing aids are quite small behind the ear, and the only visible portion is the thin wire that runs along the front of the ear and into the ear canal. Even for patients with little or no hair, they are barely detectable.

Open fit hearing aids are fantastic, but not for everyone. For patients with greater degrees of hearing loss or certain types or configurations, they may not offer the greatest potential benefit. Patients with certain conditions that cause the ear to drain or have excessive wax may also find that having the receiver in their ear canal is not efficient as it may become damaged and need to be changed regularly.

In the next section we’ll explore traditional hearing aids, which can meet the needs of another patient population.

What Are Traditional Hearing Aids?

Like open fit hearing aids, traditional hearing aids involve a piece that sits behind the ear; for this reason, they are often referred to as “BTE” hearing aids. While the open fit style involves placement of the receiver (speaker) in the ear canal, a traditional hearing aid houses all of the electronic components in the portion of the device that sits behind the ear. The sound travels into the ear via a tube connected to a custom earmold.

Image Credit: ReSound

This style is generally universal and was widely recommended to people with all types and degrees of hearing loss before the introduction of open fit styles. Today, traditional hearing aids are more commonly prescribed for people with severe to profound hearing loss due to the ability to provide greater degrees of amplification and to keep it in the ear with a custom earmold. 

While there are some standard options available for BTE hearing aids, most often a custom earmold will be ordered. This involves taking an impression of each ear to have the molds made. Soft plastic tubing is threaded through the earmold and attaches to the earhook on the hearing aid itself. The size, material, and venting of the earmold are all dictated by the type and degree of hearing loss. For the most severe hearing losses, a larger earmold that is more occluding would be recommended to keep sound in. Others may have an earmold that does not fill the entire concha bowl and has a vent to allow for some air circulation.

If you or someone you know uses hearing aids, you may be familiar with the concept of feedback. This is the whistling that can occur with hearing aids when sound exits the hearing aid and is picked up and re-amplified by the hearing aid microphones. This is unfortunately (but adorably) displayed in the Pixar movie Up.

The hearing aid manufacturers have developed a lot of technology to digitally reduce feedback, but it begins with appropriate style, fit, and retention of the ear mold. Patients who have a lot of hearing loss may not be able to use open fit hearing aids for this reason. Feedback can also occur when hearing aids are not inserted properly, or when patients have a considerable amount of wax in the ear canal.

While traditional hearing aids are more noticeable than the open fit style due to the size of the hearing aid, tube, and earmold, they are more appropriate for greater degrees of hearing loss. Traditional hearing aids are always recommended for children, as they are more durable due to not placing any electronics inside the ear canal. Additionally, the earmolds can be replaced as the ear grows. Users of traditional hearing aids will likely need their earmold tubing replaced relatively regularly, depending on their climate, lifestyle, and body composition. Earmolds can be ordered in fun colors and patterns if you would like to express yourself with your ear gear!

Which One Should I Choose?

The good news is that the decision will probably be based on your audiogram. All hearing aids come with a fitting range, so your audiologist will be able to look at your test results and see which style will be able to accommodate your amplification needs. Additionally, most of the manufacturers are able to offer the same features in terms of connectivity, noise reduction, and directional microphones, regardless of the style you choose. There are a few different levels of technology for each manufacturer, but you could choose either an open fit or a traditional hearing aid at the technology level of your choice. 

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There is some gray area in the fitting ranges; if you have a severe hearing loss but are really interested in pursuing the RIC/RITE style, it is possible you could use a power receiver with a custom ear tip. This will not be quite the same “open fit” as can be used for mild to moderate hearing losses, but you will be able to take advantage of some of the sound quality benefits of having the receiver in the ear, and the aesthetics of the receiver wire versus earmold tubing. 

One of the general advantages of having devices behind the ear, whether they are traditional or open fit, is the superior microphone position for noise reduction strategies. The front microphone and rear microphone can automatically adapt to situations to focus on speech to the front and reduce noise to the back. While in-the-ear hearing aids have some of this technology, too, it often isn’t as effective due to the position of the microphones. 

Keep in mind that hearing aids purchased from an audiologist or hearing aid dispenser should all come with a trial period, ranging from 30 to 90 days depending upon the state and location where the devices are purchased. If you choose one style and determine that it isn’t appropriate, you will be able to try another style during your trial period. The same goes for technology level; your hearing healthcare professional can help you to determine what technology level might be most appropriate based upon your lifestyle and hearing needs, and you can adjust up or down within your trial period if needed.

hearing aid technology levels
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Generally, the higher technology level and higher price point means that the hearing aids have more flexibility in programming for the audiologist or hearing aid dispenser, and that they contain more “scenes” for automatic switching. For example, the entry level devices can distinguish between noise, calm, and music. The highest technology level has automatic settings for more specific situations such as speech in car and comfort in echoing environments.

How Do I Find A Hearing Healthcare Professional?

Hearing Healthcare Professional
Image Credit: Lexie

Hearing aids are prescription devices which are specifically programmed by an audiologist or hearing aid dispenser according to a patient’s individual hearing loss using a proprietary manufacturer software. They provide different levels of volume (more accurately known as “gain”) at different pitches or frequencies based on the patient’s specific hearing loss. The audiologist or hearing aid dispenser can make continual adjustments based on patient preference, change in hearing, or need for additional manual programs. It is important to find a professional that you trust and want to work with, because it will be an ongoing relationship, most likely with annual visits at a minimum.

The professional will assess your hearing, explain your test results, make recommendations about appropriate amplification, and perform the initial hearing aid fitting as well as follow-up adjustments. Many patients find it helpful to have a spouse, friend, or other family member attend their evaluation and discussion of amplification. That individual can speak to lifestyle and demands on hearing, and can help make a decision regarding technology level and budget.

The most important first step if you are noticing difficulty with hearing is to consult a professional for a full diagnostic hearing test. The professional will help you to consider your unique needs, preferences, and lifestyle factors when making a decision. They will also ensure the chosen hearing aid option provides the best possible outcomes for your specific hearing loss. Consult the American Speech-Language Hearing Association (ASHA) or American Academy of Audiology (AAA) databases to find an audiologist near you.

erin edwards aud
Clinical Audiologist at Towson University | + posts

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.

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