All about hearing aids

One in seven people have a hearing loss. If you think you might be one of them, and have thought about getting a hearing aid but are not sure if it would help, this leaflet is for you.

A hearing aid might help you if your hearing is not as good as it used to be. Do not be put off by the idea of wearing one, or think it will not make a difference. The hearing aids that are now available can help most people.

In the UK, you have a choice. You can either:

Get a free NHS hearing aid - anyone registered with a GP (family doctor) whose tests show they need a hearing aid is entitled to this service.
Buy a hearing aid privately from a registered hearing aid dispenser.

The next step

Visit your GP if you would like an NHS hearing aid. He or she will refer you to an ear, nose and throat (ENT) clinic at a hospital near you. If your doctor seems reluctant to refer you, insist. Explain that you are worried about your hearing and would like to see if a hearing aid would help. You are entitled to this, and if you think you have a hearing loss it is best to get your hearing checked as quickly as possible.

If you are over 60, your doctor may refer you straight to a hearing aid clinic, so that you do not have to wait to see an ENT consultant first.

If you prefer to buy a hearing aid, you can choose to go straight to a private dispenser. The dispenser will tell you if you need to see your doctor about your deafness. Always check that the dispenser is registered with the Hearing Aid Council, the regulatory body for hearing aid dispensers, tel: 01908 235700.

It may be a good idea to see your GP first anyway, in case you have an infection, or there is wax in your ears which needs to be removed.

NHS or private?

All hearing aids use batteries, but if you have an NHS aid, they are free. There are advantages and disadvantages with both options.

NHS hearing aids
The advantages: NHS hearing aids are free. So are batteries and, normally, repairs or replacement hearing aids. If you need
a more powerful hearing aid later on, you will not have to pay for it. You will be under the care of an ENT specialist or audiologist.

The disadvantages: You may have to wait several weeks for a first appointment and then a few more weeks for your hearing aid. You cannot choose which hearing aid you get. However, the NHS has a range of hearing aids, and there should be one to suit your hearing loss. In special cases, the consultant may prescribe a private hearing aid - one that is outside the usual NHS range - and the NHS will pay for it. You will probably only be given a hearing aid for one ear. If you lose your hearing aid, or damage it, you may be asked to pay towards replacing or repairing it.

Private hearing aids
The advantages: You can choose the kind of hearing aid you want. Some kinds of aid, such as canal aids and digital aids are not available on the NHS at present. If you are buying privately, you can choose any suitable aid and you will be able to get it within about two weeks.

The disadvantages: Hearing aids are expensive to buy. Costs range from about £300 to £2,500. If you buy an aid for each ear, the cost may be nearly doubled. You also have to pay for repairs when any guarantee runs out, new earmoulds, tubing and batteries.

Medical insurance may cover the cost of a hearing aid, but check with your insurer first - often it does not. You need to insure your hearing aid for loss, theft or damage if you buy it privately. Hearing aids last about five years and you will have to pay for new ones when you need them.

How to get your hearing aid

A typical audiogram for someone with age-related hearing loss. The symbols show the quietest sounds heard in each ear

Getting an NHS hearing aid
If your doctor refers you to an ENT clinic, you will see a consultant who examines your ears and asks about your hearing, any illnesses you have had and deafness in your family. You then see an audiologist who tests your hearing with a machine called an audiometer. This makes bleeps at different pitches and loudness levels. You tell the audiologist which sounds you hear and he or she draws a chart called an audiogram showing them.

If the consultant thinks a hearing aid will help you, an audiologist takes an impression of your ear to make an earmould to fit in it. You are asked to come back in a few weeks to have your aid fitted when the mould is ready. At this second appointment, you get your hearing aid. You will be told how to use your aid and should be given an appointment for a follow-up visit. You may also have the opportunity to see a hearing therapist.

If you decide to buy a hearing aid
The best way to find a dispenser is to get a recommendation from a friend or doctor. RNID can give you a list of dispensers near you, but cannot recommend one. Dispensers must be qualified, or in training, and registered with the Hearing Aid Council (see page 3). Check with them. Compare prices to get the best deal.

Everyone's hearing loss is different. A hearing aid that suits your friend may not suit you. The dispenser will test your hearing and discuss with you which hearing aid would be best for you. Before you sign a contract, read the RNID factsheet Buying a hearing aid? and be sure you know where you stand legally. Ask for a money-back guarantee or 28-day trial period so you can return the hearing aid if you are not happy with it. Get any agreement in writing.

Some hospitals have hearing aid shops, or recommend dispensers. If you want to try a free NHS hearing aid, do so, unless you are sure the aid you want is only available privately and you are happy to pay.

What you can expect from your hearing aid

A hearing aid will not give you perfect hearing. It makes sounds louder and may help you to hear on the telephone, make
conversations easier and increase your confidence.

Hearing aids do not make your hearing get worse. If you have tinnitus (hissing, buzzing or other noises in your ears or head) you will probably notice this less when you use a hearing aid.

It takes some time to get used to a hearing aid. Until you have used it in a lot of different situations you will not know if it suits you. Do not be afraid to ask to see the dispenser or audiologist again. You may need to have the aid adjusted several times; it is worth persevering until you are happy with it.

When you get your hearing aid, ask your dispenser or audiologist how to clean it and look after it. What you have to do varies, depending on the type of hearing aid you have.

The 'T' position

Using a hearing aid with a loop

The picture on the right shows a behind-the-ear hearing aid. You will see that the switch on it has three positions: 'M' for
ordinary use, 'O' for off and, in the middle, a setting marked 'T'.

When your hearing aid is switched to the 'T' position, you can use an induction loop, a piece of equipment which lets you hear sound more clearly at a distance or across a counter window.

The induction loop may be in a theatre or conference room, at the counter of a bank or booking office, or in a telephone receiver. You may even have one installed at home.

Most NHS hearing aids and many private ones have this 'T' position. If you are buying a hearing aid, ask the dispenser if your aid will have this setting. If it is a very small aid, there may not be room.

Different kinds of hearing aid

There are many different kinds of hearing aid:

Behind-the-ear aids have an earmould which fits inside your ear. The hearing aid itself sits behind your ear, and a plastic tube connects it to the earmould. This is the most common kind of hearing aid and most people who get an NHS hearing aid have one of these.

In-the-ear aids and canal aids fit inside your ear. The working part of the hearing aid is enclosed in the earmould, so that the whole aid fits into your ear. With big in-the-ear aids, the aid can be seen from the side. The smallest canal aids fit right inside your ear canal, where they cannot be seen. If you have a severe hearing loss, or very small ear canals, canal aids will probably not be suitable for you.

Body worn aids have a case to wear on your chest or on a belt, connected by a lead to an earphone and earmould. They are very powerful.

Digital hearing aids are the newest kind of aids. There is more information about them later.

Programmable hearing aids can be adjusted to suit your hearing loss, using a small computer.

Spectacle aids combine spectacles with a hearing aid. However, you cannot separate the spectacles from the aid, so if either needs repairing you have to manage without both, or have spares. Many people who use a behind-the-ear aid also wear spectacles without any problem anyway.

Bone conduction hearing aids are for people with conductive hearing loss who hear sound better if it is delivered by vibrations through their skull.

CROS/BiCROS hearing aids are for people with a severe or profound hearing loss in one ear and less or no hearing loss in the other.

Digital hearing aids

You may have heard about digital hearing aids. The difference between digital and ordinary analogue hearing aids is in the technology inside the aids and how they work. Like analogue hearing aids, digital aids have a microphone to pick up
sound. They can be behind-the-ear, in-the-ear or in-the-canal models. However, digital hearing aids contain a tiny
computer.

The aid converts sound into a series of numbers - information that the computer can understand. Digital aids therefore have much more flexibility for processing sounds than analogue aids. It is likely that within a few years all new hearing aids will be digital.

One of the biggest problems people who have hearing aids face is in hearing what they want to hear - such as conversation - when there is a lot of background noise. Digital aids are marketed as being able to give better sound when there is noise in the background. Most cut out some background noise but it is worth remembering that some analogue aids are designed to do this too.

Digital aids have other advantages, however. Some are designed so that they whistle less than analogue hearing aids, and they may also last longer than analogue hearing aids because they have fewer parts. They also process sound in different ways to make it easier to understand speech, even when there is no background noise. Like analogue hearing aids, digital hearing aids vary, and may have different features such as directional microphones.

Cost
Digital hearing aids cost up to £2,500 each. This is why most hearing aid users do not have them. Until now, the NHS has not been able to provide digital hearing aids because providing such expensive aids to some people would mean there was not enough money to buy aids for everyone who needed one. However the government now intends to introduce digital aids into the NHS, starting with about 20 selected audiology clinics in England. RNID is working with the Department of Health on this.

HEARING