Digital hearing aids - About this factsheet

This factsheet is part of RNID's hearing aids range. It is written for deaf and hard of hearing people who would like to find out more about digital hearing aids. It explains:

• How digital hearing aids work.
   
• Their advantages when compared to traditional analogue hearing aids.How to get one on the NHS.
   
• How and where to buy them privately.

Analogue hearing aids

Analogue hearing aids have a microphone that picks up sound and converts it to small electrical signals. These signals vary according to the pattern of the sound. The signals are then amplified by transistors and fed to the earphone so that the person using the hearing aid can hear them.

Most of the better analogue hearing aids compress the sound using 'automatic gain control' (AGC). This amplifies quiet sounds until they are loud enough to be heard, but gives less amplification to sounds that are already loud, so that the person using the hearing aid is protected against uncomfortably loud sound levels. Analogue hearing aids are generally not as flexible as digital aids, but they are the cheapest hearing aids available.

Digital hearing aids

Digital aids work in a different way. They take the signal from the microphone and convert it into 'bits' of data - numbers that can be manipulated by a tiny computer in the hearing aid. This makes it possible to tailor and process sounds very precisely, in ways that are impossible with analogue aids. The better digital aids can be very finely adjusted to suit individuals. Many even adjust themselves automatically to suit different sound environments.

Cutting out background noise

When someone talks to you, you usually want to hear what they are saying, rather than whatever noise is going on in the background. People who use traditional analogue hearing aids often complain that they find it difficult or impossible to follow conversation in noisy places.

Many digital aids are designed to reduce steady kinds of background noise such as the rumble of traffic or the whirr of a fan. This makes listening more comfortable. However, it does not necessarily help you to pick out a single voice from everything else that is going on, especially when several people are talking.
 

Two things have been shown to improve hearing in noisy situations more than anything else - wearing hearing aids in both ears, and using hearing aids that have twin microphones.

Twin microphones

'Twin' or 'dual' microphones are a type of directional microphone that works effectively in hearing aids. The twin microphone picks up sounds that come from in front of you much better than sounds to the side or behind you, making it easier for you to focus on what you want to listen to in a noisy place. Some - but not all - digital hearing aids have twin microphones. Ideally, they are switchable so that you can change to 'all round sound' when you need to - when you are crossing the road, for example.

Some sophisticated analogue hearing aids also have twin microphones but digital hearing aids can improve the directional effect of twin microphones.

Less whistling

Some digital hearing aids have 'acoustic feedback suppression'. This means that they can automatically reduce the whistling that bothers many people who use hearing aids.

More comfortable listening

Many digital hearing aids have a feature called 'wide dynamic range compression' that can be adjusted separately in each of several 'bands' or 'channels'. It means the aid can be programmed to suit your particular hearing loss and ensures that you always hear different sounds at levels that are comfortable for you. This type of aid is often completely self-adjusting. Remember, though, that the aid will only work well for you if the person who fits it adjusts its settings carefully in the first place. Some fine-tuning may be needed when you have become used to the aid.

Some types of analogue aid can be programmed to suit individual users but the way loudness is controlled in these aids is less sophisticated than in multi channel digital aids. These types of aid may not always give as comfortable listening as digital aids.

The 'T' switch

As with all NHS analogue aids it is generally possible to switch to 'T' with a digital hearing aid. This allows you to pick up sound from a loop system or inductive coupler. However, if you choose a very small style of analogue or digital aid that fits into your ear canal there may not be room for a telecoil and so you will not have the 'T' option.

What size are digital hearing aids?
 

Digital hearing aids - just like analogue ones - come in 'behind-the-ear', 'in-the-ear' or 'in-the-canal' models. They are not necessarily smaller than analogue hearing aids. You may be offered a choice but remember that the very small styles, though less noticeable, may be more fiddly to use, tend to break down more often and you may not be able to use them with a loop system.

Digital hearing aids on the NHS

RNID has campaigned long and hard for modernisation of the NHS hearing aid service. In January 2000 the Government announced that it would fund a project to upgrade the service and introduce high quality digital hearing aid technology.
 

The NHS is the largest buyer of hearing aids in the world and can use this purchasing power to obtain high quality digital aids in bulk and at greatly reduced prices. It provides these free of charge as with traditional analogue NHS hearing aids.

The upgrade of the NHS hearing aid service in England

In September 2000 the first of 20 selected NHS trusts in England began to provide digital aids as part of the 'First wave' project. This has been funded to run for approximately two years (see Table One).
 

The Department of Health asked RNID to manage the work needed to make sure that hearing aid departments were ready to provide the new service. They required additional equipment and training, and most needed extra staff to deliver the modernised service.
By April 2002 the 20 'First wave' Trusts had fitted 20,000 people with digital hearing aids.
 

An independent evaluation of the 'First wave' showed that people were benefiting more from the new digital hearing aids than they had from the old analogue NHS hearing aids provided by the traditional service. They were also using their hearing aids for more of the time in different situations.
 

50,000 RNID supporters campaigned with us for the modernisation to be extended throughout the NHS, by sending postcards to MPs - who then took up the campaign in Parliament. On Christmas Eve, 2001, the Health Minister announced an additional £20 million to modernise hearing aid services in at least 30 more NHS Trusts during 2002. This also means that almost a third of people in England will have access to digital hearing aids free of charge on the NHS.

The 30 additional NHS Trusts were selected in April 2002 (see Table Two). Many other Trusts were also keen to modernise. However, the funding organisations - Primary Care Trusts - of the 30 chosen in April 2002 were also able to contribute financial support to their modernisation. Their audiology departments will upgrade their equipment and facilities, receive training and should be ready to start fitting digital hearing aids some time between October 2002 and March 2003.
 

Fifteen further Trusts will be selected, trained and equipped later in the year ready to start the new service in 2003.
 

The eventual goal is the provision of digital hearing aids on the NHS throughout the UK.

What sort of digital hearing aids are available on the NHS?

Both moderate-power and high-power digital hearing aids are available for adults and children. They are sophisticated multi-channel aids with features such as directional microphones and automatic noise reduction. The NHS is able to buy them much more cheaply than the £2,000 it would cost you to buy them privately.

Who can qualify for a digital aid?

If you have not had an NHS hearing aid before you must go to your GP to be referred. The audiology departments that have now been modernised are offering digital hearing aids to every patient waiting for their first hearing aid if their hearing tests show that they would benefit from one. You may be offered two digital hearings aids, one for each ear. If so, it is worth trying because many people benefit more from an aid in each ear than from just one.
 

If you are a war pensioner you will be given priority for hearing aids if your pension was awarded for deafness resulting from service. This means that you may be seen more quickly at your clinic but it does not mean that you are entitled to better hearing aids than other patients receive. If your local clinic is part of the modernisation project you will probably be able to try digital hearing aids.

You can get an NHS digital hearing aid even if you have already bought a hearing aid privately. If you are a private ear, nose and throat (ENT) patient you must wait the same amount of time to be fitted with an aid as NHS patients referred by their GP. You will not be given any priority over other referrals.

Who will not be eligible for a digital aid?

You will generally not be eligible to get digital aids if you have been fitted with a new hearing aid within the last three years, unless your hearing has got significantly worse since then. If you already have an NHS hearing aid you should wait to be invited for a review appointment, unless you are having real difficulties with your aid or you think that your hearing has got worse, in which case you should ask for an appointment.
 

If you are an overseas patient, as defined by the NHS rules, you will not generally be eligible to be fitted with digital aids.
 

It is very unlikely that hospitals will accept patients from outside the areas they normally provide a service for. Many already have long waiting lists and demand is increasing all the time.
 

Follow-up service on the NHS

You will be given a follow-up appointment if you get digital aids on the NHS. Batteries and hearing aid repairs will be available free of charge. NHS hearing aids remain Government property so they cannot be insured on your household policy, and should be returned to the audiology department if you no longer need them. If you lose or damage a digital hearing aid you may, in some circumstances, be charged or have to accept a non-digital - analogue - aid as a replacement.

The upgrade of the NHS hearing aid service in Northern Ireland

RNID is actively lobbying for the modernisation of audiology services in Northern Ireland.

The upgrade of the NHS hearing aid service in Scotland

At present only 1.4% of hearing aids issued by the NHS in Scotland are digital. The Scottish Executive is currently reviewing audiology services and they have allocated an additional £750,000 towards this service. While this is welcome, it is a one-off payment and RNID is continuing to campaign for the introduction of digital hearing aids and for the Scottish hearing aid service to have a fully funded modernisation programme.

The upgrade of the NHS hearing aid service in Wales

The Welsh Executive has announced that it will provide £2.25 million to modernise audiology services and hearing aids in Wales.

Living in an area where digital hearing aids are not available

Your local hospital may not have applied to take part in the modernisation project, or it may have applied but not been selected. RNID recognises that, while thousands of people are already benefiting from digital hearing aids, for others the chance to try them may seem a long way off.
 

If your hospital is not part of the project, that does not necessarily mean that it cannot provide digital aids at all. If your audiology department already has staff with the training, facilities and experience necessary to fit digital hearing aids they can obtain limited numbers of them for people with particular needs.

Buying digital aids privately

It is also possible to buy digital hearing aids from high street dispensers, but the cost of private purchase is very high - up to £2500 for each aid. If you choose to buy privately, you will want to be sure that what you are getting is right for you. Ask the dispenser for a 28-day money-back guarantee so that you can try the hearing aid out properly in plenty of different situations, before committing yourself.
 

See the RNID factsheet Buying a hearing aid? for more information.

Digital hearing aids available privately in the UK

Table Three shows some digital hearing aids that are available privately in the UK at the time of writing this factsheet. However, new models are being launched all the time. People with access to the Internet can get the latest information on manufacturers' websites. If you do not have access to the Internet and would like a list of hearing aid manufacturers and distributors please contact the RNID Information Line.

Please note that the inclusion of an item in this factsheet does not imply recommendation by RNID or suitability for your needs. It is not our intention to list every product available.
 

Most of the groups of hearing aids listed in Table Three are available as behind-the-ear, in-the-ear or in-the-canal (ear canal) models. Only those marked with an asterisk* include models that are likely to be suitable for severely or profoundly deaf people.
 

Many of these hearing aids can be programmed with different settings for different listening situations, so that you can choose the programme you want. Some have a remote control that you can use to change the settings.

Buying abroad

Some people have bought digital hearing aids on the Continent, where they are much cheaper. If you decide to buy abroad you should be aware of potential problems. The main concern is lack of follow-up and after-care. People often take weeks to get used to new hearing aids. You may need further fine-tuning of your hearing aid in order to get the most from it. It is important to check beforehand what will happen if you need more help or if your aid breaks down once you are back home again.

Further information from RNID

If you want to find out more about some of the subjects covered in this factsheet, the following RNID factsheets may be useful - Buying a hearing aid? and The NHS hearing aid service. You may also wish to get RNID's leaflets, A user's guide to hearing aids and All about hearing aids.
The RNID Information Line offers a wide range of information on many aspects of deafness and hearing loss. You can contact us for further copies of this factsheet and the full range of RNID information factsheets and leaflets.

RNID Information Line

E-mail: informationline@rnid.org.uk
Tel: 0808 808 0123; Textphone: 0808 808 9000; Fax: 020 7296 8199.
RNID Information Line, 19-23 Featherstone Street, London EC1Y 8SL.

* Only the hearing aids marked with an asterisk* include models that are likely to be suitable for severely or profoundly deaf people.

RNID Information Services, May 2002