Hearing aids have come a long way—and they’re not the only option
By Wendy Haaf
Unless you’re a health-care professional specializing in hearing or you were recently prescribed hearing aids, you’re probably not up to speed on the exciting advances in the sophistication of the technology that can now be squeezed into these small devices. And you’re unlikely to know much about a growing category of lower-tech, non-prescription amplifying gadgets that can be useful for some with hearing loss.
When it comes to hearing aids, “it’s a rapidly changing industry,” says Andrea Bull, a Vancouver registered audiologist and member of Speech-Language & Audiology Canada’s board of directors. “We’ve seen some really cool advancements.”
Bluetooth, GPS, and More
For one thing, with some models, there’s no longer any need to fiddle with and replace tiny disposable batteries—you simply recharge the built-in batteries as you’d recharge a cellphone. “That’s great for both the environment and people with dexterity or vision issues,” Bull says.
“I just stick them in the charger at night, and they’re ready to go in the morning,” says Christine Peets, a Napanee, ON, writer and fitness instructor. Moreover, rechargeable aids have become more affordable. “There wasn’t much of a price difference between the rechargeable ones and those with disposable batteries,” Peets says.
Speaking of cellphones, many aids are now designed to connect with Bluetooth-enabled devices, a feature that’s opened up a world of new possibilities. For example, “many manufacturers are now enabling the most recent hearing aids to be programmed remotely” by a health-care professional, explains Marilyn Reed, a registered audiologist and audiology practice advisor at Toronto’s Baycrest Health Sciences. Obviously, this feature can’t entirely replace in-person visits with an audiologist, but it can cut down on the number of visits necessary to tweak the program until it’s doing the best job possible. (Prescribing and programming hearing aids is a less precise science than correcting vision with glasses or contact lenses and consequently involves some trial and error.) Reed predicts that the convergence of developments such as this one and the global pandemic means that from now on, more audiology services will need to be delivered digitally.
If you have a smartphone, you can pair it with your hearing aids via Bluetooth and exploit one of the phone’s features to make it act as a remote microphone. Say you’re in a crowded restaurant and you’re having trouble making out what your dining companion is saying over the din. “You can turn on a function called Live Listen and put your phone next to your partner,” Reed explains, “to help you hear him or her better [through earbuds] over the background noise.” (Live Listen is the app for the iPhone; for Android phones, there’s Sound Amplifier.)
A smartphone can also be used for such functions as adjusting the volume of hearing aids. While Joan Hutchinson’s hearing aids aren’t the most advanced on the market, they’re set up so the London, ON, woman’s cellphone acts as a remote control, allowing her to customize settings for different environments. For example, with one of her grandchildren in the back seat of the car as she drives, “with the program on my phone, I could set it so that noise behind me is amplified,” Hutchinson says. “That has been helpful.”
“There are lots of apps that help people have control over their hearing aids,” Bull says. This offers more flexibility not just with different sound environments, she says, but also with tinnitus support and with the interplay between hearing aids and cochlear implants. (Bull explains that people who wear a cochlear implant on one side often wear a hearing aid on the other. In the past, these operated independently, but now, like a pair of hearing aids, they can communicate with each another—which, among other things, gives the wearer a clearer sense of the direction from which a sound is emanating.)
Some manufacturers have begun to merge hearing aids with technology from other consumer wearables. “Some hearing aids can do things that the Apple Watch can do, such as record biometrics and physical activity,” Reed says. “I remember one engineer saying that the ear is the new wrist.” One company has even incorporated a sensor that can detect falls, triggering automated notifications that include the GPS location of the wearer and are sent to as many as three pre-selected contacts. (You can also manually activate that alert function by tapping the hearing aid.) The same manufacturer also has an app that can remind you when it’s time to do certain tasks, such as take medication.
GPS can be used for another purpose, as well. “Let’s say you go to a community centre to play bridge and there’s a lot of background noise,” Reed says. Once you’ve set up your hearing aids for the optimal response in that environment, “you can ‘tell’ the device to remember that particular setting for that particular environment.” Because the phone contains a GPS, it can tell when you return on subsequent occasions and automatically switch the hearing aids to the preprogrammed settings.
Of course, more basic hearing aids are fine. Ron Warner of Toronto, for instance, is satisfied with the aid he began using in his “good ear” (he’s been deaf on his right side since very early in life) a few years ago. “I don’t have a smartphone and I don’t want to connect the hearing aid to anything,” he says. Nonetheless, when using the aid, he can hear the radio more clearly even at a lower volume, and when listening to someone standing on his deaf side, he doesn’t have to turn his other ear towards the speaker nearly as often.
Under certain circumstances, much lower tech devices can be useful, too. When Baycrest began arranging remote physician consultations and virtual visits between residents and their families at the start of the COVID-19 pandemic, a problem soon became apparent to Reed and her colleagues. “Immediately we noticed how difficult communication was because so many residents have hearing loss and don’t wear hearing aids,” she says. While the iPhones and iPads used to facilitate video chats were paired with Bluetooth speakers with excellent sound quality, “it’s still not like having something in your ear, such as a hearing aid, or even holding a telephone up to your ear,” Reed says.
Enter something called a “personal amplification device”—in this instance, one called a Pocket Talker, which costs around $185. (The SuperEar SE9000 is another example.) “It’s a generic amplifier the size of a Sony Walkman with earbuds or headphones, and you can adjust the volume,” Reed explains. Unlike a hearing aid, which amplifies only those sounds in the ranges affected by a patient’s hearing loss, a Pocket Talker indiscriminately makes all sounds louder. The device is commonly used on a temporary basis by people whose hearing aids have been sent away for servicing or by hospital patients who have hearing loss but no hearing aids. And in the context of video chats and virtual consultations, “we noticed the device made a big difference,” Reed says.
For those with more profound hearing loss—for which a personal amplification device is not as effective—Reed and the Baycrest team came up with another relatively simple fix. “We started using a voice-to-text app, which, when paired with a smartphone or iPad, allows you to read what someone is saying in real time on the screen,” Reed explains. The Baycrest team used an app called Ava, which is just one of several available options.
Still, the Pocket Talker and its ilk are some of the simplest examples of a growing range of over-the-counter devices referred to as hearables or personal sound amplification products (PSAPs). Reed is involved in research studies in collaboration with Johns Hopkins University that look at the use of these simpler devices in combination with a one-hour hearing rehabilitation program that includes instruction on good communication skills. Called HEARS (Hearing Equality through Accessible Research and Solutions), the program is aimed at testing the effectiveness of non-prescription assistive listening devices and trying to make treatment for hearing more affordable and widely accessible. The rationale is that hearing loss is a public health issue, since it’s linked with increased rates of problems such as social withdrawal, falls, and dementia, and treatment is most effective when begun as early as possible.
“We’re offering participants a choice of two devices,” Reed says. One is a Pocket Talker or equivalent, and the other, a more advanced PSAP, such as a CS50 or Sidekick (essentially two versions of the same thing). A fraction of the cost of a conventional hearing aid at roughly $350, the latter choices are “very sophisticated Bluetooth devices that you can program to fit the hearing loss,” Reed says. “And if you pair them with a smartphone via Bluetooth, again, you can use the smartphone as a remote control. Some scientific studies that have compared the performance of these more sophisticated over-the-counter devices with hearing aids have shown that some of them compare pretty favourably.”
At the moment, however, there are some potential pitfalls in purchasing and using PSAPs. For one thing, while hearing aids are regulated by Health Canada as Class 1 medical devices, there are currently no controls in place for assuring that hearables are safe and effective, or that they meet a specified set of standards. “It’s ‘Buyer beware,’” Reed says. “You don’t know what you’re getting for your money.” In addition, for optimal results, people, especially older adults, will still “need help setting them up, making them fit their hearing loss, and learning how to use them properly,” Reed says.
Some manufacturers and retailers blur the distinction between hearing aids—which are designed to improve speech intelligibility by addressing a specific pattern of hearing loss—and non-prescription products that are intended for use in specific listening environments. “The contentious part of the PSAP industry is that the marketing isn’t very clear,” says audiologist Andrea Bull. “A lot of people will mistake them for hearing aids because they’re sold under names like ‘hearing amplifier aid’ and ‘digital sound amplifier’ and they can look very much like a hearing aid.”
Changes may be on the horizon, however. The US Food and Drug Administration (FDA) has created a new category for PSAPs that deems these devices electronic rather than medical, as well as a new set of regulatory standards, which may set the stage for Health Canada to follow suit. The move is also likely to unleash a barrage of new products. “Companies such as Bose, Samsung, and Apple can all enter the market once they comply with the FDA regulations,” Reed observes.
In the meantime, the best path forward if you believe you might have a hearing problem is to see an audiologist, who can do testing not only to diagnose a hearing loss but to determine which frequencies are affected and provide advice tailored to your specific needs.
“Don’t shop for price, shop for the professional,” Bull urges. Since several rounds of initial adjustments and fittings, and later, periodic repairs or cleanings may be necessary, “you need to see an audiologist more often than you might think,” she explains. “The care you receive is really important. You need to build a relationship with someone who will go above and beyond and take the time necessary for a medical/health issue. The right professional will be able to find you the right solution and the right price point for your needs.” (Audiologists are also well versed in the various government and other programs that cover a portion of the cost of hearing aids.)
“If you think you’ve got a hearing problem, look after it,” hearing-aid user Ron Warner advises. “Get a test.” He, Joan Hutchinson, and Christine Peets all believe their hearing aids have been worthwhile investments. “It’s a big improvement,” Hutchinson says. “I’m definitely glad I made the decision, and I think my family’s happy, too.”
The Canadian Hard of Hearing Association (chha.ca)
Canadian Hearing Services (chs.ca)
The Hearing Foundation of Canada (hearingfoundation.ca)
Speech-Language & Audiology Canada (sac-oac.ca)