The purpose of this article is to discuss unique aspects of the most common form of hearing loss - age-related hearing loss. We will discuss how basic hearing aids can be the best value investment for this type of hearing loss. As well, we touch on traditional limitations all clients and practitioners face when treating age-related loss, as well as how new hearing aid technology and clinical best practices can be used to achieve more effective results.
You'll also have the opportunity to sample some audio recordings of actual hearing aids, recorded in our clinic (using the world's more beautiful keymar, I might add) in both quiet and in noisy settings. This helps to make ideas discussed below more real, demonstrating how hearing aids will sound when faced with your real world environments.
What Makes Age-Related Hearing Loss Unique?
About 10% of the general population and more than 50% of people over the age of 55 have hearing loss. More than 80% of our clients have purchased hearing aids due primarily to age-related hearing loss.
Age-related hearing loss has a rather unique profile. It is characterized by higher degrees of hearing loss at high frequencies (see illustration below). This type of hearing loss can be deceptive because you may hear normally in lower frequencies, but struggle to hear higher frequencies clearly. This results in an inability to hear subtle but crucial clarity consonants (i.e. 's', 'f', 't', 'sh', etc.). Often, this type of hearing loss is accompanied by high-frequency tinnitus in the region of loss. Many people struggle in particular in more noisy, real-world environments. This is when you may notice your hearing loss impacts you the most.
Below are two recordings that demonstrate how age-related hearing loss can impact our ability to hear in both a quiet environment as well as in background noise. (We suggest listening to all recordings, below, using headphones, for maximum effectiveness.)
Basic Hearing Aid Features for Age-Related Loss
Hearing aids configured for typical age-related hearing loss are often considered the most comfortable. This stems from the fact that these hearing aids do not plug the ear canal as much as other configurations, allowing both air and sound to move freely into and out of the ear. With hearing aids set up in this manner, there is little to no change to the way the client hears others and, most importantly, hears themselves. Clarity is used to supplement natural hearing - not to replace it.
Lower cost basic hearing aids are a good choice for typical age-related hearing loss for a number of reasons. First, expensive noise reduction and speech focus features, not found in basic devices, are rendered much less effective when hearing aids do not plug the ear. Secondly, studies and in-clinic experience suggest that mild tinnitus may actually be treated more effectively with basic hearing aids due to the fact that they have less noise reduction features. Noise reduction, in all its forms, is proven to increase subjective perception of tinnitus. Third, due to the fact that age-related hearing loss occurs gradually from high frequencies to low, the hearing loss threshold curve for age-related loss is often "gradually sloping" or rather low in complexity, which often means that a basic hearing aid with less equalization handles are able to adequately meet your amplification requirements.
Listen, below, to the difference basic hearing aids can make when treating typical age-related hearing loss...
Do I need Premium Hearing Aids for Age-Related Loss?
For those with age-related hearing loss, investing in more expensive hearing aids with more equalization handles, expensive tinnitus management features, or noise management features may yield only slight percentage-point improvements in select environments. It's not a risk worth taking for a price point that may be up to ten times higher. If you can get 90% of what you require for 10% of the cost with a basic hearing aid, most price-conscious consumers would choose the better value option.
The features that virtually all hearing aids share, whether basic, mid-range or premium, which offer the best benefit for those with age-related hearing loss. Age-related hearing loss is a loss of clarity. Basic hearing aids have the same subjective clarity, or frequency response, as more advanced models. Frequency compression, or the ability of the hearing aid to lower sounds in frequency for better audibility, exists in most basic hearing aids. Gain compression, which serves to amplify softer sounds more than louder sounds, is an important feature which separates all certified hearing aids from cheap online hearing amplifiers (which typically increase volume for all sounds equally).
UBHearing's basic level hearing aids are meeting a great need in our community. They offer most of our clients everything they need at a lower price, allowing them to realize exceptional value for their hearing aid investment. They are the perfect starting point for addressing typical age-related hearing loss.
Listen to the difference between basic hearing aids and premium hearing aids for typical age-related hearing loss...
Basic Level Hearing Aid Expected Benefits
Some people with age-related hearing loss feel they are hearing normally. Many people with age-related hearing loss complain that others are mumbling. However, when we perform a "soft speech test", where a normal hearing person would have a perfect score, those with age-related hearing loss are often surprised to typically score lower than 70%. Clarity consonants are always more difficult to hear. It's impossible to say an "s" or a "th" or an "f" any louder. By amplifying soft, high-frequency sounds, clarity is significantly restored. Also, sounds that are made at a distance become more audible. Finally, the ability to locate where a sound is coming from is also improved (an important part of hearing effectively).
As mentioned earlier, basic, vented hearing aids have little to no noise reduction. However, because noise tends to be in the lower frequencies, the increase in high-frequency clarity offers sound cues that often rise above the noise.
Listen to how hearing loss impairs the ability to hear speech in noisy settings. Then, listen to how the increase in clarity of traditional vented basic or premium hearing aids make.
Traditional Age-Related Hearing Aid Limitations
The traditional hearing aid, set up for age-related hearing loss, does have its limitations. Age-related hearing loss is a permanent loss that affects the inner ear. The instrument of the inner ear loses some ability to convey sound to the brain in a pure fashion. This is referred to to this as "sound distortion". For most clients, the level of distortion is not disruptive. For others, it's important to be prepared for the reality that, although hearing aids will allow them to hear all sounds, they will still struggle to carry on a conversation, especially in difficult environments.
Hearing aids for age-related loss should minimize "bulk" in the ear. The more plugged the ear becomes, the more uncomfortable you may be with the sound of your own voice (being too loud). Hearing aids that introduce bulk into the ear canal must compensate by replacing blocked, natural sounds with amplified sound. This makes it much more difficult to get used to hearing aids. In-the-ear hearing aids are not ideal as a first consideration for the treatment of age-related hearing loss.
Often, those with age-related loss may benefit from connection to assistive devices or smartphones that can help them hear the television, listen to music, or have a phone call. While these "audio streaming" features are available with most hearing aids, audio streaming is much less effective or even impossible with hearing devices that do not plug the ear (due to loss of low frequency sound). This is a source of disappointment for some with age-related hearing loss, who may hope to use their hearing aids as entertainment devices as well as helping with hearing loss.
Listen to audio heard through fully vented hearing aids which offers only a "tinny" representation of the underlying sound...
Finally, those with steeply sloping losses may incur "feedback" (or hearing aid "squealing") when their high frequency hearing loss is severe. Feedback happens when a hearing aid hears itself, and this is more likely when treating age-related hearing loss. The remedy for feedback (assuming the ear is free from wax blockage or other debris) is either to lower the amplification of clarity, or to further plug the ear - both solutions are less than ideal.
Overcoming Traditional Hearing Aid Limitations
Thankfully, some traditional hearing aid limitations for age-related hearing loss can be overcome with existing or new hearing aid features, or different fitting approaches, which we will discuss further. These include:
Traditional Volume Control
With hearing aids for age-related loss, volume control does not increase and decrease all sounds - only the higher frequency sounds in the area of the hearing loss. Volume control can be used to create an increase or decrease in the difference between the volume of natural low frequency sound, and amplified high frequency sound. Noise tends toward low frequencies, so increasing amplification of clarity can offer significant benefit in noisy settings. Conversely, lowering the volume of these same hearing aids will not lower noise, only clarity. As a rule of thumb, when a client has difficulty hearing speech in ANY environment, noisy or not, turn the hearing aid volume up.
Effectiveness-First Hearing Aid Programming
Ensuring the effectiveness of the hearing aids as the first priority over all else, is a must. HOW a hearing aid is programmed is just as important as the hearing aid selected. When a hearing aid is selected based solely on client preferences, or when clarity is significantly reduced on day one for the sake of comfort, the effectiveness of the hearing aid suffers. It is the job of the trustworthy hearing practitioner to strategically select and program hearing aids in such a way that the you will experience maximum benefit. It is the job of the client to trust their practitioner’s expertise and to realize that the hard work of acclimatizing to new devices in the short term will reap benefits in the long term.
Compare the sound of hearing aids "programmed for comfort" vs. both basic and premium hearing aids properly programmed for effectiveness targets...
Choosing Behind-the-Ear Models
Behind-the-ear hearing aids are more effective than in-the-ear hearing aids for treating age-related hearing loss, all things considered.
Although behind-the-ear hearing aids frustrate some wearers due to conflict with masks and glasses, behind-the-ear hearing aids have directional microphones that are physically oriented forward (above the ear) which delivers superior, front-facing clarity. With less bulk in the ear, behind-the-ear hearing aids do not plug the ear, delivering more tolerable and natural sound for those with age-related loss. While in-the-ear hearing aids have obvious convenience advantages, they should not be the first consideration for those with age-related high-frequency loss.
New Hearing Aid Features
New hearing aid features have emerged which, for minimal added cost, have been proven to result in meaningful audiological benefit for those with age-related hearing loss. The top two features are Signia’s Own Voice Processing (OVP) and Phonak’s ActiveVent technology.
Signia’s Own Voice Processing (OVP) is a mid-level hearing aid feature, available on Signia behind-the-ear hearing aids. OVP lowers the amplification of the wearer’s own voice in a noticeable fashion, without lowering the amplification of other sounds. This results in easier acclimatization and greater potential effectiveness of hearing aids (as they can be set at more effective levels without causing sound discomfort).
Phonak’s ActiveVent technology, available as an option for mid-range Phonak products, may result in the biggest step forward for treating age-related hearing loss. ActiveVent allows Phonak behind-the-ear hearing aids to switch between a vented fitting (a natural choice for age-related loss) to a closed fitting (an effective setup for noise management and improved audio streaming quality), either automatically or when prompted.
By removing all venting at opportune times, the hearing aid is able to take full control of all sound entering the ear, which allows the hearing aid to fully exploit its speech-in-noise and comfort-in-noise settings. Due to the mechanical nature of the ActiveVent receivers, these hearing aids are not recommended for those who produce significant earwax. These limitations can often be overcome by taking care of your ear wax at home via self-irrigation or by scheduling proactive wax removal appointments with a medical practitioner of your choice.
Compare traditional vented hearing aids with a less vented solution. Hear how the closed dome solution increases effectiveness of "speech focus" and "comfort in noise", as well as higher quality audio streaming...
Age-related loss is the most common form of hearing loss and is truly worthy of unique consideration. It is generally the easiest hearing loss to treat with relatively basic hearing aid features which, at UBHearing, are well within any budget. When considering age-related loss, spending more money for more expensive features may not lead to an increase in overall satisfaction and effectiveness. Realistic expectations are important, as hearing aids set up for treating age-related loss have inherent limitations. However, new features offer meaningful benefits for those willing to consider them for their next hearing aid purchase.
It’s important to partner with a hearing clinic you can trust - one that shares your goal to maximize the effectiveness of every hearing solution at the lowest price possible. With hearing aids starting from $199/each, an average price of $1200/pair, and premium hearing aids for less than $3000/pair, chances are you or someone you care for may benefit from UBHearing's expertise and value focus.
To purchase the best hearing aids for your individual needs, contact UBHearing to book an advanced hearing test and in-clinic demo today.
Click here to read more about new hearing aid features for 2023...