How an Ear Surgeon with Hearing Loss Chooses His Own Hearing Tech

Chad Ruffin, MD

CI Surgeon and Bilateral Cochlear Implant Recipient

14 April 2020

More people are becoming aware of the necessity to treat hearing loss not only to increase quality of life but also to slow the onset of cognitive decline and dementia. Unfortunately, choosing between the plethora of hearing technology devices on the market can be paralyzing. How do you choose the right system for you? Many factors will depend on your type and degree of hearing loss as well as other considerations such as your personality and lifestyle needs.

The goal of this article is to share the things I look for in my own hearing technology. Hearing tech should not only help you hear better, but also to function better. It should seamlessly fit into your lifestyle and help you achieve your goals.

My perspective is unique. I was born with severe hearing loss, and my use of hearing technology has included hearing aids, hearing assistive technology, and cochlear implants (CI’s). My experiences as a hearing scientist and hearing tech innovator have also shaped my thoughts on how hearing tech should work. Along the way, I’ve learned how important it is to cut through marketing hype and focus on both usability and what science shows is important for hearing.

Cut your mental workload

Hearing technology can address one of the biggest challenges that comes with hearing loss—increased mental workload. For most people, hearing is an “automatic” task that requires little mental effort. But when you have hearing loss, your ears fail to send robust signals to the brain about the speech you need to comprehend. The brain then has to work hard to “fill in the gaps” by lipreading and using contextual information. For example, when initially meeting another person, you exchange pleasantries, and you listen for common phrases like “Hi, how are you? Sorry I’m late! Isn’t the weather nice?” Familiar as those phrases may be, with hearing loss your brain only catches key words. Then it must assess their context and go to work filling in the blanks to discern the rest of those familiar phrases.

Then as the discussion becomes more substantive or complex, your brain has to work even harder just to keep up. That’s because understanding the words is only the first step. Comprehending their meaning and responding cogently requires a lot of additional mental effort. That extra effort can detract from other tasks your brain needs to handle, impacting your performance in work and social situations. And the extra work can also lead to serious fatigue after a day spent trying to listen and understand others in noisy environments. Reducing your mental workload will help you truly engage with loved ones, friends, and coworkers.

Hearing technology can greatly reduce your mental workload by increasing the number of words you “automatically” understand, versus having to make an extra effort to understand them.

Hearing technologies that make a difference

How do I assess hearing technologies for my personal use? Well, there’s lots of marketing hype out there. However, the reality is that most of the name-brand hearing devices are very similar in how they improve your hearing performance. In fact, all good hearing instruments zero in on three technologies that are firmly rooted in science, and that are necessary to make your hearing tech work for you.

Noise reduction strategies

Hearing aids are sophisticated computers, with software algorithms that perform multiple miracles of digital sound processing. As a general rule, these algorithms don’t help you pick up more words, but they do make it easier to hear, decreasing your mental workload. This is a rapidly improving area of technology that will change dramatically over the next decade.

Directional microphones

Directional microphones cancel out noise coming from behind you and improve what you hear from the person speaking in front of you. This technology has also improved dramatically in recent years, with most directional microphones now able to cancel out noise coming from the sides as well so that you essentially hear only what is in front of you.

Moreover, the amount of directionality can be adjusted in your hearing aids’ program settings. For example, when walking next to a friend to a restaurant, I will use my least directional microphone setting. Once inside, I sit across from a friend (never side-by-side at a bar) and switch into my most directional microphone setting. One thing to note -- these super directional microphones work best in places with carpeting and other soft surfaces that reduce echoes and reverberation.

Bilateral hearing assistance

Not too long ago, people with hearing loss often thought they only needed one hearing aid. However, research has proved conclusively that hearing assistance on both ears leads to dramatic improvements in comprehension of speech and reduction in listening fatigue. Even if your hearing loss is mild, getting hearing aids on both sides is a good idea.

Those are only three of the advanced digital technologies that I look for in my hearing assistance technologies. They make today’s hearing aids and other devices such as cochlear implants much more effective than the simple amplification provided by hearing devices in past decades. And while today’s premium hearing aids can be expensive—a good pair can cost several thousand dollars—the technologies inside them are a godsend for many people with moderate-to-severe hearing loss.

Personal factors that I consider

Many people are at a loss when evaluating which hearing technologies are best for them. There are many types and styles of hearing aids and lots of hearing assistive technology options on the market. The best place to start is to look at your own personal communication and lifestyle needs, and then look at what hearing technology solutions may exist that are geared toward meeting those needs.

What factors do I personally consider important? First let’s consider my lifestyle—I’m highly mobile, very social, work in noisy environments, and play solo and water sports like tennis and rowing, where communication is nice to have, but not necessary. For an active lifestyle, I need hearing devices that are rugged and reliable. But at work, I am in highly-professional environments and discuss complex ideas with others. In addition to the best sound processing I can get, I also look for products that look good and make me feel good. I do not want my hearing equipment interrupting my thoughts or affecting how I am perceived by other people. In other words, I want to be able to culturally fit in seamlessly with my surroundings.

Water resistance

Hearing aids, cochlear implants, and other hearing devices hate moisture. Perspiration, humidity, and even condensation from your breath in cold air can corrode the fine electrical components and connections that enable them to function. For that reason, device manufacturers provide various levels of moisture resistance. For example, my cochlear implant processors are water resistant, which helps with sports and my active lifestyle. And maybe one day they’ll come out with truly waterproof CI’s. Manufacturers of hearing aids publish ingress protection (IP) ratings that let you know how water-resistant they are. If you’re very active, or live in a very humid environment, asking about IP ratings when you’re buying hearing aids is a good idea.

Battery power

Until recently, most hearing aids were powered by tiny disposable batteries that had to be replaced several times a month. They gave all-day power for many days at a time, so hearing aid wearers had no complaints about their performance. But changing the small disposable batteries can be a challenge for seniors struggling with “fine motor” skills. And the costs of replacing the batteries can run up to $100 a year or more. Recently, however, makers of lithium-ion rechargeable batteries have succeeded in shrinking their products while providing just enough power to use in hearing aids for a full day without requiring a recharge. So in the past several years, rechargeable hearing aids that you power up when you’re sleeping have become very popular. If you want the convenience of a rechargeable solution, ask if the product you want comes with rechargeable batteries.

Battery Case

Another example of mental workload is the worry from loss of an expensive, rechargeable battery. This 15 year old zipper pouch is a key to my sanity as my cochlear implant goes through multiple batteries daily. Depleted batteries are immediately and always inserted into this pouch to prevent loss. Since adopting this system, I’ve never lost a battery.

Multiple program settings

Hearing devices usually have multiple settings or program “slots” for programs that are customized to a user’s listening needs. Different programs can activate noise reduction algorithms, directional microphone settings, engage wireless Bluetooth connectivity, and perform other useful functions. Most people actually use only one or two programs – but I use four! My first slot is the least directional microphone setting, leading up to the most directional setting in slot three. (The fourth is reserved for telecoil). They are ordered in an intuitive way, and it’s convenient to switch program settings as I move between different acoustic environments.

Telecoils

My fourth program slot is reserved for my telecoil, or T-coil, setting. A telecoil receives a signal from a phone or an induction loop so that sound is transmitted directly into your hearing device. Induction loops, often installed in auditoriums, theaters, and houses of worship, send audio signals from a microphone at a speaker’s podium or pulpit directly into your hearing devices. Telecoils also help make voices on the other end of a phone call more clear, something that can help you perform much better at work.

On-the-go flexibility

Often, features that work well for some people work less well for others. For example, many hearing aids come with remote control accessories or with mobile phone apps you can use for push-button adjustments of volume and program settings. These are great for people who have trouble finding and pressing the tiny buttons on their hearing devices to perform those functions. Unfortunately, I hate having things in my pockets and frequently forget where I left my cochlear implant processor or batteries. So it’s important that my devices are able to operate independently of any physical remote accessory or smartphone control app. Therefore, if a remote is required to switch programs, I would not consider the hearing platform. I use two cochlear implants, and being able to change the volume and program settings of both simultaneously and quickly is critical.

“Automagic” features

Manufacturers can enable sound-enhancing features in your hearing instruments that automatically turn on and turn off when you move between different sound environments. For example, if it’s quiet in my car on the way to a restaurant, I don’t need to activate noise suppression or directional microphones. But when I walk into the noisy restaurant, I want either or both of them to be turned on. My hearing processors can be set to have them turned on “automagically.” However, I prefer to turn those settings on or off manually. This can be distracting when they rapidly enable/disable. The good news is I’m able to have my audiologist set my programs to operate exactly the way I want them to—either automatically or manually. The lesson here is that everyone’s preferences are different. When you have a good pair of programmable hearing instruments, you should make sure your hearing care provider knows exactly how you want them to operate and adjust the program settings to meet your individual needs.

Hearing Assistive Technology (HAT)

Once you’ve chosen a device (or devices) with the features and functions that match your preferences and lifestyle, there is still a world of choices ahead of you with hearing assistive technology (HAT). Assistive devices extend the range of your hearing instruments with remote microphones and other technologies, including wireless Bluetooth transmission. They help you hear better in specific situations such as with a TV, telephone, or conference microphone systems. Often these devices are locked to one specific hearing aid manufacturer to create a proprietary hearing technology ecosystem.

So when you’re choosing hearing aids or a brand of cochlear implants, it’s important to ask about their compatibility with HAT accessories. And again, consider your personal requirements. If you are retired at home and watch a lot of news on the TV, a TV streamer that transmits the audio signal directly into your hearing instruments can be a real joy. If your work requires a lot of in-person meetings with groups of people, consider getting remote microphones that transmit wirelessly to your hearing aids and help you hear people even at the end of the conference table. Some hearing platforms allow you to use multiple remote microphones. For people who are often in multi-talker settings, this can be critical. And so on.

Remember, the most important thing to assess when you embark on the journey to better hearing is your own lifestyle and your own personal hearing requirements. If you map out all the situations where you need hearing assistance in social and work environments, you will find there are multiple technologies available designed to meet your every need. Fitting into your lifestyle is important, but it is equally important to embrace change and to continue to learn about and adapt to new technologies. Don’t be shy about asking for them!