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Smart Hearing Aids Go Beyond Help With Audio

Cutting-edge technology can help you hear more clearly but also detect your heart rate or a fall

a doctor putting a small smart hearing aid into a mans ear

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En español | If you haven't upgraded your hearing aids in three to five years, or have been putting off hearing tests because of the stigma of wearing the devices, it may be time to discover what's new.

The technology is more advanced than ever. But even less expensive hearing aids offer sound and speech processing, digital noise and wind noise reduction, plus improved management of feedback — those annoying high-pitched screeches, squeals and whistles. These features work together to ensure that the sound going into your ears is clearer, not just louder.

"I have participated in studies showing that with all of the latest technologies being incorporated into hearing aids, the less expensive models often work just as well as the most expensive models. But they have fewer bells and whistles,” says Nicholas S. Reed, an audiologist and assistant professor at Johns Hopkins University Bloomberg School of Public Health in Baltimore.

Most people who have bought the most expensive and cutting-edge hearing aids never wind up using the extra features and functionality, research shows.

ENT, audiologist or
hearing aid dispenser?

All hearing specialists have to pass state licensing exams to serve patients. The amount of education is generally the difference among these professionals:

• Otolaryngologist. This medical doctor — also known as an ear, nose and throat (ENT) specialist — diagnoses the causes of hearing loss and determines whether hearing aids are needed.

• Audiologist. This clinical practitioner assesses and treats hearing and balance disorders, can determine the need for hearing aids and the type best-suited for a patient. Most have doctorates in audiology (Au.D, although others have a Ph.D., doctor of science (Sc.D.) or master's degree.

• Hearing aid dispenser/hearing instrument specialist. Each state regulates the training needed to become a licensed professional who fits and dispenses hearing aids. Many require an apprenticeship program with an experienced audiologist or hearing aid dispenser; others may require a two-year degree from an accredited program or even a master's degree in audiology.

"The benefits someone receives from wearing hearing aids is often more of a function of how well they're fitted to them,” says Abram Bailey, an audiologist and president of Austin, Texas-based HearingTracker.com, a shopping resource for hearing aid consumers.

So you don't necessarily need to purchase the most expensive and technologically advanced equipment. But you do need to work with a skilled audiologist, hearing instrument specialist or hearing aid dispenser to match the devices to your needs and ears.

"The one critical thing I recommend a patient look for is an audiologist who runs real ear verification tests on everyone when fitting and customizing hearing aids,” Bailey says. “This is a test where a tiny microphone is placed within the ear along with the hearing aid to measure the hearing aid's output” and what the patient actually hears.

Though the insides of people's ears have the same basic shape, little differences can change how sound bounces around before it hits the eardrum. The size of the ear canal, where the hearing aid's speaker is placed within it and personal preference for louder or softer sounds from the device are among the variations that play a part.

Hearing aids generally last four to seven years, according to manufacturers. Ones that sit within the ear tend to have a lifespan on the shorter end of the scale because they're exposed to more earwax and even sweat inside the ear canal.

But like smartphones and smart TVs, some of the newest hearing aids have features not available even a few years ago. That doesn't always mean higher prices because the devices take advantage of advances in chips developed for Bluetooth headsets, computers and smartphones. Competition from less expensive personal sound amplification products (or PSAPs, pronounced PEE-saps), devices that aren't regulated by the FDA like hearing aids, also plays a part.

"Whether or not you should pay extra for a hearing aid with certain functionality should depend on if you plan to use those functions or not,” Reed says. “If a feature is not something you need, you already have on another device or it's something you know you won't use, look for hearing aids that don't require you to pay extra for those functions."

Some of the more advanced features will require you to be comfortable working with technology, especially using your hearing aids in conjunction with a smartphone, smartwatch or other Bluetooth devices.


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"Some people want more control over their hearing aids and want the ability to make adjustments in real time from their smartphone or smartwatch,” he says. “Other less tech-savvy people often want to rely on the adjustments made by their audiologist and any automatic adjustments made by the hearing aids themselves using AI [artificial intelligence] or machine learning.”

Audiologists recommend a hearing test yearly after getting hearing aids that includes assessment and removal of earwax; daily cleaning of the devices at home to prevent buildup from dirt, oils and earwax; and professional cleaning to remove trapped moisture and debris every three to six months, depending on the type of hearing aid you have.

Features inspired by smartphones

Among the newest innovations now available:

• Artificial intelligence. Algorithms allow the hearing aid to analyze a wearer's environment and the sounds coming in, identify sounds and specific people, and automatically adjust the audio based on the wearer's level of hearing loss and preselected preferences. The hearing aid learns to identify specific voices, so it can focus on the familiar, which reduces the need for a wearer to make manual adjustments throughout the day.

"I think AI and machine learning are the biggest changes we're seeing now in hearing aids. These provide a more personalized listening experience,” Reed says. Artificial intelligence allows a machine to simulate human behavior, and machine learning is a facet of that, allowing a device to learn automatically from what it has encountered in the past.

AI and machine learning also make wearing a cutting-edge hearing aid much easier for people who aren't comfortable with technology, don't want to tinker with a smartphone app or prefer not to visit an audiologist frequently for programming updates or adjustments.

• Bluetooth streaming. Hearing aids with this feature can play audio directly from a compatible Bluetooth device, such as a computer, smartphone, stereo or television. The user hears clearer sound with less interference or feedback.

• Fall detection. Like some new smartwatches, some high-tech hearing aids can figure out whether the wearer has taken a tumble. They then wirelessly connect to the user's smartphone to call 911 or text preselected contacts. For this feature to work, the hearing aid must remain near the smartphone it's paired with.

• Fitness tracker. Instead of using a separate heart rate monitor, pedometer or smartwatch, hearing aids can track movement and the wearer's heart rate, sharing the information with your smartphone.

• Improved directionality. Hearing aids worn in both ears can detect the direction that sound is coming from automatically and reduce or eliminate lesser sounds from other directions, so audio that the wearer wants to hear will be more understandable. The wearer also will be able to figure out the direction of the sound more easily.

• Reduced size. Some of the more recently released hearing aids fit almost entirely within the ear canal. Others that mainly sit behind the ear are smaller, lighter, more comfortable and less visible to others.

• Rechargeable batteries. One of the most sought-after features makes hearing aids more like wireless earbuds. Instead of stockpiling the small batteries, replacing them every three to 10 days and worrying that a pet or small child might try to swallow one, the latest hearing aids contain rechargeable batteries that last all day.

You take the entire hearing aid out at night to recharge it in its holder while you sleep. This eliminates an ongoing expense for batteries and the need to fumble around to insert a battery that is about a quarter-inch to a half-inch in diameter.

Control through your smartphone

In addition to streaming audiobooks, music or phone calls directly from your newer model Android or Apple smartphone, you can customize your hearing aid's settings via a proprietary mobile app. Talking with a friend while walking in the woods requires your hearing aid to perform differently than grabbing lunch at a crowded restaurant.

But people don't always know the settings they need, Reed says. Volume and clarity are what people notice most about sound. Volume comes from low frequencies, and clarity tends to come from high frequencies. But most people with hearing loss have problems with high-frequency sounds.

"If you give someone with hearing loss the ability to make their own hearing aid adjustments, they often adjust the base because it impacts volume,” he says. “They notice an immediate change” and sometimes increased feedback.

"In reality, what they needed was a change in treble and high frequency to improve clarity,” Reed says. “Ideally, you want a hearing aid that knows what adjustments to make automatically using AI and machine learning to achieve optimal levels for you but that also allows you to make minor adjustments via a mobile app."

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