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All About Hearing Aids

An audiologist offers answers for every question you should ask before buying a hearing aid.


Hearing aids are like eyeglasses. They help you manage the unfortunate loss of one of your five senses. And much like a pair of glasses, you need an expert to set you up with the right fit.

An expert like an audiologist — the go-to doctor for hearing-related issues. Terra Cano, AuD, audiologist at The Iowa Clinic West Des Moines and Ankeny campus locations shares her expertise to help answer all the questions patients ask — or should ask — about hearing aids.

How do I know if I need a hearing aid?

The only way to know for sure is to visit an audiologist to get your hearing tested. But if you’re asking that question, you’ve already noticed the signs of hearing loss.

“If you have ringing in your ears, you’re having trouble understanding certain speech sounds, especially certain consonants, things sound muffled, you’re asking people to repeat things or speak more slowly, or you’re just working harder to understand what others are saying — those are warning signs,” Dr. Cano says. “It can get to the point where you feel a lot of mental strain. Things just don’t come as naturally as they used to and you have to start relying heavily on visual cues.”

Maybe you’ve already been diagnosed with mild hearing loss or tried out some assistive listening devices. If you haven’t seen the benefits of other options, hearing aids may be necessary.

What’s the benefit of going to an audiologist at The Iowa Clinic?

You can find hearing aids at a variety of places from audiology clinics to big box stores. But buying a hearing aid is not a shopping experience. You need comprehensive testing and an accurate diagnosis to ensure you get hearing aids that meet your level and type of hearing loss.

“Hearing aid dispensers are licensed by the state of Iowa but the education requirement is only a high school diploma. Audiologists are required to have a master’s degrees or doctorates. So there’s a big difference in education,” Dr. Cano says. “There’s also a big difference in testing. We work really closely with Ear, Nose and Throat physicians to give you more comprehensive testing and treatment options.”

What types of hearing aids are out there?

There are many different styles of hearing aids. BTE, RIC, ITE, ITC, CIC — the acronyms alone are enough to confuse you. Dr. Cano likes to break things down more simply, into just two types of hearing aids.

Behind-the-ear hearing aids, BTE for short, has a piece that sits on top or behind your ear where glasses would rest,” she says. “Then a wire or tube goes into the ear canal and connects to an earpiece or custom ear mold.”

Custom in-the-ear hearing aids are the other big style. They fit all inside the ear, kind of filling up that bowl shape of your ear. They’re usually made of hard, skin-colored material.”

Many people prefer a hearing aid that is discreet but there are pros and cons to both styles aside from aesthetics. The type of hearing aid you need is based on the type of hearing loss you have. Certain hearing impairments offer more options, while others require specific kinds of hearing aids for best results.

How much will hearing aids cost me?

A hearing aid is an amazing piece of technology. It’s a tiny device that contains microphones to pick up sound, a computer chip that processes this auditory information, a speaker to amplify the signal, and a battery to power the whole process. All that fits inside (or around) your ear!

As with any technology, there’s a wide range of prices that vary based on style, manufacturer and features.

“Most manufacturers we work with have comparable products. There isn’t one that’s necessarily better than the rest,” Dr. Cano says. “Different brands might be more appropriate for you based on the environments you’re in, the features you want and the level of technology you need.”

And that’s what really defines the price point. There are four different levels of hearing aid technology that largely come down to the processing power of the chip inside. The chip is what controls how your hearing aid works in different environments, like how much background noise is filtered out or the specific pitches you need to amplify. Modern hearing aids can even pair with your smartphone.

“Here at The Iowa Clinic, we use a bundled approach, meaning that all of your follow-up visits are included in what you originally pay for the hearing aids,” Dr. Cano says. “So there are no co-pays or office visit fees for hearing aid checks. Those are included for the life of the hearing aid.”

How do I decide which hearing aid is best for me?

You don’t have to. That’s what a comprehensive test and diagnosis can do for you.

“The first thing you should do is see an audiologist for a hearing test. The results are plotted on a chart called an audiogram. That audiogram is kind of like a prescription we use to fit the hearing aid,” Dr. Cano says.

That one test says a lot. It shows how much hearing loss you have at each pitch so an audiologist knows the levels of amplification and volume you need at every specific pitch.

Once the audiogram is in, you have a hearing aid evaluation where your doctor reviews the results with you. They’ll also learn about your lifestyle and communication needs based on the different environments you’re in regularly.

“We’ll look at your ear anatomy as well. All that helps us decide what type of hearing aid is appropriate,” Dr. Cano says. “We can narrow your options down to the specific technology level, style, and manufacturer based on the combination of these factors.”

How do I get fitted for a hearing aid?

There are no one-size-fits-all solutions. The audiogram narrows your choices but you and the audiologist come to the final decision together based on your individual preferences.

“After the evaluation, we place the order and it usually comes in about a week or two. We hook the hearing aids up to the computer and program them based on the audiogram. That’s when you come back in for a fitting appointment,” Dr. Cano says.

The fitting is not only about the placement of a device in your ear. It’s a series of tests to make sure the hearing aids are programmed right for you.

“We can then run a test called speech mapping, which provides verification of hearing aid settings. We’ll test the hearing aids to confirm that the volume the computer says you’re receiving is what’s actually getting to your ears,” Dr. Cano says. “Once we know the hearing aids are set appropriately, you can take them home with you.”

But you’re not locked in. If you’re unsure about your decision or the hearing aid you bought isn’t what you expected, there’s a trial period. So you can try out the hearing aid for 60 days to make sure it’s the right fit for you. If the hearing aid just isn’t working the way you wanted it to, you can trade it in for a different style or brand.

From there, you can count on the hearing aid to last five to seven years — even if your hearing changes. Because hearing aids are digitally programmed, they can be reprogrammed to adjust to continued hearing loss over time. Routine hearing tests and hearing aid checks once or twice a year help you stay on top of any changes to your hearing.

Because, unfortunately, a hearing aid is not a cure. It helps you manage the hearing loss but does not restore normal hearing. That’s why, from the moment you experience hearing loss, it’s important to establish a relationship with an audiologist who knows your needs and monitors them regularly.

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