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Hearing Aids

ColumbiaDoctors’ Guide to Hearing Aids

Hearing aids help people with hearing loss by improving audibility for soft sounds that would otherwise be unavailable to them.  Hearing aids are small, battery-powered devices made of the following basic parts:

  • Microphone: receives sound from various directions
  • Microchip: digitizes and adjusts the signals to the wearer’s prescription
  • Amplifier: increases the volume of the signals
  • Speaker/transducer: reproduces the altered sounds for the listener

Current hearing aids are in fact miniature sound processors that are programmed to amplify specific sounds to specific levels of loudness.  Once a hearing aid is prescribed, it can be customized for each user based on the audiogram, sound tolerance, and comfort of the individual. 

Choosing the Right Hearing Aid

At ColumbiaDoctors, we view the hearing aid as a rehabilitation device.  Our audiologists will help you decide which make, model, and style is best for your hearing issues by taking into consideration your communication needs, lifestyle, physical abilities, financial concerns, personal preferences, and self-image.

We take into account evidence-based data and the latest wireless communication technology when recommending and fitting hearing aids.  For example, most people with hearing loss in both ears have best results with two hearing aids.  Research has shown that in most cases, two hearing aids improve understanding of speech and assist in the ability to locate the source of sounds and voices.  Patients may be offered Bluetooth compatible accessories, which can open up a world of sounds, music, and telephone conversations that were previously inaccessible to persons with severe hearing loss.

Types of Hearing Aids

Custom Devices

Custom-molded, self-contained hearing aids are formed by the hearing aid manufacturer to fit the patient’s ears.  The audiologist takes a silicone impression of the patient’s ear/s.  The manufacturer uses 3-D printing technology to form the shell of the hearing aid.  Electronic components are assembled inside the shell.  The cosmetic appeal of a single-piece custom instrument depends on the size and shape of the patient’s ear canal and outer ear, as well as the electronic features required, the degree of loudness needed to accommodate the hearing loss, and the size of the battery powering the device.  Not all patients can have “invisible” devices when the ear canal is very small or narrow, or when the hearing loss is too severe.

Completely-in-the-canal (CIC) is the least visible custom product.  The smallest, simplest hearing aid, it provides audibility for adults with mild to moderate hearing loss.  A remote control may be used to vary loudness or access internal programs.

In-The-Canal (ITC) extends from the ear canal to the ear opening, snuggling into the bottom of the ear entrance above the ear lobe.  It is easier to handle for some people and allows the addition of specific features, such as volume control or a venting channel. ITC is suitable for mild to moderately severe hearing loss.

In-the-ear (ITE) is the largest custom hearing aid.  It fills the ear canal and the entire outer ear.  ITEs accommodate multiple program features and allow a strategically placed microphone to increase power while reducing possibility of feedback (whistling or screeching sound) from the device.  

Behind The Ear Devices

Open fit or mini-behind-the-ear (Mini-BTE) is a small instrument that sits on top of or behind the outer ear.  A narrow, transparent tube connects the aid to an earpiece.  The earpiece may be standard or customized to the individual’s ear.  It is designed to allow natural sounds to enter the ear along with amplified sounds.  This style works well for people with mild to moderate hearing loss and for those with high-frequency hearing loss. 

Receiver-in-the-canal (RIC/RITE) aids look very similar to Mini-BTE aids, but they function differently.  The components are housed in the case which is seated on or behind the outer ear.  The speaker is connected to the device by a tiny wire.  The prescribed sound is produced directly into the ear canal. This separation allows RIC aids to be smaller and lighter behind-the-ear pieces with superior sound quality.  They are the most cosmetically appealing and preferred BTE option.

Traditional behind-the-ear (BTE) aids fit over and toward back of the outer ear.  A tube hooks over the front of the ear connecting it to a custom earpiece, commonly called an “ear mold.”  BTEs are generally larger than other types of hearing aids.  They can be very powerful and require a larger battery to drive them.  BTEs are best for people with severe to profound hearing loss.  BTE aids are also the preferred choice for young children, because they are durable.  Ear impressions are taken as the child grows to provide well-fitting ear molds without having to replace the hearing aid itself.  They also have space to accommodate electronic features compatible with school FM systems.

Additional Features

Hearing aid manufacturers offer features and accessories that provide solutions for specific situations that pose challenges to hearing impaired persons. These features are optional and vary, depending on the make, model, and level of technology of the hearing aid.  Features include wireless interface with Bluetooth-compatible devices such as cellphones and televisions, rechargeable batteries, remote controls, environmental noise control, directional microphones, and variable programming.  Our audiologists recommend features suitable to each patient’s particular hearing needs.

Assistive Listening Devices

Assistive listening devices (ALDs) or assistive listening systems can improve audibility in particular settings.  ALDs are not covered by insurance.  ALDs can help in situations with background noise or poor acoustics, such as theaters and other public venues, and they can improve telephone communication and television volume.  Some systems use a microphone that is placed near the source of the sound, a transmitter which sends sound to the ear, and a receiver the listener can control for volume.  

ALDs can enhance hearing for people with hearing aids and cochlear implants, who need additional help in specific situations.  They are also useful for people who do not need a hearing aid but who need assistance in certain situations, or for those who have hearing loss but choose not to use hearing aids.

Personal Sound Devices and “Hearables” are devices sold by manufacturers of electronics and gaming systems.  They are designed for technologically savvy people with normal hearing or mild hearing complaints.  These devices often combine Bluetooth connection to other stand-alone components.  They provide generic sound reproduction similar to that of earphones or speaker systems.  Our audiologists are carefully tracking the development of these devices to determine potential benefit for our patients. 


While some insurance plans provide a benefit to help cover the cost of hearing aids, many others, including Medicare, have no hearing aid benefit at all.  This creates significant challenges for patients, audiologists, and institutions committed to the aural rehabilitation of hearing impaired persons. ColumbiaDoctors strives to develop a system that makes the most of your insurance benefit, yet sustains a viable hearing aid program for your hearing loss.  Our audiologists present fitting options with your budget in mind while striving to maintain a standard of care that we can be proud of.  We encourage our patients to become well informed of their insurance plan benefits and exclusions.

Adjusting to Hearing Aids and Amplification: Let’s Make the Most of Our Investments!

Current research in rehabilitation and brain plasticity demonstrates that it is our brains that hear and make sense of the world of conversation, music and environmental sound.  Once exposed to new sounds, previously unnoticed, it takes time to get used to the new sound qualities hearing aids provide.  Time, patience, and practice are required to become comfortable and to perceive maximum benefit.

ColumbiaDoctors audiologists are committed to this new journey of learning to listen.  Follow-up appointments with your audiologist within the first few months of hearing aid use are a crucial part of hearing aid acceptance.  These visits are provided for patients who purchase from us at no additional cost, because they serve to address any issues that arise.  The audiologist makes the necessary program and fitting adjustments and, as part of that process, educates the patient about the dynamics of communication.  Our goal is to optimize current technology, help patients become comfortable with their devices, and participate fully in daily life.