Three Must Have Hearing Aid Features for the best hearing aid performance
PLUS a few more niche ones for specialist applications
Time to Read: 25 minutes
- How are you supposed to know which hearing aid features really matter?
- The very best hearing aids should have these three important features
- Multi-Base Automatic Switching – for best automatic performance and less need for manual program changes
- Exceptional Sound Quality – Improved speech clarity, better music enjoyment and less distortion in loud environments
- That’s not all folks…
- What is likely coming later in 2021
Modern hearing aids have many built-in features.
The biggest question is which is the best hearing aid for you?
It is hard for the layman to know which features actually make a real difference. There is a lot of marketing out there promoting various features and benefits, which just confusing matters more. Typically more expensive hearing aids have more features, but ironically not all of them matter much.
This is extremely confusing, but let me help clear that up.
How are you supposed to know which hearing aid features really matter?
Some features, such as multiple channels, are easy to implement and look impressive on paper, but in reality don’t make much of a difference in the hearing aid’s actual performance for the average hearing aid user. Interestingly, some smaller manufacturers push these “paperweight” features as they tend to lack in the technically difficult features that really matter most to user benefit. You
often see multiple channels (32, 64 or even 196) advertised as one of the key features in “cheaper” online hearing aids. These aids are often advertised as premium technology at low prices. In reality, 6 - 8 channels are all you really need for an optimally performing hearing aid.
This article will reveal which features you should consider having in your next hearing aid to achieve the best possible benefit available today. We have filtered out all the fluff, as well as the features such as effective feedback management, open fitting, Impulse Noise management, Noise reduction, Telecoil, electronic wind noise reduction etc., which are already well established.
We have selected three universally applicable important hearing aid features that can really make a difference to a user’s experience.
They are however, strictly the opinion of the author, who has over 20 years’ experience in hearing aid fitting and technology and who has seen the progress of digital hearing aids since their inception.
The very best hearing aids should have these three important features:
Automatic Directional microphones – For better speech understanding in noise
Hearing aids have been able to effectively improve hearing in quiet situations pretty much since their inception. Over the last decade there really hasn’t been much difference between different hearing aid models’ performance in quiet situations. There are some factors which affect an individual person's ability to hear well with hearing aids, but overall, most proper hearing aids do a great job of optimising hearing in quiet if fit professionally.
A much bigger challenge is improving hearing in noise. In this respect, hearing aids have gradually become more effective in separating the speech you want to hear from the speech you don’t. Each person's ability to hear in noise is different, so your needs regarding which technology is right for you can only be determined using comprehensive speech in noise testing.
The only proven way to achieve this is through the use of directional microphones. A modern directional microphone system consists of two microphones on each hearing aid. When the directional microphone system is activated, the hearing aid focuses the direction of sound pick-up forward. This means you hear loudest from the direction you are looking at, while sounds next to and behind you are suppressed.
Directional microphones are most effective when they automatically switch when interfering background noise, often other speech, is detected. Manual systems only get it right when the user remembers to push the button to switch modes, which unfortunately does not happen consistently. Automatic systems get it right 90%+ of the time as they are analysing the sound hundreds of times a second.
There are several levels of directionality, listed below in order of complexity, from least to most complex.
Fixed Directionality – Does not alter to follow the sound around you. Instead, it picks up the best in front and worst right next to you. Has been available for decades. If you move your head the noise level changes based on the fixed pattern. This is normally available in the lowest levels of hearing aid technology and most often require manual switching.
Adaptive Directionality – A little smarter in that it follows the one loudest noise behind you as it moves, notching it out. (Many lower-end hearing aids have at least this level of directionality). This first became available around 20 years ago. This technology is often found in automatically switching hearing aids. This level is perfectly suitable if your hearing in noise is only mildly impaired.
Multi-Band Directionality – Follows multiple sound sources behind you, suppressing them even if they move or you move your head. The number of bands range from around 4 up to 48 in some more advanced models. This requires more processing has been available for the last decade or so. This improves your hearing in noise further and can suit a mild to moderate speech in noise difficulty.
Super Directionality (Beam Forming)– This is the most complex level of Directionality and can offer the best hearing in noise in certain situations like at cocktail parties. Here a hearing aid on one ear wirelessly combines its two microphones with the two on the other ear to form a four-microphone array. This is the latest innovation and has been available in limited brands, first released publicly around 8 years ago.
This provides maximum pickup in a narrow beam in front of the hearing aid user while offering maximum suppression behind the hearing aid user. More modern versions of this can automatically trigger and follow the loud noises behind you.
Super Directionality is only available in limited brands, most notably Phonak (Marvel) has 3rd Generation Super Directionality) and Signia (Bx, Nx and X range). Not all models within the brand has this premium feature. Super directionality becomes important for moderate to severe signal to noise ratio hearing loss as tested using speech in noise testing.
Oticon has released a new take on directionality, using its new Open Sound Philosophy. This is only available currently in Oticon Opn S hearing aids. They claim that directionality as we know it is dead. They do seem to be onto something, but there appears to be some clients who do well with Super Directionality and not Oticon’s Open Sound strategy, while others have the reverse experience. We recommend choosing a clinic where both are available. A trial period allowing for the option to exchange is also recommended, so you have to opportunity to change to another brand if the first selection is not working optimally.
Note: Directionality requires hearing aid microphones to be spaced at least 9 mm apart to be effective. For this reason, it tends to be available only in hearing aids with sufficient space to house the microphones. So as a rule, they are not available in Completely-in-the-canal or Invisible in the canal hearing aids. These small hearing aids tend compromise functionality for size. The exception is Signia NX and X Silk and CIC, which wirelessly connects the two single microphones in each hearing aid (Left and right) to form a directional microphone with two microphones. The directionality is not as good as with two microphones but is better than nothing. I would say it gets close to the performance of a Fixed Directional microphone, but is still far from ideal. This simulated directionality would only suit the mildest of signal to noise ratio hearing losses.
NOTE: The better a hearing aid’s directionality, the more expensive it tends to be. Not everyone requires the most expensive hearing aid with top end directionality to do well however. The only way to know is to undergo a speech in noise test and have your score matched to a hearing aid’s performance in noise. You can read more here about improving your hearing in noise
It is also critical you work with the hearing aid to get the most out of its directional microphones. Basically, keep noise to your back and the person you are listening to, to your front. We have an article detailing tips and tricks to get the most out of your hearing aids here.
Update: Oticon has once again altered the way hearing aids work in noise with the introduction of its More range of hearing aids. These hearing aids offer only very basic directionality to emulate the shape of the ear. Instead they use a brand new Neural Noise reduction technique using advanced onboard artificial intelligence to analyse a sound scene in real time and focus on sounds that are important to the user. Watch this space as this has the potential to change the way hearing in noise is addressed going forward.
Multi-Base Automatic Switching – for best automatic performance and less need for manual program changes
This one is likely to cause a bit of controversy as most Hearing Aid brands DON’T offer this feature. The reason for this goes back to the early days of digital hearing aids when it was technically very difficult to create a multi-base automatic hearing aid without some serious performance issues. Most manufacturers chose single base automaticity as the foundation of their digital strategy. A brave few chose the more complex multi-base automatic system as their foundation.
To understand Multi-Base Automaticity, you first need to understand its counterpart, Single-Base Automaticity. Single-Base Automaticity means that the hearing aid, which is essentially a computer dealing with sound, has a single set of features active for its automatic program based on a few core settings like compression (how it deals with different levels of sound) and frequency response (how it corrects for your hearing at the different pitches).
When an environment is encountered requiring an automatic change, those underlying strategies stay the same, but adaptive features like noise reduction or directionality are increased or decreased.
A big advantage with this approach was that it was relatively easy to do without causing any noticeable switching effects to the end user. The big disadvantage is that if a setting required any underlying changes to the core processing, such as those required for music, then a manual program would need to be used for optimal performance.
Another limitation to the clinician would be that if a client has issues in one situation that is automatically adapted for e.g. background noise, they were left with one of two choices.
They could either change the noise settings and hope that all the other situations will remain acceptable, or they would have to create a manual program to address that single situation. This essentially means that the hearing aid is semi-automatic. More manual programs often means more confusion as the user has to figure out which setting is best for any given situation, which distracts from the conversation you are trying to have at the same time.
Multi-Base Automaticity essentially switches the hearing aid automatically from one set of core features to another (Automatic program switching). So not only can the adaptive features change, but the frequency response and core compression characteristics can change automatically. This approach is much more automatic than single-base systems.
In the past, the biggest disadvantage was that hearing aid users could hear the hearing aid switch from one program to another, which was quite unsettling. With each generation, hearing aids become ever faster and now new strategies, like the blending of programs, gradually got rid of the side effects altogether. Today you can experience smooth transitions with optimal automatic functioning without compromise.
The biggest advantages of modern Multi-Base Automatic hearing aids are that each automatic program can be changed independently of any other. This means, if you have difficulties hearing in noise, the clinician can confidently change only that program without any concern of changes to programs that are working well. The clinician also has very little need to add manual programs, which in turn means less manual fiddling from you, the user.
Availability of Multi-Base Automaticity:
Hansaton (Post Sonova Acquisition models)
Why don’t other manufacturers just switch to Multi-Base Automaticity?
Most manufacturers tend to build on features from their previous generation hearing aids. This means that the next generation of hearing aid has all the features of the previous one PLUS MORE. To change to a completely new core digital strategy would mean that much of what was done previously would have to be discarded, and they would likely have to start everything from scratch. They basically have too much to lose as they have to learn or licence what they don’t know about making Multi-Base Automaticity work effectively. They also run the risk of alienating the clinicians who are used to the way things have always been done in the past.
Some manufacturers like Siemens (now Signia) have tweaked their Single-Base Automatic system to allow a change to the frequency response and a few other criteria in its automatic settings, which is an improvement on other Single-Base Automatic systems. They do not however allow the full flexibility of a true Multi-Base automatic system and manual programs are still required at times.
Update: Real time artificial intelligence on the hearing aid has the potential to change the way hearing aids react to different environments, negating the benefit of multi-base Automaticity. We are starting to see applications of this e.g. Oticon's More range of hearing aids.
Exceptional Sound Quality – Improved speech clarity, better music enjoyment and less distortion in loud environments
Digital Hearing aids have always had pretty good sound quality, but over the last 36 months we have seen some impressive advancements in how sound is captured and processed in these miniature computers.
In the past, limitations in size, power usage and processing ability, limited the range of sound input that could be processed in a hearing aid. The limited resources available then were focused on speech audibility at the cost of sound quality.
This is all starting to change, however. Big manufacturers have gradually been updating their hearing aid ranges with much more powerful processing, allowing them to deal with a wider range of incoming sound. This greatly improves their sound quality, especially for music. It also means less distortion in very loud environments.
The top rated manufacturers regarding sound quality are:
- Widex (Unique, Belong, Evoke, Moment)
- Starkey (Livio Edge, Livio, Synergy, IQ)
- Phonak (Belong, Marvel, Paradise)
- Unitron (North, Tempus)
- Hansaton (Post Sonova Acquisition models)
- Oticon (Opn, OPN S 1& 2 and the latest Oticon More hearing aids) - They have chosen to artificially lower the soft sound pickup of their lesser models
- Signia with their new X range
- GN Resound Quattro 3D
- Bernafon Zerena & Viron
- Sonic Innovations Enchant & Captivate
That covers the top three features I believe one should consider as must haves in your next hearing aid. A combination of the features is better than any single one on its own through. Saying that, most modern hearing aids are far removed from their older siblings in terms of performance and quality. This is because the chips driving hearing aids are basically computers dedicated to sound. A 5 year old computer cannot perform as well as a modern computer. The exact same can be said for hearing aids in my opinion. Beware, there are still plenty of hearing aids using old chips delivering sub-optimal sound quality and/or performance. That is also why you should never purchase an older model offered at a lower price. This practice is rife in the industry and is used by large chains such to keep their prices low. Fortunately these hearing aids are often rebranded to the retailers own brand, so it makes it easier to identify. Be wary if you search the brand name and only the retailers name shows up in results. You also need to understand that not everything out there that is advertised as hearing aids are actually hearing aids.
Artificial intelligence in hearing aids could change all of this...
I would be amiss to not mention the introduction of artificial intelligence in hearing aids. Widex Evoke, Widex Moment and Starkey's Edge are al examples of Artificial intelligence being used to tweak hearing aid settings to deliver better performance. All these tweaks tends to be made via smart phone, using cloud processing to make the changes to hearing aid settings. This has some advantages, but are limited to the settings available in the aid as well as being limited by not happening in real time.
The bar has now been significantly raised by Oticon's introduction of the More range of hearing aids. These hearing aids have a pre-trained deep neural network on chip, allowing for real time artificial intelligence. This means the aid can adjust to novel situations in real time, offering a level of intelligence not seen on hearing aids before. This allows for better contrast between important (speech) sounds and unimportant (noise) sounds. These technology have just become available at the time of the update. We'll be monitoring this area closely as it has potential to deliver significant breakthroughs in hearing aid performance.
That’s not all folks…
The three features above are certainly key features that can make or break a hearing aid in today’s competitive market. They are universally beneficial and would apply to any hearing aid user. There are however a range of features which, are very helpful, but apply to only a certain hearing aid users.
Our Bondi Audiologist Emma, discussed her three most important hearing aid features in the video below:
Rechargeable hearing aids introduce an new level of convenience with hearing aids and this segment of hearing aids is growing rapidly.
Available in over the ear (RIC and BTE models) - Starkey, Widex, Unitron, Phonak, Oticon OPN S, Bernafon, Sonic, Signia.
Also now available in in-the-ear models (Starkey Livio, Livio AI and Livio Edge models)
One should not that Lithium-Ion technology is the one to get as the alternative Z-power has proven to be fraught with issues.
Features to reduce tinnitus:
Tinnitus masker features have found their way into even the most basic hearing aids and are available from many manufacturers Widex, Siemens, Oticon, Phonak, Starkey, Unitron, Signia, Bernafon - You can read about how hearing aids help with tinnitus here.
Powerful Features to dramatically improve hearing in Wind noise:
Phonak, Widex, Starkey, Siemens, Oticon (Opn S & More), Unitron
Features to address severe or greater hearing loss in the high frequencies
Phonak, Unitron, Widex, Bernafon, Siemens, Starkey, Oticon (Opn)
Features to improve landline Phone use: (Allows you to hear landline calls in both ears)
Phonak, Unitron, Starkey, Oticon (Landline phone adapter)
Features to greatly assist with single Sided Deafness (Wireless CROS)
The Ability to upgrade to a higher level of hearing aid later on by upgrading the hearing aid software
Phonak, Unitron, Hansaton, Siemens, Signia, Oticon, Bernafon, Sonic, Widex, Starkey
Direct connectivity to your phone allows not only remote control, but also has the additional benefit of allowing you take phone calls and listen to streamed audio (in stereo with 2 aids) . This takes the hearing aid from a practical devices to one that is enjoyable as well, so its importance should not be underestimated.
iPhone & iPad only: Oticon OPN S, Oticon OPN, Oticon More, Widex Evoke, Widex Moment, Starkey Livio, Resound Linx & Quattro and One, Signia BT and Nx and X, Captivate, Viron, Bernafon Alpha, Sonic Radiant
ASHA (made for Android - select models): Resound Quattro and One, Beltone Imagine, Oticon More, Starkey Livio & AI & Edge, Bernafon Alpha, Sonic Radiant
Phonak Marvel, Oticon OPN S * Ruby & More, Signia NX and X, Widex Evoke & Moment, Resound Linx and Quattro, Beltone Imagine and more.
What is likely coming later in 2021:
- Direct to Android and iPhone streaming will become more prevalent with the AHSA protocol developed by Google and Resound
- Full featured remote assistance - where your clinician can access your hearing aids and adjust them via your smart phone. This means fewer clinical visits and the possibility of adjustments in the situations you are having trouble in. Phonak , Resound, Oticon and Signia appear to be first in line to release this functionality
- More made for all hearing aids in the in-the-ear style
- More rechargeable hearing aid options from various brands and possibly the introduction of in the ear rechargeable options
- Artificial intelligence will become more important for hearing aid performance
- Hearing aids with sensors, like step counters and fall sensors will become available.
- Remote microphone technology to assist hearing over distance and in background noise will become more main stream
- The quality of direct audio streaming to TVs, Phones, Computers and other Bluetooth audio sources will become more important and allow the hearing aid to replace headphones for many users.
- New self fitting hearing aids will become more widely available