Success with hearing aids - What it looks like and how to achieve it

Time to Read: 8 minutes

Success with hearing aids does not necessarily mean hearing normally in all situations.

In rare cases this does happen, but it is the exception rather than the rule.

It all comes down to realistic expectations.

You have to keep in mind that hearing aids work by correcting for the damage in your ear and putting that corrected sound through the damaged ear. However, your damaged ear might add distortion or have other limitations affecting the sound quality.

Finally the brain has to take this "new" signal and form new connections over time, in order to make sense out of the "new" way of hearing. This process of adapting takes time.

Success with hearing aids should mean improved quality of life, improved social interaction, better relationships and more enjoyment of life. Hearing aids worn consistently and successfully have also been linked to significantly reduced risk of dementia, reduced risk of anxiety and depression and improved energy levels.

So, even though no one can promise to make you hear normally again, there are some very significant benefits to be had with the right hearing aid.

I define hearing aid success as: the ability to hear optimally and comfortably within the limits your hearing loss, for at least 10 hours a day, and for years to come.

Three Steps to Hearing Aid Success

There is a lot information out there about which hearing aid model is the best and much of it is confusing.

Being successful with hearing aids can be boiled down into three steps. Each step has a key component, often missed but which is critical to success. Make sure your hearing aid journey contains all three keys for your best chance at hearing aid success.

Step 1: Choosing the right hearing aid

Closeup portrait of young man, student, worker, employee covering his ears from loud noise, having headache isolated on white background. Conflict resolution. Negative human emotions, face expressionsThe first step is possibly the most important, as this forms the foundation of your hearing journey for at least the next 5 years. This is the average life expectancy of a hearing aid.

It also appears to be the step which most people find confusing. What is worse, is that you naturally expect that the best option offered by any provider to be the best hearing aid available. Unfortunately, this is not always the case.

This confusion is entirely understandable as there are so many options out there and far too few strongly personalised recommendations based on fact.

Choosing the right hearing aid starts with a comprehensive hearing aid assessment.

Most assessments are able to reveal how much help you need to do well in quiet environments. As a result, most people do pretty well with hearing aids as long as things are quiet, and you only have a single person to listen to, and there is no competing background noise.

It does not take much to disrupt this perfect listening situation, though. Move into a different room with more people, or switch on the TV or kettle and this easy listening situation is destroyed.

Few tests take it to the next stage and discover how much help you actually need in noise.

Most hearing aid selection is based on your lifestyle and speech test results in quiet. This leaves a massive piece of the puzzle up to guesswork. I believe this is a big reason why so many people are still disappointed with hearing aid performance in noise, despite big advances in technology.

If there is one test that can significantly reduce the frustration and hours of confused research people looking for hearing aids go through, it is speech in noise testing.

Speech in noise testing is the missing piece of the puzzle. The results of this test can help pinpoint exactly which hearing aid will do well for you in noise. It will also help you understand any limitations you can expect in noise, leading to much more realistic expectations.

Unfortunately the speech in noise exam is a rarely used. This 2 minute-long test consists of a number of short sentences, which you need to repeat. Each sentence comes with increasing levels of background speech babble. We can then find the exact level where noise drowns out speech for you.

With this information, your audiologist is able to match your hearing loss in quiet and in noise, to pinpoint the best single solution that is most likely to lead to hearing aid success, without having to always go straight to the most expensive hearing solution you can afford and hope for the best.

Key 1: Get Speech in Noise Testing performed on your ears, as part of a comprehensive hearing assessment, before committing to any hearing aid.


Step 2: Personalised setup and adjustment

Picture of smiling nurse assisting senior man-1Once you have found the hearing aid most likely to lead to long term success, it needs to be optimally fitted to you. Optimal fitting is not a matter of setting the hearing aids up in the software and sticking them in your ears.

Each person is different, with different hearing loss, different ear canal shapes and sizes, and different levels of sound and touch tolerance. The 'first fit' in the software, which is how internet-bought hearing aids are often fit, is based on an average. So unless you are perfectly average, which no one is, this just won't work optimally.

Even the best hearing aid, poorly fitted, might not work as well as a much less expensive hearing aid fitted well.

Optimal hearing aid fitting is a process of finding the most comfortable way to connect the hearing aid to your ears, then measuring the performance, using real ear measurements. To obtain a real ear measurement we place a small microphone deep inside your ear to measure the sound reaching your eardrum. Your hearing aids can then be adjust perfectly to your unique ear acoustics.

Once the basic setup has been completed, the audiologist needs to take into account the effect the additional sound has on you, and adjust the aids accordingly. There is a fine line between hearing well and being overwhelmed by what you hear. This is especially true if your brain has been deprived of some sounds for years. Without this personalised tweaking, an aid fit perfectly using real ear measures may also fail as you could end up rejecting the hearing aid.

An important part of the initial fitting is helping you learn to manage your hearing aids effectively. This requires patience from both you and the clinician, as well as careful guidance towards successful self reliance.

It does not stop at the fitting visit. You will likely also attend follow-up visits around two weeks post fitting. At these visits, the audiologist will check your usage, revisit anything that needs clarification and tweak the hearing aids to address any hearing concerns.

Key 2: Undergo personalised hearing aid fitting using Real Ear Measurements


Step 3: Ongoing tweaks to enjoy optimal long term benefit

Business man pointing to transparent board with text Follow UpStep 2 is where most people expect their hearing aid journey to end, and where it seems to end for many hearing aid users... until their clinic wants to resell them new hearing aids.

The problem with this approach is that things can change in a relatively short time. Hearing aids are worn in quite harsh conditions, in sweaty, humid, waxy, hot ears, for thousands of hours a year.

Without regular care and checkups, things can and do go wrong. On the human side of things, your hearing might change, your needs might change, your lifestyle might change. As a result, your hearing aid settings need to change in order to keep up with these challenges.

It is human nature to forget about the details and assume things are as good as they can be, unless you are actively reminded. Clinics can save significant costs if they leave it up to you to contact them when you have issues. Human nature dictates that most clients won't. This however, leaves many people disatisfied with their hearing aids after initially being thrilled with them. Things deteriorate to the point where you then convince yourself that the hearing aids never worked.

The best way to avoid this downward spiral in your hearing aid success is to choose a provider where active recalls are part of their process. Regular 6 monthly recalls seem to work the best, without being too inconvenient or annoying. Consider whether these recalls cost you each time you visit, or whether they are included in the hearing aid pricing. From my experience, people who need to pay each time for a recall are much less likely to make use of such recalls, rendering them ineffective.

Even if a provider offers unlimited visits over years, it is of limited value without active recalls because it is human nature to let things slide unless prompted.

Key 3: Regular ongoing active recalls to check that the hearing aid is performing optimally.