They're still hearing aids. But they're better--and smaller
It's a small world. But near invisibility forces trade-offs. As a hearing aid shrinks, so does the space for circuitry--and for the battery to power it. That means people with severe or profound hearing loss aren't candidates for CICs or ITCs. Even the shrunken version of behind-the-ear hearing aids may not be enough for them. And the tinier the battery (and the higher the volume), the more often it has to be replaced. A CIC battery might quit after 80 hours, while one used in a full-size BTE may be going strong at 200 or 300 hours. The smallest CIC battery, moreover, is less than half the width of a contact lens--a challenge to arthritic fingers and imperfect vision.
Another annoying feature of the tiniest models is occlusion, a sensation almost like wearing earplugs; it can distort the user's own voice or create noise when the jaw moves. (To see what it's like, gently seal each ear with a finger, then talk or chew gum.) And because they are buried in the ear, CIC aids can't offer "directionality," an extra-cost option on larger models. This feature, switched on and off by the wearer, reduces the hearing aid's sensitivity to sounds coming from behind and the sides. That cuts down on overall noise and makes it easier to understand someone talking from the front. On the other hand, snug and unexposed CICs are superior at conquering telephone feedback, the irritating squeal that often occurs with small, exposed hearing aids. Sounds from the hearing aid speaker, trapped in the outer ear by the telephone receiver, feed back into the microphone a fraction of an inch away.
The slimmed-down BTEs offer an appealing mix of size and performance and can almost pass as wireless Bluetooth headsets. But they're not for everyone, either. "You have to put the unit in place behind the ear and then put the tube in the right position, and some people just can't do it," says Dennis Hampton, an audiologist in White Plains, N.Y., who writes a quarterly consumer newsletter on hearing aids. "I just took a man in his mid-70s off one and put him on a bigger BTE type. He just didn't have the dexterity or the vision to manipulate it."
Hearing aids of any size can unravel a nicely worked-out budget, although figures of $6,000 or more that circulate in horror stories are hardly typical. An average hearing aid cost about $1,840 in 2005, including testing, fitting, and follow-up visits. About three quarters of buyers need a pair. In general, the smaller the hearing aid, the higher the price. CICs command a premium of roughly $250 to $350, or $500 to $700 for a pair. And since life spans typically are only four to seven years--thanks to long daily exposure to moist warmth, skin oils, and earwax--this probably won't be a one-time purchase.
While prices may be lower than many people expect, they hardly amount to small change, and help is unlikely. Medicare doesn't cover hearing aids. Nor will most health insurers pay. Families who would be pressed can tap programs like Audient (www.audientalliance.org), launched last year by the Northwest Lions Foundation for Sight and Hearing. Cooperating local providers will fit two behind-the-ear digital hearing aids for about $1,000 for families whose income is less than 2 1/2 times the federal poverty level, or about $31,225 for a family of two or $47,125 for a family of four.