Winning the War Against Hearing Loss, part 7: The Cosmetic Battle
Bob Martin
September 1, 2015

So far in this series, I have discussed Kim, David, Dr. Judy, and Sam. Improvements in hearing aid technology and the skill of their audiologist have helped each of these patients become more productive people. Today we take a look at the miniaturization of electronics and the impact of cosmetic concerns on the field of hearing aids.

Michael and Ann are twins with almost identical hearing losses. They are also both very concerned with their appearance.

Several years ago when they were teenagers, I fitted them with completely-in-the-canal hearing aids (CICs), but they had poor luck using them. One day at school, Ann’s hearing aid started whistling and she had trouble getting it out of her ear. Everybody in her class laughed, and she was so embarrassed that she stopped wearing both aids, even though her mother, father, and twin brother strongly encouraged her to continue using them.

I saw both twins recently for new hearing aids. Ann had two major concerns: feedback and control of environment noise. After considerable discussion I fit her with tiny CICs that can be controlled by a remote. Knowing that feedback was an issue, I ordered tiny vents and warned her about hearing her own voice.

Unlike Ann’s old CICs, these new hearing aids:

  • Allow her to adjust the volume level as needed, using a remote control.
  • Switch to different listening programs to help control perceived noise.
  • Are feedback-free.

After I put her new hearing aids in her ears and “tuned them,” Ann asked me to bring her a mirror. She looked at herself in the mirror, and when she was unable to see even the slightest hint of a hearing aid, she decided to wear them.

She then put her hand up to her ear to check for feedback. Success! No feedback. None! I had anticipated this test and had adjusted the hearing aids carefully.

Michael selected a pair of tiny RICs (receiver-in-the-canal instruments) with custom canal-only earmolds. They are not quite as invisible as Ann’s tiny CICs, but Michael is comfortable with them. The giant hearing aid that he used to wear has been replaced by tiny hearing aids that fit nearly invisibly behind the ear.




Without their hearing aids, Michael and Ann would be struggling in college. Their 50- to 75-dB across-the-board hearing losses are severe enough to preclude them from many of the pleasures of life.

Ann desperately needed hearing aids that don’t feed back. And, being an active young woman, she was looking for hearing aids that would function well in a wide variety of listening conditions. Improvements in miniaturization gave Ann the hearing aids she needs to lead the life she wants.

Michael was equally interested in cosmetics even though he had not had his sister’s bad experience of being embarrassed by using them. Michael is a very active young man who wants to be able to hear in crowds. He was very impressed with his new system’s ability to remove unwanted background noise.

Are these miracles?  I think so, but answer these questions for yourself.

  • Is controlling a pea-sized, deep-fitting in-the-canal hearing aid with a remote control a miracle?
  • Is decreasing the size and weight of a BTE (behind-the-ear) by 90% while dramatically improving its performance a miracle?
  • Is reducing most of the background noise in a restaurant a miracle?

You decide.




One of my patients is an electrical engineer. We have had long talks about the size of a hearing aid and the amount of amplification it can produce. I learned something: There is no correlation between a hearing aid’s size and its sound output. The only component of an aid that affects output is the receiver (speaker). Therefore, it is possible for the world’s smallest hearing aid to be the world’s “strongest,” as long as it has a large, powerful receiver.

Battery size does not determine output. Think of a battery as a gas tank. A tiny battery can provide as much power as a big battery, just not for as long.

In the next case story in this series, the miracle-or-no-miracle question will be easy to answer. The patient’s name is Sandy. I’ll tell you about her soon.


feature image courtesy of latino health zone

  1. Having basic NHS aids being able to turn down the din in restaurants would be wonderful.

    Cosmetics worry me far less, although the fact my BTE aids are purple is kind of cute, especially as hearing aids mean I need to tie my hair up.

  2. I would consider being able to reduce most of the background noise in a restaurant, something of a miracle. As a hearing aid user, I have found that striking a good aural balance is about compromise. That being said, I would take comfort and control over being able to hear more any day of the week.

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