Have We Really Come So Far? Part 1

When I first started as a young audiologist in 1981, custom hearing aids were not yet being marketed and all that was available were rather large sized BTE aids, eyeglass aids, and even body aids. I recall that there was an Oticon P11P and a Wilco H37D body aid.  The Wilco H37D came with either a red or a yellow dot receiver where the output and gain were higher with the red dot. It’s amazing that I still carry around such trivia in my memory!

Whether the hearing aids were eyeglass hearing, body, or BTE hearing aids, one can say with some certainty that they were not invisible.

Back then, the federal laws were not yet in place that prevented discrimination based on hearing loss or any other physical disability. Well, even today musicians and other “contract employees” still fall into rather large cracks in the various jurisdictional laws.  A hard of hearing conductor or musician wearing any hearing aid would simply, for “unknown reasons”, not have their contract extended.

Various hearing aid manufacturers came out with really neat advertising campaigns that tried to put things in perspective. I believe that it was Siemens (now Sivantos) that came out with a great poster that said “What is more visible- your hearing loss or hearing aid?”.   Of course they hit it on the head, and even today I wish that I had a copy of that poster.  It did however underscore the push-pull, love-hate relationship between hearing aids and what they looked like.

Times have changed but not as much as many would have us believe. It is true that hearing aids can now be seated deeply in the ear canal (and this was really the case since the late 1980s with the introduction of the Phillips Peri-tympanic aid, that we would now call an IIC).

This miniaturization was the big push in the late 1980s and 1990s and indeed there are some acoustic advantages of deep canal or deep CIC hearing aid fittings that went along with the miniaturization. I actually edited a book on this topic called CIC Handbook and among other things, a deep canal fitting (with or without a deeply set lateral end of the hearing aid) would provide significantly more amplification than  what the 2 cc coupler response could show.

I recall an instance where I “faked” an ER-15 musicians’ earplug and had the earmold lab design it as a fake cover over their canal hearing aids. To the unsuspecting public, the musician was merely wearing earplugs.

With the advent of digital technology and wireless compatibility, hearing aids became larger again, but not for too long. Mini BTE and RIC hearing aids quickly became the norm and at least as far as the non-occluding version, was made possible by advanced feedback (phase shifting) management systems.

If the musician or other performing artist wanted to hide their hearing aids, it could be easily done by arranging a few wisps of hair, here and there.

And then we had a new set of problems- digital hearing aids could handle speech as an input but could not handle the higher levels of music without significant distortion. So even if a musician would agree to wear hearing aids, they (understandably) would not wear them while performing or listening to music.  Click here for more on this technical limitation of digital hearing aids can be found at .

In the last 8-10 years, digital hearing aids have almost caught up with the improved fidelity of the old style analog hearing aids of the late 1980s. The 1988 K-AMP is considered the best of all hearing aids for music because it had a rock solid front end that did not distort with the higher level inputs characteristic of music.  It is still available from some sources such as General Hearing and is still available as a PSAP as the Bean from Etymotic.

Recent innovations by a number of hearing aid manufacturers have successfully addressed this problem and are now offering technologies that can transduce the higher level inputs of music without appreciable distortion…. So hard of hearing musicians are now starting to wear their hearing aids again in public venues while performing.

There has been an understandable 20-year hiatus for many hard of hearing musicians not wanting to wear hearing aids- first the larger size, and then the limitation in digital technology. And of course, what would an employer or conductor think of a musician wearing hearing aids?

The last hurdle is still there. Laws are in place to protect the hard of hearing musician but in many cases battles need to be waged by the musician (and their unions and audiologists) to maintain their rights.  Not all performing artists are up to that task and many unions are not as aware as they should be.  I spend as much time educating union officials about their members’ rights as I do in actually helping the performing artist win their case.

We are not there yet despite having laws on the books.  The realm of the performing artist is still very much back in the mid-20th century (and, in some cases, the 19th century).  Miniaturization is one way to do an end-run around the issue, but the issue still remains.

I am not sure that we are as advanced with our human rights when it comes to the performing artists as we should be, or we think we are.

We do have many great tools are our disposal, but none better than hard of hearing musicians who have gone “public” about their hearing difficulties are have come out the other side. The next entry in this blog series is from one, of many musicians who has gone “public” and we will hear his story.


About Marshall Chasin

Marshall Chasin, AuD, is a clinical and research audiologist who has a special interest in the prevention of hearing loss for musicians, as well as the treatment of those who have hearing loss. I have other special interests such as clarinet and karate, but those may come out in the blog over time.


  1. As a musician, what I wouldn’t give for a “body” hearing aid with a good headset that could be mistaken for consumer audio. The body hearing aid could be a smart phone app. (As an engineer, I would love to collaborate with somebody to design this app.)
    It wouldn’t be appropriate for all occasions so I’d still use barely visible hearing aids too.
    By the way, I recall Tom Jones on TV in a few decades ago and his hearing aids were clearly visible.

    1. Actually body aids, other than having the esthetic property that “IT COULDN’T BE A HEARING AID” has some nice other advantages. There is the body baffle effect and the body shadow effect. The baffle is actually a misnomer and really means body reflection effect- there is an enhancement of sound at 1000 Hz as the sound first hits the hearing aid microphone and then constructively reflects off the body. The body shadow effect means that the user can turn their back towards the noise and improve the signal to noise ratio… of course this would work better for macho football players than small ballet dancers, but the effect and possible benefits are real.

    2. Hi,

      as I don´t own an iphone, I can´t try, but the following should work out of the box:

      Buy garage band (5$). Apply equalizer and compressor to a track and switch monitoring on. Adjust the equalizer to match the frequency response of your hearing aid. The compressor is more tricky, as hearing aid compressors have two kneepoints, but maybe a compression ratio of 1:1.5 over the whole range would be a good idea.

      Add a limiter at last (this simulates the mpo of a hearing aid).

      There are hearing aid apps for the iphone, too, but I don´t see why one should not use musicians tools for that.

      An android phone won´t do, as you have too much delay on androids.

      In case you try, please report back your experience, I´m interested, too!

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