Hearing aids: diagnosis and causes of hearing loss | NDR.de – Guide

As of 07/18/2022 10:21

Hearing aids are designed to compensate for hearing losses and thus facilitate communication in everyday life. Does health insurance cover the costs? What are the causes of hearing loss?

Hearing is one of our most important senses because it enables not only communication, but also spatial orientation and the perception of threats. Good hearing and understanding is a key element of quality of life and is often essential in professional and private life.

However, many people with the first signs of hearing loss avoid having their hearing tested by an ear, nose and throat specialist or a hearing care professional. Vanity often plays a role here, as many people see the visible hearing aid as a stigma and sign of weakness and dismiss it right away. Hearing aids have long existed that are barely noticeable from the outside.

What hearing aids do

Hearing aids are designed to compensate for hearing losses and thus facilitate communication in everyday life. To do this, they have to complete four tasks:

  • amplify the noise
  • Improve speech understanding in background noise
  • enable spatial hearing
  • possibly alleviate the disturbance caused by tinnitus

Diagnosis by hearing tests: free field or sound field audiometry

A number of tests are carried out to determine whether a hearing aid is really useful and necessary.

The most common free field or sound field audiometric tests hearing sounds or speech through loudspeakers. It is used in the diagnosis of hearing problems, but also in fitting hearing aids. Free field audiometry enables the assessment of binaural hearing in a variety of conditions. First, speech recognition is checked in a quiet environment, then with background noise such as sea noise or party noise. In this way, you have to assess speech understanding in a realistic hearing situation. Further measurements are made under the headphones to measure frequencies that are no longer audible.

Initial fitting the hearing aid

On the first prescription, the ENT doctor must determine the cause of the hearing loss, examine the degree of the loss and see if the patient can handle the device. Depending on this, a hearing aid is prescribed. The initial acoustics fit is essential for your satisfaction with your hearing aid. It is based on a doctor’s recommendation and takes into account the individual hearing loss. This tuning usually requires several visits over a period of several weeks. This is followed by a medical examination in the ENT office.

The causes of hearing loss

All sounds reach our ears in the form of sound waves. First they hit the eardrum and finally reach the middle ear with the help of the three ossicles. They amplify sound and transmit it to the sensory cells in the cochlea behind it, which transmit it to the brain in the form of electrical impulses. With age, more and more of these cells disappear. Noise enhances this effect and can lead to hearing loss at an early age.

Types of hearing aids: differences in color and handling

Anyone with a problem can thoroughly test with a hearing aid acoustician which hearing aid best suits their needs. The models differ not only in appearance, but also in tone and handling. Unlike analog hearing aids that were common in the past, digital hearing aids can be programmed to automatically adapt to different hearing situations. They block bothersome background noises, such as traffic, wind, or gibberish of voices, suppress sudden noises and enhance speech.

In fact, there are currently two large groups of hearing aids: they are either placed in the ear or behind the auricle.

Behind-the-ear hearing aids are visible

Behind-the-ear (BTE) hearing aids are the most common hearing aids. When worn over the outer ear, they are basically visible, albeit much less conspicuous than their massive predecessors two decades ago. Earpieces (earplugs) are made individually for different sizes, shapes and colors of the ears. In hearing aids with a tube, the speaker sits in the hearing aid and the sound is directed through a small tube into the ear canal. In other systems, the loudspeaker sits directly in the ear canal and is connected to the hearing aid with a thin cable. They sound less distorted and are usually smaller than tube hearing aids.

Custom hearing aids are barely visible

Custom hearing aids (ITEs) are so small they fit completely into the ear canal and are barely visible from the outside. For this purpose, ear impressions are taken to perfectly fit the hearing aids. However, they can be seen as a foreign body in the ear and can lead to closure of the ear canal due to increased earwax formation, and are much more expensive. In addition, they are often overwhelmed by severe hearing loss.

The classic ITE model, known as ITE (in-the-ear), completely fills the auricle and therefore remains visible despite adapting to the individual skin tone. ITC (intra-canal) hearing aids are much smaller, the auricle remains free. The hearing aid is visible in the ear canal, but is quite discreet.

The so-called auditory systems, or CICs (fully intracanal), lie completely in the ear canal and are almost invisible. To clean the device or replace the battery, use a nylon cord to pull it out of the ear canal.
IIC systems (not visible in the channel) are even smaller. They are inserted deep into the ear canal and placed just in front of the second curve of the ear canal. They are completely invisible from the outside. They are also pulled out with a nylon thread for battery replacement.

Hearing aids: what does health insurance pay for?

If the ENT doctor prescribes a hearing aid, the costs are usually borne by health insurance companies. In addition, the health insurance covers the costs of consulting and adjusting the device by the acoustician of the hearing aid. However, full coverage only relates to medically necessary care.

It depends on the individual whether the basic model paid by the health insurance fund is sufficient. As a rule, health insurance covers a contractual price of EUR 685 per hearing aid. There is also a flat rate for individually produced inserts and a flat rate for service for repairs. In the event of a hearing loss on the verge of deafness, the health insurance fund pays around 840 euros. If you go for the more expensive, less conspicuous system, you have to pay the extra price yourself. However, if you choose a more expensive hearing aid not only for optical reasons but also for medical reasons, you should ask your health insurance provider to cover the additional costs. Modern hearing aids should last about seven years. As the aging process progresses, it must be regularly adjusted and adapted to new requirements. After six years, the health insurance fund will pay for a new device at the earliest.

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Further information


Hearing loss is the largest modifiable risk factor for dementia. Therefore, hearing loss should be treated early. still

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Visit | 19/07/2022 | 20:15

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