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  • Writer's pictureKoorosh Nejad

The best hearing aids for severe to profound hearing loss

Updated: 6 days ago

What is severe to profound hearing loss and what are your options to hear better with such a hearing loss? What are the best hearing aids for severe to profound hearing loss in the UK market? Does NHS provide hearing aids to patients with severe to profound hearing loss? Please read through this article to learn more about severe and profound hearing loss and the best hearing aids that can help hearing better with severe or profound hearing loss.


Note: Please see How to Read Your Hearing Test Results on an Audiogram before reading through this article to have a better understanding of reading an audiogram.



Hearing aid with earmould fitting for severe to profound hearing loss - hearingnow




What is severe to profound hearing loss?

A severe to profound hearing loss is when the hearing thresholds of the patient are at the severe and profound region of an audiogram. Please read more about reading an audiogram here.

Let me give you an example. The audiogram in Example-1 below is the hearing loss of a patient who has moderately-severe to severe hearing loss in the left ear (in blue) and severe-to-profound hearing loss in the right ear (in red). This particular patient has mixed hearing loss meaning the hearing loss comes from a mix of middle and inner ear problems. Symptoms of such hearing loss are that the patient needs the TV sound volume to be higher than normal, sometimes missing the doorbell, cannot hear birds chirping, following the conversation in a busy environment such as a busy restaurant is almost impossible and hearing sounds in the left ear better than the right ear.



Audiogram of asymmetrical mixe severe to profound hearing loss - hearingnow

Example 1 - Asymmetrical mixed severe to profound hearing loss



As you can see in the above audiogram, the hearing thresholds of the patient in the right ear are higher than 80 dB (in the severe band) in low frequencies, and as we approach mid and high frequencies the thresholds are elevated to range between 90 and 100 dB (profound band)



What hearing aid options work best for people with severe to profound hearing loss?

Behind-the-ear and custom-made hearing aids work best for patients with severe to profound hearing loss. Let me elaborate on this a bit more:

  • BTE and RIC hearing aids - If the hearing loss is moderately severe, or severe most of the receiver in the canal (RIC) or receiver in the ear (miniRITE) with a pair of micro-mould would work too. The P or HP receivers can be coupled with RIC and miniRITE hearing aids and cover up to 90 (to 100 dB in limited models) of hearing loss on an audiogram. For best performance, a fitting with earmoulds or ear tips (some manufacturers call it micro shell) is highly recommended versus silicon power domes.

  • Custom Made hearing aids - Same as RIC hearing aids, the custom-made hearing aids can hold P, and HP receivers and support up to about 90 to 100 dB hearing loss.

  • Ultrapower hearing aids - If the hearing loss of the patient is mostly in the severely profound or profound band then you will need at or higher than 100 dB amplification (see the audiogram in Example 2). In this case, the RIC or custom-made hearing aids are not able to provide enough power for your level of hearing loss. The only option left will be ultra-power (UP) hearing aids. Some well-established ultra-power hearing aids in the UK market are Phonak Naida UP and Oticon Xceed. Most of the ultra-power hearing aids are powered by 675 batteries and they support Bluetooth streaming. The audiogram in Example 2 (please see below) is a level of hearing loss that is best managed with Ultra-Power (UP) hearing aids, mainly because most of the hearing thresholds fall in the profound region. Using earmould for such a level of hearing loss is almost inevitable.





Profound hearing loss anaged by ultra power hearing aids - hearingnow

Example 2 - Mixed severe to profound hearing loss




My hearing loss is severe to profound, do I need earmoulds?

Very likely yes, in my experience you can hear sound and speech better with a pair of hearing aids fitted with earmoulds if your hearing loss is at a severe to profound level. The earmould helps with the acoustics of the fitting, allowing more power to be pumped by the hearing aid, hence less feedback and issues with whistling. The earmould also helps with the retention of the fitting in the ear. Some elderly with poor motor skills or arthritis benefit from earmould as putting the hearing aids in and out of the ear would be much easier.



making an ear impression for earmould for severe to profound hearing loss - hearingnow

Taking an ear impression from the patient's right ear



Is taking ear impressions painful?

No, taking ear impressions is done by a qualified and experienced audiologist and is not painful. Many people take ear impressions for custom-made hearing aids or earmoulds. Also, some need to take ear impressions to make sleeping earplugs or swimmer earplugs, or to make monitoring and musicians earplugs. Read more about special-purpose earplugs here.




An ear impression for severe to profound hearing loss - hearingnow

An ear impression ready to go to the lab for earmould or custom-made hearing aids



Do invisible hearing aids work for severe to profound hearing loss?

A short answer is that likely invisible hearing aids won't work best for severe to profound hearing loss. I have fitted invisible hearing aids for many patients with severe hearing loss, however depending on the size of your ear canal, the invisible hearing aids often fail to hold SP (Super Power) or HP (High Power) receivers needed for profound hearing loss. Also, the other problem is that the battery size of the invisible hearing aids is 10 which is the smallest size of the battery for hearing aids. A severe to profound hearing loss needs a lot of energy and will drain the size 10 battery fast, perhaps in 1 or 2 days. On the other hand, in the canal (ITC) hearing aids would be a better option as they hold size 312 batteries or even rechargeable batteries and can hold P or HP receivers in the shell.






I don't like the look of the earmoulds, what are other options for severe to profound hearing loss?

I agree with you, the earmoulds don't look smart. The earmoulds are an integral part of the acoustics of the hearing aids. In certain conditions, your audiologist might be able to avoid a large ear mould and fit your hearing aids with a smaller mould. See the below table for the 4 types of alternate fitting pieces that Oticon offers with Oticon hearing aids.


  • Grip Tip is mostly used for people who have retention problems i.e. the little speaker in their ear canal keeps popping out.

  • Lite Tip and micro mould are used for better acoustics when the hearing thresholds are about 70 dB or higher. The additional benefits of using these types of moulds are better retention and also better streaming experience. The compromise is a higher-than-usual occlusion effect for those with no hearing loss at low and mid-range.

  • Micro Shell is usually used for severe to profound miniRITE fitting where the speaker is placed into the mould (unlike the other types that it is clicked into the mould).




Fitting ear pieces for severe to profound hearing loss - hearingnow

Table 1 - Alternate mould fittings for Oticon hearing aids



I use moulds with my hearing aids but still, I have problems with understanding speech. What could be the issue?

If you have severe to profound hearing loss and you use a pair of ultra-power hearing aids fitted with earmould and still have a problem understanding the speech my best advice is to see your audiologist. Here is a list of areas for further investigation:

  1. Your hearing loss may have changed. Some underlying health issues could directly or indirectly impact your hearing loss. Please visit your audiologist for a fresh hearing test.

  2. Your hearing aids need adjustment. Please make sure that your audiologist conducts a Real Ear Measurement (REM). All types of hearing aids fitting can benefit from REM, especially closed fittings. A Real Ear Measurement should improve your understanding of speech in quiet and noisy environments.

  3. Your hearing aids may be faulty. If you notice that the sound of one of your UP hearing aids suddenly goes down I suggest visiting your audiologist to check your hearing aids. Incidents of a faulty hearing aid usually happen on one side.

  4. You may need assistive listening devices (please see the next question).



I use ultrapower (UP) hearing aids with earmould but still struggle with understanding speech in noisy environments. What else can I do?

If you have recently done a hearing test and your audiologist has done all s/he could to improve your hearing and understanding of speech and also has done a real ear measurement (REM) on your hearing aids but you still struggle to understand speech then assistive listening devices are your best option.

Assistive listening devices (ALS) such as Phonak Roger On iN are very intelligent remote microphones. They can be placed closer to the speaker and they send the speaker's voice directly to your hearing aids. They process the speech sound and reduce the amount of the noise hence making the speech more intelligent for understanding. They are a perfect companion if you have severe to profound hearing loss and need to hear speech better, especially in noisy environments such as busy restaurants, coffee shops, exhibitions and so on.


I have a pair of expensive hearing aids, how do I insure my hearing aids?

Please see this link for more guidance on hearing aid insurance.


Can I get custom-made hearing aids from the NHS?

No, in the UK, the National Health Services (NHS) only provides super-power and ultra-power hearing aids fitted with earmoulds for patients with profound hearing aids. I have received several patients with NHS hearing aids who have severe to profound hearing loss and were looking for better vanity and in-the-canal hearing aids for profound hearing loss. Please see our affordable custom-made and invisible NHS+ hearing aids collection here.






References:

  • Setia Hermawati & Katerina Pieri (2020) Assistive technologies for severe and profound hearing loss: Beyond hearing aids and implants, Assistive Technology, 32:4, 182-193, DOI: 10.1080/10400435.2018.1522524

  • Shinichi Sakamoto, Katsuhiko Goto, Makoto Tateno, Kimitaka Kaga, Frequency compression hearing aid for severe-to-profound hearing impairments, Auris Nasus Larynx, Volume 27, Issue 4, 2000, Pages 327-334, ISSN 0385-8146, https://doi.org/10.1016/S0385-8146(00)00066-3. (https://www.sciencedirect.com/science/article/pii/S0385814600000663)

  • Yoshinaga-Itano, Christine; Baca, Rosalinda L.; Sedey, Allison L.. Describing the Trajectory of Language Development in the Presence of Severe-to-Profound Hearing Loss: A Closer Look at Children With Cochlear Implants Versus Hearing Aids. Otology & Neurotology 31(8):p 1268-1274, October 2010. | DOI: 10.1097/MAO.0b013e3181f1ce07

  • Arquivos Internacionais de Otorrinolaringologia 2010; 14(03): 338-345 DOI: 10.1590/S1809-48722010000300011





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