Smaller and digital are hot words for patients looking to improve their hearing.

Russell Hearn, regional director of Avada, said the technology for hearing has gone miniature.

"Everybody wants it smaller, everybody wants it smarter," Hearn said.

The largest improvement is the small designs of devices, said audiologist Dr. John Balko, president and CEO of Hearing Healthcare Associates.

Devices that aid a patient with hearing loss fit behind an ear and lead into the ear canal with a minute wire, Balko said. The result is a device that is nearly invisible.

"They can't make them any smaller," Balko said.

The newest digital devices are programmable and include Bluetooth technology to allow people to sync with MP3 players or cell phones, Balko said.

"Technology is taking giant leaps," Hearn said.

Because of the changes in technology, hearing centers are encouraging patients to see what options they have.

"Better hearing outweighs any of the negatives of wearing a hearing device," Hearn said.

At Avada, when a patient comes to the office, the audiologist will test the person's hearing in a sound booth, view the ear through videotoscopy, and talk with the patient and family members to determine the needs of that patient.

Often patients remark they have trouble hearing in restaurants or that the television is too loud for the other people in the room, Hearn said. The patients who come to Avada often have hearing loss that is noise induced or that comes from aging.

In the booth, a technician transmits soft tones through earphones while the patient indicates he has heard the noise by hitting a trigger.

Then, using a videoscope, a small camera is inserted in the ear canal. Both the audiologist and the patient can see any physical reasons for the hearing impairment when images are projected to a TV.

While talking to the patient, the audiologist will learn about three or four situations where the patient is experiencing difficulty.

Then, after the assessment, the audiologist and the patient can decide on the proper treatment.

Once the hearing devices are programmed to correct the hearing loss, the office can simulate situations such as restaurant noise, birds singing or telephone conversations to test the improvement, Hearn said.

Balko said devices soon will be waterproof for patients who sweat more, and there will be more devices that will have Bluetooth capability.

• Open Ear/Receiver-in-the-Ear — The device rests above or behind the ear and is connected to the ear canal via extremely thin, clear wire, lightweight with no earmold to occlude the ear canal. It is nearly invisible.• Behind-the-Ear — It rests behind the ear and is connected to the ear canal via custom-made plastic tubing, earmold is required for customized fit. It is barely visible.• Completely-in-the-Canal — It resides deep inside the canal and requires a "pulling string" to allow user to remove the device. It is barely visible or not visible at all in the ear canal.• In-the-Canal — It fits outside the ear canal. It is slightly visible in the ear.• In-the-Ear — It fills the entire bowl of the outer ear. It is visible in the ear.