Hear well in a noisy world

When we set out to test hearing aids, we encountered the same challenges that hearing-aid shoppers face every day: a fragmented and confusing marketplace and difficulty sorting out good hearing-aid providers from less-capable ones.

We followed a dozen actual patients for six months as they shopped for and used hearing aids, conducted a national survey of 1,100 people who had bought a hearing aid in the past three years, and lab-tested the features of 44 hearing aids. Here's what we found:

High prices. Our shoppers purchased two pairs of hearing aids each, or 48 aids in all, ranging from $1,800 to $6,800 per pair, including professional fitting and follow-up services, in the New York City metropolitan area.

Mediocre fitting. We had audiologists check how well providers fit our shoppers' hearing aids to their individual hearing loss. Two-thirds of the 48 aids they bought were misfit: They amplified too little or too much.

Lack of information. Most of the providers our shoppers visited discussed style and features, but a significant minority didn't. One-fourth of respondents to our survey, conducted by the Consumer Reports National Research Center, didn't know whether their aids had feedback suppression, and a third didn't know whether they had directional microphones. Both features can be critical to performance.

So why bother with hearing aids? Medical evidence shows that they can improve your quality of life and relationships with friends and family, so it's worth persevering until you get aids that are properly selected and fitted. Of our survey respondents, 73 percent pronounced themselves highly satisfied with their aids. As one of our shoppers noted, "I'm hearing music sounds I haven't heard for over 20 years."

Moreover, hearing-aid technology has made major strides in recent years, most notably with the development of very small open-fit digital hearing aids. In loud social settings, the most challenging environment for hearing-aid users, survey participants reported more improvement with those aids, which don't plug up the ear canal, over other styles that use earmolds, custom-shaped inserts that fit tightly in the ear canal.

If you're avoiding noisy places or having trouble in conversation or understanding TV, it might be time for a hearing aid. In our survey 67 percent of first-time aid users sought aids because they got tired of asking others to repeat themselves.

Once you've accepted your hearing loss and are considering getting hearing aids, your most consequential decision is finding the proper professional from whom to buy them because it's likely to be a long-term relationship. This is not a project for the faint-hearted because the industry is anything but standardized. Our shoppers encountered a variety of providers, including hospital-based clinics and strip-mall storefronts, all legally able to fit a hearing aid, but with varied resources and expertise. In this report, we'll help sort things out step by step.

You can buy a noncustomized hearing aid online, without a hearing test, for a fraction of the price of a prescription aid. But should you?

We bought and tested four nonprescription hearing aids in our labs and asked experienced hearing-aid users to wear them for one to three days.

Three of the aids cost around $500 apiece: Crystal Eaz, Digital iHear, and Nexear 500 NR. They all lacked directional microphones and telecoils, useful features commonly offered in prescription aids. The Crystal Eaz and Digital iHear lacked feedback suppression, and our testers said feedback was a problem with both. We couldn't make the Nexear's volume loud enough to test feedback suppression. Wearers had trouble controlling the volume on all three aids.

The fourth product, the Magni Ear+, cost only $34.50 per aid. It was huge and uncomfortable, and it lacked a directional microphone, telecoil, and noise reduction. It generated feedback and was too loud at some frequencies and not loud enough at others. Wearers said voices were not clear.

Bottom line. The first three products offer a bit of amplification but little else for folks with mild losses who don't want to spend a lot. But those aids can't be customized for your individual hearing loss. We can't recommend the Magni Ear+ for anyone.

We evaluated major features of 44 hearing aids of varying styles and brands. We also asked our 1,100 survey respondents which hearing-aid features they had and how well their aids worked in various settings. You'll generally pay more for added features.

Telecoil amplifies sound from your phone without picking up background noise, which helps prevent feedback, though it's not needed in some styles of aids. Our survey suggested it helped. Our tests of these nine aids from seven manufacturers, performed in an outside lab, found all telecoils were effective. Behind-the-ear: GN ReSound Sparx (power model), Phonak Naída IIISP, Siemens Centra HP, Starkey Destiny 1200 Power Plus. Behind-the-ear open fit: Oticon Epoq XW, Sebotek Pac Voice-Q 821, Unitron Element 4 Moda Dir. In-the-ear: GN ReSound Ziga ZG40/D, Phonak Savia Art 33.

Directional microphone helps you converse in noisy environments. Survey results show it helps in loud social settings, while listening to the TV or radio, and for hearing household noises. These models got very good scores in our lab tests. Behind-the-ear: Starkey Destiny 1200 Power Plus, Siemens Centra HP. In-the-ear: GN ReSound Ziga ZG40/D, Phonak Savia Art 33, Widex Flash (power model).

Feedback suppression helps quell squeals when your aid gets too close to the phone or has a loose-fitting earmold. Survey results suggest the feature works. These aids got good or very good lab-test scores. Behind-the-ear open fit: Beltone Marq9, GN ReSound Dot 30, Miracle-Ear ME950.Siemens Cielo 2 Life S/Dir, Starkey Zon.5. In-the-ear: GN ReSound Ziga ZG40/D.

Other hearing-aid features worth noting

• Digital noise reduction can reduce irritating background sounds such as the clinking of dishes. But it might not help in all environments. Just one of the 44 models lacked this feature.
  
• Low-battery indicator sounds to alert you that it's time to change batteries. Most aids had this feature.
  
• Power-on delay helps prevent feedback as you insert the aid. Most aids had this feature.
  
• Wax guard helps keep the aid free of ear wax, a cause of malfunctions and a major complaint of survey respondents.
  
• Automatic volume control (compression) provides more amplification for low sound levels than high sound levels, which prevents high sound levels from being intrusively loud. Most aids had this feature.
  
• Vents are tiny tunnels in earmolds that help minimize the stuffed-up sensation they often produce.
  
• Manual volume control lets you adjust volume with a dial. Otherwise, the aid determines how loud it should amplify.

Behind-the-ear models only

• Direct audio input allows the aid to be connected by cable to MP3 players and other audio devices.
• Bluetooth capability allows hands-free use of cell and regular phones.

We'll get the easiest advice out of the way first: If you are a veteran, your first step should be to determine whether you are eligible to get your aids at your nearest Veterans Affairs facility. The 13 percent of survey respondents who went to the VA gave it high scores across the board. Depending on their eligibility, veterans might be able to get their hearing aids free, with at most a co-pay for office visits. Survey respondents who got their aids elsewhere paid a median of $3,352 per pair.

For everyone else, our suggested choice is a medical office headed by an otolaryngologist (an ear, nose, and throat physician) who employs an audiologist to fit and dispense hearing aids.

About one in five survey respondents got their hearing aids from a doctor's office. They gave those hearing-aid providers higher marks on their thoroughness in evaluating hearing loss than did respondents who went to other types of providers. Another plus: An ear doctor can rule out medical conditions such as a tumor or bacterial infection in the ear that might be affecting your hearing. He can also clear your ears of wax so that you're ready for your hearing test.

Medicare will cover the medical exam and an audiologist's test if ordered by a physician. Some private Medicare Advantage plans might cover part of the hearing-aid cost. People with other types of private insurance should check with their carriers because coverage might vary.

If you can't find a conveniently located doctor's office that dispenses aids, an independent hearing-aid provider is a reasonable alternative, our survey found. Thirty percent of respondents got their aids from that type of provider, which is usually staffed by non-M.D. hearing professionals. We consider it important to have some choice of brands, and independent providers generally carry two to four different ones. (The Food and Drug Administration requires patients to have a physician's exam before acquiring a hearing aid but lets adults who don't want one sign a waiver.)

Name-brand stores such as Beltone and Miracle-Ear, used by 18 percent of survey respondents, handle their own brand. (The remainder of survey respondents went to clinics in civilian hospitals or at big-box retailers such as Walmart and Costco. We didn't have enough responses to evaluate them.)

The professionals you might encounter at independent hearing-aid providers could fall into two categories: audiologists and hearing-aid specialists (also called hearing-instrument specialists). Name-brand stores more often use the latter.

Both types of professionals can evaluate your hearing and fit your hearing aids. But their training varies significantly. Newly minted audiologists must have a doctoral degree (generally the Au.D.), pass national and sometimes state tests, and have more than 1,000 hours of clinical training. Hearing-aid specialists generally have from six months to two years of supervised training or a two-year college degree and in most states must pass licensing tests. They can also seek national certification.

You might not necessarily know when you walk in the door which professional you are dealing with. Our shoppers occasionally encountered two or three types working at the same office. Our survey respondents had a difficult time even making distinctions among professionals; 87 percent said they'd visited audiologists, though many had gone to vendors known in the industry to be staffed primarily with hearing-aid specialists.

Does it matter whether the office is staffed by an audiologist or a hearing-aid specialist? Audiologists have broader training and, unlike hearing-aid specialists, can treat auditory conditions that might be better addressed without hearing aids, such as balance problems.

But both types of professionals made mistakes in fitting the aids purchased by our 12 shoppers. Audiologists made fewer serious fitting errors than did hearing-aid specialists, but in about two-thirds of all of the fittings, patients ended up with incorrect amplification.

In the sections that follow, we provide advice on how to increase your chances of getting a good hearing-aid fitting, regardless of which type of hearing-aid provider you choose.

Consider practical things, too, in your choice of provider. Check with your state to make sure the professionals' licenses are current, and with the Better Business Bureau or state attorney general's office for complaints.

Make sure the location and office hours are convenient. Ask whether the office does walk-in repairs rather than requiring you to make an appointment. Ask about hearing-rehabilitation services or support groups for after you get your hearing aids. Experts we interviewed said that those elements might be important for your long-term satisfaction with your aids.

Digital hearing aids, which have captured more than 90 percent of the market, come in five major types (see "Which Type Is Best for You?"). In those aids, sound goes in the microphone and is digitally processed by a chip, amplified, and delivered into the ear. Those aids also have features to modify that sound, making it more lifelike and correcting for other problems.

Because individuals' sound perception is, well, so individual, a hearing aid that thrills one person might seem just so-so to another with almost identical hearing-test results. Even within brands, there might be several versions of a model. That kind of variation makes judging hearing-aid models and brands almost impossible. "There are differences between brands, but they're not significant enough that you can say what are the best brands," says Todd Ricketts, Ph.D., associate professor of hearing and speech sciences at Vanderbilt University.

Our laboratory tests didn't compare brands, but we did evaluate features. Among the most useful were the telecoil and directional microphone. Don't pay for unnecessary features, as some of our shoppers were pressured to do. The more features you buy, the more you'll probably pay, but you might not need every one.

Even with features appropriate for you, you might need to temper your expectations. In crowds, for instance, your digital hearing aids will never completely eliminate jarring background noise. "It's going to bring people back to hearing, but because of the way we process sound, it's not going to bring them back to normal hearing," says audiologist Patricia Chute, dean of the School of Health and Natural Sciences at Mercy College in Dobbs Ferry, N.Y.

A hearing-aid provider is only as good as her evaluations—how she determines your hearing loss and verifies that the prescribed aids work.

During your first visit, the provider will establish your hearing-loss profile with audiometry testing. You'll sit in a soundproof booth and indicate whether you can hear individual words piped into your headphone, as well as tones played at various pitches and volumes. A graph, called an audiogram, displays which parts of the sound spectrum you're having difficulty hearing so that the provider can calibrate your aid properly.

A good evaluation includes several other hearing tests, too; you might be asked to listen to speech while a noisy recording plays. You might be asked to repeat words the tester says, with and without being able to see her lips move. You might answer questions about how your hearing difficulty affects your everyday life.

You should also discuss your needs and lifestyle. Do you like to chat on the phone? Does your social life involve a lot of large gatherings or restaurant meals? One lesson from our shoppers: Don't count on the provider to ask those questions.

The provider should then show you a few models and ask you to choose. If your chosen style includes an earmold, she'll make an impression of your ear canal. You might have to pay a deposit.

When you return to pick up your aids, usually in a week or two, the provider should do several hearing tests to verify that they are working optimally. Of that battery of tests, one stands out as a must-have: the real-ear test, which measures the match between your hearing loss and the response of your hearing aid. "There is evidence that you get a better fitting with a real-ear test and people are more satisfied," says Todd Ricketts, Ph.D., associate professor of hearing and speech sciences at Vanderbilt University.

More than half of hearing-aid providers have real-ear testing equipment, but less than a quarter use it regularly, according to 2006 data from the Hearing Review, an industry publication. So make sure in advance that your provider will use it to verify your hearing aid's fit.

Where we could verify the wholesale price of the aids we tested, the average markup was 117 percent, so there's room to bargain. Only 15 percent of our survey participants tried that, but more than 40 percent of those who tried succeeded. Cheryl Wruk, 62, a county board member from Crivitz, Wis., got her aids discounted to $1,500 from $1,750 by declining promotional extras such as a $100 gas debit card.

Make sure you clearly understand the terms: extra visits not covered by the hearing-aid price, length of warranty, the cost to replace a lost or damaged aid, the cost of batteries, the length of the trial period during which you can exchange or return your aids, and the return fee, if any. Make sure your contract allows you to return your aids and get all or most of your money back if you're not satisfied.

Consider your future needs; ask whether the chosen hearing aid has enough residual amplification to handle a hearing loss that gets worse.

Insist on having brand and style choices. Survey respondents gave lowest marks for choice and selection among all aspects of their shopping experience. Just less than half of our shoppers were not offered a choice of hearing-aid style. "They sold me a completely-in-the-canal model without asking if I minded using that style," a shopper reported to us.

Keep in mind that if you're not thrilled with the first provider's evaluation or personality, or want to see what other providers offer, you're entitled to a copy of your audiogram to shop elsewhere.

Before you leave with your new aids, practice inserting and removing the battery, cleaning and storing the aid, putting it into your ear, using its switches and controls, and using the telephone while wearing it. Most of our shoppers got no telephone training or help with volume controls.

Putting on new hearing aids is nothing like putting on new eyeglasses and being able to see clearly right away. "I thought that everything seemed too loud," a shopper said. "The audiologist said it takes time for my brain to get used to processing things I have not heard for a long time."

Although 26 percent of survey respondents never had a follow-up appointment, we strongly recommend scheduling at least one. Most providers include that service in their fee. Adjustments for a hearing-aid fitting might include changing the device's electronic settings, reworking an uncomfortable earmold, or getting a completely different hearing aid.

Practice everyday activities using the aids. "A hearing aid is not just an electronic device," says Brenda Battat, executive director of the Hearing Loss Association of America, a support and advocacy group. "It's part of a whole rehabilitative treatment." She suggests calling and listening to long-winded toll-free messages at the Social Security Administration or IRS.

Note any environments where you have problems. One of our shoppers, a musician, couldn't tolerate a flutter heard at certain pitches with the first set of aids he purchased. The provider told him that was just the way the aids sound. But the second pair our shopper purchased for our study worked fine, with no flutter.

In our hearing-aids comparison, we found the ideal one for you depends on the severity of your hearing loss, your lifestyle, and your manual dexterity. Smaller aids are less visible, but you pay a price for vanity: They offer fewer features (see Features) and might be more difficult to manipulate. People with more severe hearing loss might get better results with a behind-the-ear model with earmolds or an in-the-ear model. In our survey, owners of behind-the-ear, open-fit designs reported the most improved hearing in loud social settings. Prices listed below are for a single aid.

Behind the ear open-fit

Pros: Comfortable, barely visible. No earmold, so less plugged-up feeling. Might not need a telecoil.

Cons: Sweat might cause malfunction. Limited manual controls.

Price: $1,850 to $2,700

Behind the ear with earmold

Pros: Most versatile and reliable. Fits widest range of hearing loss. Good for children.

Cons: Most visible. Vulnerable to sweat and wax. Plugged-up feeling from earmold unless vented.

Price: $1,200 to $2,700

Completely in the canal

Pros: Does not need telecoil. Almost invisible.

Cons: Short battery life. Too small for directional microphone. Ear might feel plugged up unless aid is vented. Vulnerable to wax and moisture.

Price: $1,365 to $2,860

In the canal

Pros: Barely visible.

Cons: Same issues as with completely-in-the-canal models, though less severe. If the ear canal is large enough, might have telecoil or directional microphone.

Price: $1,300 to $2,750

In the ear

Pros: More room for features such as telecoil, directional microphone, volume control. Less of a plugged-up feeling.

Cons: More visible. Vulnerable to wax and moisture.

Price: $1,200 to $2,700

Where to go when buying hearing aids. Veterans, try the VA. Others, first consider a medical hearing practice that also dispenses hearing aids.

What to expect from the provider. An audiology degree or hearing-aid-specialist certification. A choice of several brands, styles, and features. Convenient hours. Walk-in repairs. Soundproof booth and several types of hearing tests. Real-ear test done at the fitting. Rehab classes or therapy after fitting. Flexible trial period. Money-back guarantee.

At the first visit. Discuss your activities and needs. Focus on features, not brand. Ask about a telecoil, directional mike, and feedback suppression. Ask for residual amplification. Insist on product choices.

At the fitting visit. Practice talking on the phone and other activities. Review the product manual, warranty, trial period, and return and repair policies.

At home. Practice using the hearing aids in different environments. If not satisfied, don't just leave them in a drawer. Return at least once for a follow-up check, and go back as often as needed thereafter.

Unless you're a military veteran who qualifies for virtually free hearing aids from the U.S. Department of Veterans Affairs, you'll have to find a way to pay for them yourself.

Traditional Medicare excludes the price of hearing aids from coverage, but, like many private insurers, will pay for the doctor's exam required for obtaining hearing aids. Medicare also will pay for an audiologist's hearing tests, if prescribed by a physician. Private Medicare Advantage plans have varied coverage; check with your plan administrator.

Your private health insurance may pay nothing toward hearing aids or batteries, or it may reimburse some portion of the hearing aid costs. In Rhode Island, group health insurance plans are required to include coverage for hearing aids for adults and children. For adults (age 19 and older), the benefit is $700 per hearing aid, per ear, every three years. For children (anyone under the age of 19), the benefit totals $1,500. Ten other states—Connecticut, Delaware, Kentucky, Louisiana, Maryland, Minnesota, Missouri, New Jersey, New Mexico, and Oklahoma—require health benefit plans in their state to pay hearing-aid costs for children. However, requirements and coverage vary. Other states have no mandate. Check with your insurance carrier to see what your coverage might be.

Some examples of hearing-aid benefits provided by private insurers:

• As of Jan.1, 2009, the Blue Cross/Blue Shield Federal Employee Program, which covers more than half of all federal employees and retirees, began offering a hearing-aid benefit for adults ages 22 and over, up to $1,000 total per ear, including batteries, every three years. The Federal Employees Health Benefits Program, which acts as a central exchange for BC/BS and some 270 other private health insurers covering federal employees, is encouraging participating insurers to add or enhance their hearing-aid coverage for adults this year. (Last year the FEHBP pushed for hearing benefits for children.) In spite of this initiative, the coverage is optional. So if you're a federal employee, check with your carrier to see what's covered.
• Your union may have negotiated hearing-aid benefits. For example, in New York City the United Federation of Teachers offers a supplemental plan for eligible members and dependents, for example, that pays up to $500 per aid, to be replaced no more frequently than every three years.

Other means of financing your aids

• Use a medical flexible spending account. Many employers let you contribute a portion of your pretax income to such plans. The proceeds can be used toward all manner of health-care costs, including hearing aids and batteries. A taxpayer in the 28-percent bracket who set aside $5,000 in such an account and used all of it for a $5,000 pair of hearing aids would reap an effective savings of $1,400.
• Deduct the cost. Health-care costs that exceed 7.5 percent of your adjusted gross income can be deducted from your federal income taxes if you itemize. Both hearing aids and their batteries can be deducted this way. The best way to reach this threshold is to bunch hearing-aid costs together in a single year. So if you know you need elective surgery and hearing aids, pay for them all in the same year. Check IRS Publication 502, Medical and Dental Expenses, for details.
• Contact your state's rehabilitation services. These offices provide assistance for workers with disabilities. Depending on your state, you may be able to get help paying for hearing tests and hearing-aid purchases. Maryland, for instance, provides low-interest loans for hearing aids and assistive technology. The Pennsylvania Rehabilitation Council provides links to state vocational-rehabilitation departments. (If the Web site from your state has a search engine, type in "hearing aid" to find relevant materials.)

Getting help if you have limited means

• Lions Affordable Hearing Aid Project, a project of the Lions Club International Foundation, assists hearing-aid users who can't afford aids. The program provides two specific behind-the-ear styles of aid from Rexton, Inc. (Keep in mind that the style offered may not be best for your hearing loss.) Contact your local Lions chapter for more information.
• Hear Now, sponsored by the Starkey Hearing Foundation, offers hearing aids to people of very limited means. Assistance comes through manufacturer gifts, hearing health-care providers, and donors of used aids from across the U.S. In 2009, for instance, an individual would need to have total income of $18,403 or less; a couple would need to have total income of $24,675.
• Sertoma (short for "service to mankind") provides mostly refurbished hearing aids to people who need assistance.
• State Medicaid programs may provide hearing aids to people of very limited means. Contact your county social services for an appointment to determine your eligibility for Medicaid. The Hearing Loss Association of America, a support and advocacy group, provides a list of Medicaid-provided hearing services for qualifying individuals in all 50 states and the District of Columbia.

In-person and online support groups

Alexander Graham Bell Association for the Deaf and Hard of Hearing
www.agbell.org
For families dealing with childhood hearing loss and hard-of-hearing adults who choose to communicate through spoken language and speech reading. Extensive resource list.

Alt.support.hearing-loss
newsgroups.cryer.info/alt/support.hearing-loss
Discussion group for people with hearing loss.

American Tinnitus Association
www.ata.org
The nonprofit ATA is an organization working to cure tinnitus, as well as a support group for sufferers.

H.E.A.R.
www.hearnet.com
For musicians and music-lovers with hearing loss or who want to avoid hearing loss.

Hearing Loss Association of America
www.hearingloss.org
Hearing-loss support and advocacy group and links to hearing professionals.

The Listen-Up Web
www.listen-up.org
For families of deaf and hard-of-hearing children.

National Association for the Deaf
www.nad.org
Advocacy group for deaf and hard-of-hearing people, with a focus on American Sign Language users.

Say What Club
www.saywhatclub.com
Online support group of late-deafened, hard-of-hearing, and deaf adults.

General information on hearing loss

Better Hearing Institute
www.betterhearing.org
Hearing-aid industry-sponsored site. Includes non-product-specific information.

National Institute on Deafness and other Communication Disorders
www.nidcd.nih.gov
Government clearinghouse on hearing-loss issues.

Other government agencies

U.S. Department of Labor Office of Disability Employment Policy
www.dol.gov/odep
Resources for disabled people in the workforce.

U.S. Department of Veterans Affairs
www.va.gov
Information on hearing aids for service veterans.

Professional organizations

American Academy of Audiology
www.audiology.org
Find an audiologist.

This consumer checklist is drawn from our Consumer Reports testing and shopping experience, our audiology consultants, and from the resources of the Hearing Loss Association of America, an advocacy and support group. Ideally, you should make sure the provider offers what's listed below:

1. Initial visit to the provider (typically an audiologist or hearing aid/instrument specialist)

The provider or the office:

• Has convenient business hours.
• Makes it easy to schedule an appointment.
• Describes the provider's training and experience, and provides a business card with this information.
• Provides information on demand on up-to-date state licenses.
• Offers walk-in repair service.

You:

• Bring a family member, significant other, or friend.
• Take notes during visits.

2. Medical clearance and other basics

The provider:

• Requires a medical examination, or asks if your ears have been checked recently by an ear, nose, and throat doctor or other licensed physician.

OR:

• Has you sign a waiver required by the Food and Drug Administration in lieu of a medical exam. (The waiver allows you to exercise the right to make your own decisions but only after stating, for example, that your best health interests would be served if you had a medical evaluation by a licensed physician before purchasing a hearing aid or aids.)

3. Testing and lifestyle information

The provider:

• Discusses with you the effect of hearing loss on your lifestyle and relationships at home, work, school, or when going out, for example (or has you complete a questionnaire). The questions should include how well you hear conversations on the telephone.
• Asks about your manual dexterity (your ability to handle small batteries or controls, for example) and/or vision problems that might affect your ability to handle hearing aids.
• Gives you the opportunity to discuss your lifestyle, interests, and activities, which might affect the choice of styles and features.
• Gives you the opportunity to discuss the listening situations, such as noisy or large rooms, theaters, or meetings, in which you have the most difficulty hearing.
• Tests your hearing in a soundproof booth and conducts other hearing tests (to gauge your ability to understand certain words and sentences, for instance).
• Gives you a copy of the hearing test results and fully explains them.
• Discusses realistic expectations (what hearing aids will and will not do).

4. Picking brands, styles, features, and controls

The provider:

• Mentions which hearing-aid brands he or she works with, and why he or she recommends a particular brand for you.
• Reviews the pros and cons (including cost trade-offs) of different hearing-aid styles and features (such as Bluetooth, remote control, telecoil, feedback suppression, noise reduction, and manual-volume control).
  
• Considers your personal preferences concerning style, aesthetics, color, cost, and features.

5. Picking up your new hearing aid

Testing:

• The provider conducts a real-ear test to properly adjust the aid as well as other tests of hearing and understanding speech in quiet and noisy environments.

6. Use and maintenance

The provider:

• Asks you if the aid and/or ear molds fit comfortably, and makes necessary adjustments while you wait.
• Discusses the battery type for your hearing aid, battery life, the handling of batteries, where to buy them, where to store them, and the importance of keeping spare batteries handy.
• Explains controls (for volume and program changes, for instance) and has you practice using them.
• Discusses what squealing (feedback) means, and what to do about it.
• Reviews how to insert the aids, including discerning right from left.
• Teaches you how to clean and store the hearing aids and keep them free of wax.
• Explains precautions, such as not getting the units wet and removing them during radiological and other diagnostic testing.
• Has you practice using the telephone with your aids.
• Discusses why you don't need a telecoil (if your chosen aid doesn't have the feature).
• Outlines a schedule for wearing the aids until you get used to them.
• Advises you to keep track of when and where the aids help and don't help, so adjustments can be made.

7. Financial issues and contract details

You:

• Get a written contract detailing the cost of the aids, the cost of the provider's services, the number of follow-up visits included in the cost, the brand and model of the hearing aids, and the date and place of sale.
• Try bargaining for a lower price with the provider, or ask for a lower-priced model.

The provider:

• Helps you determine what your health insurance will pay toward the aids.
• Mentions other potential ways to offset the cost of your hearing aids.
• Offers to sell you loss/damage insurance that will go into effect when the warranty expires.

8. Disclosure

The provider:

• Explains and offers written information about the trial period, fees charged if you return the aids within the trial period, options for trying a different model, and whether the trial period is suspended if you have to wait for a repair.
• Explains the length of the warranty period and what is and is not covered (e.g., replacing a lost aid and repairing or replacing a nonfunctioning ones).
• Offers to be flexible about the trial period and/or other aspects of purchase.
• Gives you a copy of the product brochure and reviews its contents with you in detail.
• Schedules a follow-up appointment with you to make sure everything is working properly.
• Calls you at home a few days after the initial fitting to see how you are doing.

9. Proper fitting, adjustment

The provider:

• Conducts verification tests, including a real-ear test. This test, also called a real-ear measure, involves placing a thin probe in your ear while you're wearing your hearing aid to measure the match between your hearing loss and the response of your hearing aid.
• Asks you how the hearing aids improve your understanding of others at home, at work, in meetings, in restaurants, and in other quiet and noisy situations.
• Answers your questions and concerns about any discomfort and/or difficulty of use.
• Makes adjustments to the aids based on your comments.
• Teaches you troubleshooting strategies to fix problems yourself.
• Reviews use and maintenance tips.

10. Using hearing aids with other technologies

The provider:

• Discusses the compatibility of your aids with cell phones and other cordless phones.
• Discusses using or supplementing your hearing aids with assistive listening devices such as FM and infrared systems, and audio loops.
• Mentions other assistive and safety devices, such as light-up doorbells, special smoke alarms, and vibrating alarm clocks.

11. Other support

• The provider offers group hearing-aid orientations.
• You go to orientations or plan to go.
• You join a support group in your area and/or online.