Hearing Aid Buying Guide
Sound Advice

An estimated 48 million Americans suffer from some form of hearing loss—the vast majority of them older adults. Almost one-third of people ages 65 to 74 report difficulty hearing, and the number rises to about half at 75, according to the National Institute on Deafness and Other Communication Disorders.

Evidence is mounting that untreated hearing loss is a significant national health concern, and studies have linked it with other serious health problems, including depression, a decline in memory and concentration, and perhaps even dementia.

1

What You Should Know About Hearing Loss

Causes of Hearing Loss
The most common type of hearing loss, called sensorineural, often stems from damage to the tiny hair cells that line the inner ear. These cells convert incoming sound waves into electrical signals that are then shuttled to the brain. The brain interprets the signals as meaningful sounds.

Aging and chronic exposure to loud noises are the most common causes of damage, but certain medications, illnesses, and a family history of hearing loss can also increase your risk.

Although sensorineural hearing loss is often not reversible, it can be managed with hearing aids, which selectively amplify sounds. Cases of severe hearing loss or hearing loss in only one ear can be managed with cochlear implants, which electrically stimulate the auditory nerve by bypassing the damaged portions of the hearing system.

Conductive hearing loss is less common and often occurs as a result of a physical blockage or malformation in the middle or outer ear. Impacted earwax, fluid buildup in the middle ear from an infection, and certain disorders can block sound from reaching the inner ear and brain.

Removing the wax buildup in the outer ear, treating infections in the middle ear, and, in the case of malformations, having corrective surgery typically restore hearing. If not, a hearing aid may be used.

Older adults sometimes have a mix of both types of loss. For example, an age-related hearing loss plus wax in the middle ear can interfere with sound conduction to the inner ear.

2

Understanding Hearing Aids

Once hair cells in the inner ear are dead, there's no bringing them back. But hearing aids may significantly improve your ability to hear by making sounds louder and easier to understand.

Hearing aids have a microphone to pick up sound, an amplifier to make sound louder, and a receiver that sends the sound into the ear canal. In modern digital aids, microphones transmit sound to a computer chip, which adjusts the volume and amplifies the sound frequencies needed to help improve your hearing. (Though analog aids are less common and less complex than digital aids, they do have advantages, including fewer advanced features. That can make them more user-friendly.)

A hearing professional can program a digital aid to filter out wind and other background noise, as well as fine-tune the aid to match your specific hearing-loss pattern. More and more models can sync wirelessly with your smartphone, enabling you to take calls, stream audio, and even adjust your aid’s settings using an app.

The right hearing aid for you depends on several factors, including the type and severity of your hearing loss, your lifestyle, and your manual dexterity. However, a hearing aid that one person likes might not work for someone else, even if both have almost identical audiograms (charts that show the degree of hearing loss for low-, middle-, and high-pitched sounds).

Most hearing aids will never completely remove background noise and allow you to hear only the person—or people—talking. "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, Ed.D., provost and vice president for academic affairs at Dalton State College in Dalton, Ga.

And even within the same brand, there can be several versions of a given model. That kind of variation makes comparing hearing-aid models and brands very challenging.

3

Tuning In to Hearing-Aid Types

Digital hearing aids come in five major styles and are categorized by where on or in the ear they're worn. In the fall of 2015 we asked more than 131,000 subscribers about their experiences with hearing loss and hearing aids. More than 20,000 aids were rated. Of them, the majority (62 percent) were mini-behind-the-ear types.

Illustration of a behind-the-ear hearing aid.

Mini-Behind-the-Ear Hearing Aid (mBTE)

This type goes by various names, including receiver-in-the-canal (RIC), receiver-in-the-ear (RITE), receiver-in-the-aid (RITA), and canal receiver technology (CRT). With RIC hearing aids, the receiver (the speaker that sends sounds to the inner ear) is inside the ear canal. It attaches to the ear via a thin wire and a custom-made earmold (a piece of soft material made to fit snugly in the ear and channel sound into the ear), or a noncustom dome-style ear-canal piece.

Pros: Comfortable, barely visible. Prevents a plugged-up feeling (especially when using an open ear tip, which is appropriate if you can hear well in the low pitches). Larger versions are easy to insert.

Cons: Wax and moisture buildup may limit the life of the receiver. Does not allow for significant amplification, especially in the low frequencies.

Illustration of a standard-tube behind-the-ear hearing aid.

Traditional Behind-the-Ear Hearing Aid (BTE)

In this group of aids, which sometimes includes RITA hearing aids, all electronic components are in the plastic case worn behind the ear. Sound is sent to the ear through the tubing that connects the case to the receiver and a custom earmold worn in the ear canal.

Pros: Considerable low- and high-frequency amplification. Offers flexible features and considerable amplification, making it good for those with severe hearing loss. On larger, traditional models, controls are easy to manipulate and the telecoil mode is easily selected and used (see below for more information on the telecoil). The custom-made earmold can be easily cleaned. Accommodates larger batteries for more power.

Cons: Some custom molds are visible (clear molds are not). Vulnerable to sweat and wax buildup, but the tubing and mold are easily cleaned. The earmold must fit snugly and fill the entire ear canal, which can cause a plugged-up feeling. On a positive note, feedback is rare because of the snug fit.

Illustration of a completely-in-the-canal hearing aid.

Completely-in-the-Canal Hearing Aid (CIC)

Pros: Recessed into the ear canal and fits deep and tight in the ear. Minimal feedback when used with a phone. Because it's in the canal, it has low visibility and can be removed with a removal string. Less sensitive to wind noise.

Cons: Too small to include a directional microphone (which reduces background noise by picking up sound from a specific direction), but often has some directional sensitivity. Ear might feel plugged up unless hearing aid is vented. Vulnerable to wax buildup and moisture. It can accommodate only a small battery, so battery life is relatively short, and typically only powerful enough for milder hearing loss. Because of their small size, the batteries can be difficult to insert and remove. The aid may be challenging to handle and adjust.

Illustration of an in-the-canal hearing aid.

In-the-Canal Hearing Aid (IIC)

Pros: Barely visible, less of a plugged-up feeling because the aid sits deep in the canal. Larger units can include directional microphones.

Cons: Discomfort is an issue for many, along with the concerns that are typically associated with completely-in-the-canal models. These models are susceptible to moisture, and the receiver is vulnerable to clogging from earwax. The battery tends to be small, so battery life is relatively short. May be challenging to handle and adjust.

Illustration of an in-the-ear hearing aid.

Traditional In-the-Ear Hearing Aid (ITE)

All electronic components are included within the case, which rests in the bowl of the outer ear.

Pros: Offer more room for features such as telecoil, directional microphone, and wireless streaming. Less of a plugged-up feeling when vented. Relatively easy to insert.

Cons: Some people consider ITE units to be more visible, and the telecoil may not be as powerful as those on BTE hearing aids because they are smaller in size.

4

Which Features Are Important?

In our survey, 33 percent of people who wear hearing aids said that the option of multiple program settings (which allows users to optimize aids for a variety of environments, such as quiet rooms or loud restaurants) was the most important feature they looked for when purchasing a hearing aid. Twenty percent said automatic noise level adjustment was most important. Other key features, according to hearing-aid experts, include the following:

Telecoil
An option on many modern hearing aids, a telecoil is a small sensor or copper wire that is placed in the hearing aid. When activated, it wirelessly picks up a magnetic signal from hearing-aid-compatible telephones and public address systems—such as those that may be in conference rooms, concert halls, museums, taxis, and even subway trains—and converts that energy into sound. An audio induction loop, or hearing loop, which is a wire that circles a telecoil-compatible room or space, emits the signal that the telecoil picks up.

Such technologies help people—especially those with moderate to profound hearing loss—better understand a speaker’s voice by making it louder and eliminating most background noise and reverberation. Ask your provider for a “manual T-switch,” which enables seamless connection to loop systems. He or she should also activate your telecoil and show you how to use it. Make sure your provider explains how to use this feature.

Directional Microphone
Many modern hearing aids have a directional microphone, which helps you converse in noisy environments by making the audio signal in front of you louder than the noise from the rear or sides. This technology works best when you are close to the sound source. Almost all hearing aids with this feature are able to automatically switch between directional and omnidirectional settings depending on the environment. Advanced versions can focus behind the listener or to the listener’s side. A negative: It's prone to picking up wind noise.

Feedback Suppression
Feedback suppression, or digital feedback reduction, helps quell high-pitched whistling sounds. Most modern hearing aids include this feature, but its effectiveness differs from aid to aid. It’s useful for minimizing feedback if you're close to the telephone or if the aid is slightly dislodged from your ear when you move your jaw. It can also allow for much more venting, comfort, and sound quality for listeners who have good hearing in the lowest pitches. A proper fit can also reduce feedback.

Digital Noise Reduction (DNR)
Improves listener comfort and communication in noisy environments by blocking out some background noise. This makes it easier to hear and understand speech, though it is not a fix for all situations.

Other Hearing-Aid Features Worth Noting
Most newer aids also have low-battery indicator sounds, wax guards to prevent buildup, automatic and manual volume control, wireless connectivity between hearing aids, data logging, and a memory of your listening preferences. Another newer feature is direct audio input, which allows users to connect directly to a television or other electronic device. At the higher end, Bluetooth wireless technology allows users to stream music and calls from computers, smartphones, and TVs directly through their hearing aid. Some aids also have frequency shifting technology (for those with hearing problems in the highest pitches) and accessories such as remote microphones (sometimes called "spouse mics"), advanced smartphone remotes, and more.

5

Selecting a Hearing-Aid Provider

Some people who notice they're having difficulty hearing start with their doctor or an otolaryngologist—a board-certified doctor who specializes in ear, nose, and throat problems—then get referred to an audiologist. (The Food and Drug Administration announced in 2016 that it’s no longer enforcing the requirement of a medical exam for adults before purchasing a hearing aid.)

What should you do? Our hearing expert recommends that you see an audiologist, who can determine whether you might have an underlying medical issue (such as a bacterial infection, impacted earwax, or a tumor in your ear) that is causing your hearing loss and refer you to a physician if necessary.

The audiologist will conduct tests to assess your hearing-aid requirements. He or she will then match your ability to understand speech in different settings, your listening needs, and more to the appropriate technologies. There are many hearing technologies, so it is important to work with your audiologist to decide what will be best for you. 

Many audiologists work in private practices (freestanding offices) where 30 percent of our survey respondents purchased their aids. Audiologists may also be on staff at wholesale clubs like Costco (where 15 percent of respondents purchased aids) or hearing-aid stores owned by manufacturers such as Oticon, Phonak, Starkey, ReSound, and Widex.

Our survey respondents put wholesale clubs at the top of the chart for types of hearing-aid retailers. Note that some big-box stores often have employees known as hearing-aid or hearing-instrument specialists. Their license is typically posted, but it’s always wise to ask whether you’re seeing an audiologist or hearing-aid specialist (Costco and Connect Hearing—chain hearing-aid retailers—were rated among the highest in customer satisfaction.)

Both audiologists and hearing-aid specialists can evaluate your hearing needs and fit your hearing aids. But their training varies significantly. Requirements differ by state, but audiologists typically have a doctoral degree (Au.D.) and well over 1,000 hours of clinical training in testing and rehabilitation of people with hearing loss, and have passed a hearing-aid licensure exam.

Requirements for hearing-aid specialists (also called hearing-instrument specialists) vary widely. In some states no formal training or licensure is required and these practitioners may simply have to pass an exam. In other states they may have to have at least two years of supervised training to earn a license to practice.

Working With a Hearing Healthcare Provider
• The provider or the office should have convenient business hours, offer walk-in repair service, and make it easy to schedule an appointment.
• You should take notes and bring a family member, significant other, or friend and ask for written material to cover the information your provider went over during the appointment (including a list of facilities in your town that are looped).
• The provider should discuss the effect of hearing loss on your lifestyle and relationships, and how best to manage these difficult listening situations yourself. The conversation should include how well you hear on the phone.
• The provider should ask about your manual dexterity and vision status because these can affect your ability to handle hearing aids successfully. The dispenser should also discuss realistic expectations and ask about your lifestyle, which can affect your choice of style and recommended features.
• The office should test your hearing in a soundproof booth and should give you a copy of the hearing-test results.
• The provider should verify that the hearing aids are working effectively for you (including in a noisy environment). They’re also required to review the instructional brochure that accompanies the hearing aids.
• Return to the provider annually to learn about new technologies and to ask whether your hearing aid might be retrofitted to take advantage of any advances.
• If you find that your hearing aids aren’t helpful or are difficult to use, see a professional for tips and strategies on how to best manage them.

6

Shopping Tips

More than 70 percent of the survey respondents who use hearing aids waited two or more years after noticing a hearing loss to buy an aid; almost 50 percent of them blamed high prices. If you need an aid but worry about the cost, these tips can guide you to some affordable solutions:

1. Check out your coverage. Most insurance does not cover hearing aids, though some children, federal workers, and veterans, as well as residents of Arkansas, Connecticut, New Hampshire, and Rhode Island, can get them covered. A few plans, including some from Medicare Advantage, offer at least partial coverage or discounts.

If you have a high-deductible insurance plan, you can put up 
to $3,400 per individual or $6,750 per family in a health savings account to pay for aids with pretax dollars. With a flexible spending account, you can use 
up to $2,600 in pretax dollars for aids, batteries, and maintenance.

2. Get a detailed written contract. Make sure your contract allows you to return your aids and get most of your money back if you're not satisfied. It should also detail the length of the trial period, the length of the warranty and what it covers, adjustment services, loss and damage insurance coverage, and what exactly is included in the price you're given.

3. Buy only what you need. Bluetooth capability is a convenient extra, but it can add hundreds of dollars to your bill. If you don’t think you’ll use it, skip it. Economy hearing aids may provide the advantages you need without your having to pay for more expensive premium hearing aids. Ask your provider to compare your performance on speech-in-noise tests using a premium aid and an economy aid.The provider should also help you determine what, if anything, your health insurance or homeowner policy will pay.

4. Ask for a price break. Though only 16 percent of hearing-aid users in our survey tried to negotiate a lower price, almost half were successful when they did. Note that some audiologists may carry only a few brands, which can limit your ability to comparison shop.

Your provider should explain why he or she recommends one brand over another and should go through the pros and cons of each. Wherever you buy, try bargaining or asking for a lower-priced model.

5. Look for bargains. Costco offers free screenings at select locations and very competitive prices on hearing aids. Only certain stores have on-site audiologists or hearing specialists, so make a phone call before you go; appointments are a must.

Buying aids online can help you save as well, but you may have to send them back for adjustments or pay a local hearing specialist to help you.

6. Seek out organizations that may offer assistance. A number of government, state, and independent groups, such as the Lions Clubs, may help you pay for hearing aids or offer discounts. (Find information on participating programs here.)

7

Your New Hearing Aid

When You Pick It Up

Ask your hearing-aid provider to do a real-ear test, also called a real-ear measure, which involves placing a thin probe in your outer ear while you wear your hearing aid to measure whether your hearing aid is responding appropriately to your level of hearing loss. He or she should also test understanding of speech in both quiet and noisy areas.

The provider should ensure that the aid is comfortable. He or she should explain how to use, clean, and store it; where to buy batteries in the correct size; how to store, change, or recharge them; and how to minimize squealing and feedback. He or she should also go over the importance of keeping the aid dry and of removing it before radiological or other diagnostic testing.

Speak up about any discomfort or difficulties with use, and practice talking on the phone while you’re in the office. Your provider should make any adjustments while you wait. The office should schedule a follow-up and check in with you by phone a few days after the fitting. If it is not comfortable or helpful, the provider can make adjustments.

Make sure your aid is compatible with your cell phone and cordless phones, and that the T-switch is enabled. Discuss using your hearing aid with assistive listening devices such as FM and infrared systems, digital wireless routing, and audio loops. If it comes with a smartphone or smartwatch app, make sure you know how to use it.

At Home With a New Hearing Aid 

Practice everyday activities using your new hearing aid and be aware that it takes time to adjust to wearing a hearing aid. Some sounds might seem too loud at first because your brain isn’t used to processing sounds you haven’t heard in a long time. If you’re unsure whether your hearing aid is working as well as possible, take it in for an adjustment, especially if your voice sounds funny or if your ear feels clogged.

8

Other Hearing Helpers

If you think you have a problem but aren’t ready to spend thousands on hearing aids, consider these cheaper alternatives:

Personal Sound Amplification Products (PSAPs)
These over-the-counter products, which generally have fewer features and less functionality than hearing aids, may offer a lower-cost solution for some people with situation-specific hearing difficulty. PSAPs, which are designed for people who want to amplify certain sounds, cannot be marketed as devices that can help people with hearing loss (because they aren't subject to the same standards as hearing aids). When purchasing a PSAP it is helpful to ask an audiologist or dispenser to test the device to make sure it is suitable for your hearing loss (not dangerously loud for you, for example, and able to amplify speech in the frequencies where you have hearing loss).

To find out whether PSAPs can help, we tested two cheaper models ($20 to $30 range) and two higher-end ones ($200 to $350). Three CR employees with mild to moderate hearing loss used these PSAPs at home, at work, and in our lab, where we tested how well the devices could assist with hearing conversations in a noisy environment. An outside hearing-aid expert also assessed each device in areas such as amplification, battery and microphone function, and sound distortion.

With the right fit and adjustment, we found that the higher-end models can help those with mild to moderate hearing loss, especially when watching TV. Some adjustable models can even have the same functionality as an entry-level hearing aid. But beware the penny-saver PSAPs: The cheaper options didn’t measure up, and more important, our expert found that they could potentially damage hearing if used long-term—by over-amplifying some loud sounds, such as a fire engine siren.

Other Assistive Listening Devices
If you need just a little help with hearing, there are a number of low-cost listening options to aid you in addition to hearing aids and PSAPs. These include apps that let you amplify sound with your smartphone and earbuds, and portable wireless devices that let you listen to your TV and other audio devices with earphones. You can also find amplified, flashing, or vibrating versions of basic household items such as telephones, alarm clocks, and doorbells.

Shopping links are provided by eBay Commerce Network and Amazon, which makes it easy to find the right product from a variety of online retailers. Clicking any of the links will take you to the retailer's website to shop for this product. Please note that Consumer Reports collects fees from both eBay Commerce Network and Amazon for referring users. We use 100% of these fees to fund our testing programs.