Hearing aids

Hearing Aid Buying Guide
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.


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, which interprets them 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 severe hearing loss can also increase your risk.

Although it’s often not reversible, sensorineural hearing loss can be treated with hearing aids, which selectively amplify sounds, or cochlear implants, which bypass the damaged portions of the hearing system and electrically stimulate the auditory nerve.

Conductive hearing loss is less common and often occurs as a result of a physical blockage or malformation in the middle or outer ear that prevents sound waves from passing through the ear canal. Impacted earwax, fluid buildup from an infection, and a variety of disorders can cause the blockage.

Removing the blockage or, in the case of malformations, corrective surgery usually restores hearing, but if not, a hearing aid may be used.

Older adults sometimes have a mix of both types of loss.


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 stimulating the remaining hair cells.

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. (Analog aids, which are less common and less complex than digital aids, amplify all sounds.)

A hearing professional can program a digital aid to filter out wind and other background noise, and can often match your specific hearing loss pattern. Some higher-end models can sync wirelessly with your smart phone, enabling you to take calls, stream audio, and even adjust your aid’s settings through an app on your phone.

The right hearing aid for you depends on several factors, including the kind and severity of your hearing loss, your lifestyle, and your manual dexterity. However, a hearing aid that one person likes might not impress someone else, even if both have almost identical audiograms, a hearing test that also measures the degree of hearing loss.

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.

Also, it’s important to have realistic expectations. 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.


Tuning in to Hearing-Aid Types

Digital hearing aids come in five major types 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 hearings 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.

Receiver-in-the-Canal Hearing Aid

Here, the receiver (the speaker that sends sounds to the inner ear) is inside the ear canal. This type goes by various acronyms, including mini-behind-the-ear (mBTE), receiver-in-the-ear (RITE), and canal receiver technology (CRT). Receiver-in-the-canal hearing aids attach to the ear via a custom-made earmold (a piece of soft material made to fit snugly in the ear and channel sound into the ear), or a non-custom dome-style ear canal piece.

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

Cons: Wax and moisture may limit the life of the receiver. Does not allow for significant amplification in the low frequencies. Limited in terms of the potential to add amplification.

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

Behind-the-Ear Hearing Aid

Pros: Also called receiver-in-the-aid (RITA), some models can provide considerable low- and high-frequency amplification. Good for people with moderately severe to severe hearing loss who require considerable amplification across many frequencies. On larger models, controls are easy to manipulate and telecoil mode is easily selected and used. Earmold can be easily cleaned. Accommodates larger batteries, so it's easier to handle.

Cons: Custom mold tends to be visible. Vulnerable to sweat and wax buildup. You can get a plugged-up feeling from earmold unless vented.

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

Completely-in-the-Canal Hearing Aid

Pros: This hearing aid fits deep and tight in the ear, which might prevent whistling feedback when used with a phone. Because it's in the canal, it has low visibility and is easy to remove. Plus, this style of hearing aid is 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). Ear might feel plugged up unless hearing aid is vented. Vulnerable to wax and moisture. It can only accommodate a small battery, so battery life is relatively short. In addition, the batteries can be difficult to insert and remove. May be challenging to handle and adjust.

Illustration of an in-the-canal hearing aid.

In-the-Canal Hearing Aid

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

Cons: Same concerns as with completely-in-the-canal models, though less severe. These models are susceptible to moisture and wax buildup. The battery tends to be smaller, so battery life is relatively short. May be challenging to handle and adjust.

Illustration of an in-the-ear hearing aid.

In-the-Ear Hearing Aid

Pros: This offers more room for features such as telecoil, directional microphone, and volume control. Less of a plugged-up feeling when vented. Relatively easy to insert.

Cons: More visible.


What 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:

Many modern hearing aids are equipped with a telecoil, a small copper wire that picks up sound directly from phones and public address systems, which improves clarity. Conference rooms, concerts, museums, and even subway trains and stations are often equipped with what’s called an audio induction loop or hearing loop, a cable that circles a room and emits a magnetic signal that’s picked up by the telecoil.

Such technologies help people—especially those with moderate to profound hearing loss—better understand what they’re hearing by reducing background noise and reverberation.

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 in the rear or from the sides. Nearly 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 and/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 unpleasant sounds that can occur when inserting a hearing aid. Most aids have this feature, which is 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 fitting with much more venting, to improve comfort and sound quality in listeners who have good hearing in the lowest pitches. 

Digital Noise Reduction
Improves listener comfort and sound quality in noisy environments. Can also make it easier to listen and make specific noises less annoying.

Other Hearing-Aid Features Worth Noting
Most newer aids also have low-battery indicator sounds, wax guards to prevent buildup, and automatic and manual volume control. 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 lowering 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.


Selecting a Hearing-Aid Provider

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. 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—and then get referred to an audiologist.

The audiologist will conduct tests to assess your hearing aid needs. He or she will then match those needs—which include your ability to understand speech, your listening needs, and more—to the appropriate technologies.  

Some audiologists work in 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 brand stores, such as Phonak, Widex, Oticon, and ReSound.

Wholesale clubs also topped the chart for general types of hearing-aid retailers. But note that such dispensers may also have employees known as hearing-aid specialists. You might not know when you walk in the door which professional you're dealing with, so it’s wise to ask. (In terms of specific retailers, Costco and Connect Hearing—a chain hearing-aid retailer—were rated among the highest for customer satisfaction.)

Both audiologists and hearing-aid specialists can evaluate your hearing needs and fit your hearing aids. But their training can vary significantly. State-by-state requirements can differ, but audiologists must generally have a doctoral degree (Au.D.) and more than 1,000 hours of clinical training. Requirements for hearing-aid specialists (also called hearing-instrument specialists) vary widely. In some states, no formal training is required and specialists may simply have to pass an exam. In others, they may have at least two years of supervised training and a license to practice.

Working With a 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.
The provider should discuss the effect of hearing loss on your lifestyle and relationships. The conversation should include how well you hear on the phone.
The provider should ask about your manual dexterity and vision problems that could affect your ability to handle hearing aids. They should also discuss realistic expectations and ask about your lifestyle, which can affect your choice of style and features.
The office should test your hearing in a soundproof booth and conduct other hearing tests, and give you a copy of the results.
The provider should say which hearing-aid brands he works with, why he recommends a particular brand for you, and review the pros and cons of different aids.  


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 veterans, some children and federal workers, and 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 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 all or 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, 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. (The provider should help you determine what, if anything, your health insurance 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 different 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.

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 adjust your aids.

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


Your New Hearing Aid

When You Pick It Up

Your hearing-aid provider should 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. She should also test hearing and understanding of speech in both quiet and noisy areas. 

The provider should ensure that the aid is comfortable; explain how to use, clean, and store it; where to buy batteries and how to store, change, or recharge them; and how to minimize squealing and feedback. She should also go over the importance of keeping the aid dry and 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.

Make sure your aid is compatible with your cell phone and cordless phones, and discuss using your hearing aid with assistive listening tools such as FM and infrared systems, digital wireless routing, and audio loops.

At Home With a New Hearing Aid 

Practice everyday activities using your new hearing aids 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 those 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.


Other Hearing Helpers

If you think you have a problem but aren’t ready to spend thousands on a hearing aid, 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 mild to moderate hearing loss. PSAPs are designed for people who want to amplify certain sounds, but they’re not legally allowed to be marketed as devices that can help with a hearing loss (that’s because they aren't subject to the same standards as hearing aids).

To find out whether PSAPs can help, we tested two cheaper ($20 to $30 range) and two higher-end ($200 to $350) models. 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 may 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 importantly, 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. 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.

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