This article is the archived version of a report that appeared in July 2009 Consumer Reports magazine.
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 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 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 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 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 Types). 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 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 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 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," Ricketts says.
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 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 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.
For more buying tips, check out our Web site, at www.ConsumerReportsHealth.org.