Hearing Aid Buying Guide

    Hearing Aid Buying Guide

    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 by age 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.

    An estimated 28.8 million Americans could benefit from using hearing aids. Although over-the-counter hearing aids may be available soon (see “OTC Hearing Aids?” below), for now, you’ll need to get a hearing aid fitted by an audiologist or another hearing healthcare provider. Our buying guide can help you figure out where to get a hearing aid and what to look for.

    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
    This 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 two types of loss. For example, age-related hearing loss plus wax in the middle ear can interfere with sound conduction to the inner ear.

    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, EdD, 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.

    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 spring 2018 we asked more than 122,000 Consumer Reports members about their experiences with hearing loss and hearing aids. The majority (71 percent) of the hearing aids were mini-behind-the-ear types.

    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). Here, 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.

    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: Offers flexible features and considerable low- and high-frequency 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. Feedback is rare because of the snug fit.

    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.

    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. Because of its small size, the battery can be difficult to insert and remove. The aid may be challenging to handle and adjust.

    In-the-Canal Hearing Aid (ITC)
    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 a problem 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.

    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: Offers 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 might not be as powerful as those on BTE hearing aids because it is smaller in size.

    Which Features Are Important?

    In our survey, 53 percent of people who wear hearing aids said that rechargeable batteries were one of the most important features they looked for when purchasing a hearing aid. Smartphone capabilities or tinnitus masking was noted as most important by 43 percent, and 42 percent said automatic noise level adjustment was most important.

    Forty-one percent said that the option of multiple program settings (allowing users to optimize aids for a variety of environments, such as quiet rooms and loud restaurants) was one of the most important features they looked for. Forty percent mentioned advanced microphone features, and 37 percent said wireless connectivity to other devices was most important. Other key features, according to hearing aid experts, include the following:

    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—to 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. Your provider should also activate your telecoil and show you how to use it. 

    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 better 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 another 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.

    Selecting a Hearing Aid Provider

    Some people who notice they’re having difficulty hearing start with their doctor or an otolaryngologist—a 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. They can refer you to a physician if necessary.

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

    Many audiologists work in private practices (freestanding offices), where 29 percent of our survey respondents purchased their aids. Audiologists may also be on staff at wholesale clubs, such as Costco, where 19 percent of respondents purchased aids, or at hearing aid stores owned by manufacturers such as Oticon, Phonak, ReSound, Starkey, and Widex.

    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 a hearing aid specialist.

    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 (AuD) 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 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 that covers the points 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 difficult listening situations. The conversation should touch on the level of challenges you experience in hearing over 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 are 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.

    Shopping Tips

    More than 60 percent of the survey respondents who use hearing aids waited two years or longer after noticing a hearing loss to buy an aid; 42 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 $3,600 per individual or $7,200 per family in a health savings account to pay for aids with pretax dollars. (If you are 55 or older, you can contribute an additional $1,000 to an individual or family plan.) With a flexible spending account, you can use up to $2,750 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 what you need. 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 how much, if anything, your insurance will pay.

    4. Ask for a price break. Though only 14 percent of hearing aid users in our survey tried to negotiate a lower price, almost half of those were successful when they did. So wherever you buy, try bargaining or asking for a lower-priced model.

    Note that some audiologists may carry only a few brands, which can limit your ability to comparison shop. Ask your provider to explain why they recommend one brand over another and the pros and cons of each. 

    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; an appointment is 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.)

    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. This 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. Your provider should also test your understanding of speech in both quiet and noisy areas.

    The provider should ensure that the aid is comfortable. They should explain how to use, clean, and store it; where to buy batteries in the correct size; how to store, change, or recharge batteries; and how to minimize squealing and feedback. They 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.

    Office staff should schedule a follow-up and check in with you by phone a few days after the fitting. If the hearing aid is not comfortable or helpful, the provider can make adjustments.

    Also, make sure that 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 and hearing loops. If your hearing aid 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. 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.

    OTC Hearing Aids?

    In 2017, Congress passed a law directing the FDA to come up with standards and criteria that manufacturers could use to begin selling some hearing aids over the counter (OTC). These will be legally considered hearing aids (unlike PSAPs; see below), and they’ll be aimed at those with mild to moderate hearing loss. The FDA was to have three years from the law’s passage to come up with rules for which products will fall into this new category, what their technical specs must be, and how they’ll be labeled and marketed. The agency was supposed to release a draft of these standards in December 2020—but missed the deadline because of the COVID-19 pandemic.

    Medical experts and the Hearing Loss Association of America (HLAA) have called on the FDA to release these standards so that these OTC, hopefully cheaper, devices will be available to consumers as soon as possible. The HLAA has warned consumers to remember that no real OTC hearing aids—their efficacy will have to be demonstrated—are yet available. For now, it does not mean much if a device is marked as “FDA cleared” or “FDA registered.”

    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 a 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, a number of other lower-cost listening options are available. 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, and vibrating versions of basic household items such as telephones, alarm clocks, and doorbells.