Hearing Aids

Hearing aids are primarily useful in improving the hearing and speech comprehension of people who have hearing loss that results from damage to the small sensory cells in the inner ear, called hair cells. This type of hearing loss is called sensorineural hearing loss. The damage can occur as a result of disease, aging, or injury from noise or certain medicines.

A hearing aid amplifies sound vibrations entering the ear. Surviving hair cells in the ear detect the larger vibrations and convert them into neural signals that are passed along to the brain. The greater the damage to the hair cells, the more severe the hearing loss and the greater the amplification needs to be. However, there are practical limits to the amount of amplification a hearing aid can provide. In addition, if the inner ear is too damaged, even large vibrations will not be converted into neural signals. In this situation, a hearing aid would be ineffective.

If you think you might have hearing loss and could benefit from a hearing aid, visit your physician, who may refer you to an otolaryngologist or audiologist. An otolaryngologist is a physician who specializes in ear, nose, and throat disorders and will investigate the cause of the hearing loss. An audiologist is a hearing health professional who identifies and measures hearing loss and will perform a hearing test to assess the type and degree of loss. If you are told you have “nerve deafness” and nothing can be done, get a second opinion. 

•  Behind-the-ear (BTE) hearing aids consist of a hard plastic case worn behind the ear and connected to a plastic earmold that fits inside the outer ear. The electronic parts are held in the case behind the ear. Sound travels from the hearing aid through the earmold and into the ear. BTE aids are used by people of all ages for mild to profound hearing loss.

  A new kind of BTE aid is an open-fit hearing aid. Small, open-fit aids fit behind the ear completely, with only a narrow tube inserted into the ear canal, enabling the canal to remain open. For this reason, open-fit hearing aids may be a good choice for people who experience a buildup of earwax, since this type of aid is less likely to be damaged by such substances. In addition, some people may prefer the open-fit hearing aid because their perception of their voice does not sound “plugged up.”

• In-the-ear (ITE) hearing aids fit completely inside the outer ear and are used for mild to severe hearing loss. The case holding the electronic components is made of hard plastic. Some ITE aids may have certain added features installed, such as a telecoil. A telecoil is a small magnetic coil that allows users to receive sound through the circuitry of the hearing aid, rather than through its microphone. This makes it easier to hear conversations over the telephone. A telecoil also helps people hear in public facilities that have installed special sound systems, called induction loop systems. Induction loop systems can be found in many churches, schools, airports, and auditoriums. ITE aids usually are not worn by young children because the casings need to be replaced often as the ear grows.

• Canal aids fit into the ear canal and are available in two styles. The in-the-canal (ITC) hearing aid is made to fit the size and shape of a person’s ear canal. A completely-in-canal (CIC) hearing aid is nearly hidden in the ear canal. Both types are used for mild to moderately severe hearing loss.

  Because they are small, canal aids may be difficult for a person to adjust and remove. In addition, canal aids have less space available for batteries and additional devices, such as a telecoil. They usually are not recommended for young children or for people with severe to profound hearing loss because their reduced size limits their power and volume.

Hearing aids work differently depending on the electronics used. The two main types of electronics are analog and digital.

Analog aids convert sound waves into electrical signals, which are amplified. Analog/adjustable hearing aids are custom built to meet the needs of each user. The aid is programmed by the manufacturer according to the specifications recommended by your audiologist. Analog/programmable hearing aids have more than one program or setting. An audiologist or hearing instrument specialist can program the aid using a computer, and the program can be changed for different listening environments — from a small, quiet room to a crowded restaurant ,to large, open areas, such as a theater or stadium. Analog/programmable circuitry can be used in all types of hearing aids. Analog aids usually are less expensive than digital aids.

Digital aids convert sound waves into numerical codes, similar to the binary code of a computer, before amplifying them. Because the code also includes information about a sound’s pitch or loudness, the aid can be specially programmed to amplify some frequencies more than others. Digital circuitry gives an audiologist or hearing instrument specialist more flexibility in adjusting the aid to a user’s needs and to certain listening environments. These aids also can be programmed to focus on sounds coming from a specific direction. Digital circuitry can be used in all types of hearing aids.

The hearing aid that will work best for you depends on the type and degree of hearing loss. If you have a hearing loss in both  ears, two hearing aids are generally recommended because two aids provide a more natural signal to the brain. Hearing in both ears will help you understand speech and locate where the sound is coming from.

You and your audiologist or hearing instrument specialist should select a hearing aid that best suits your needs and lifestyle. A thorough needs assessment discussion should take place before considering a hearing aids. Price is also a key consideration because hearing aids range from hundreds to several thousand dollars. Similar to other equipment purchases, style and features affect cost. However, don’t use price alone to determine the best hearing aid for you. Just because one hearing aid is more expensive than another does not necessarily mean that it will better suit your needs.

A hearing aid will not restore your normal hearing. With practice, however, a hearing aid will increase your awareness of sounds and their sources. You will want to wear your hearing aid regularly, so select one that is convenient and easy for you to use. Other features to consider include parts or services covered by the warranty, estimated schedule and costs for maintenance and repair, options and upgrade opportunities, and the hearing aid company’s reputation for quality and customer service.

Before you buy a hearing aid, ask your audiologist or hearing instrument specialist these important questions:

• What features would be most useful to me? Make sure to confirm that you will have telecoils in the hearing aids you purchase. Telecoils expand the usefulness of hearing aids and cochlear implants, especially in environments where it is typically challenging to hear clearly. Hearing aids with a telecoil can make a dramatic difference in the user’s ability to hear clearly on the telephone, in meetings, a noisy restaurant, at the theater, while navigating buses, airports and train stations, and other challenging environments.
• What is the total cost of the hearing aid? Do the benefits of newer technologies outweigh the higher costs?
• What is included in the cost? Are the costs of the hearing aids, services and fees all bundled together or is there a breakdown of costs?
• How many visits/adjustments are included in the cost?
• Is there a trial period to test the hearing aids? (Most manufacturers allow a 30- to 60-day trial period during which aids can be returned for a refund.) What fees are nonrefundable if the aids are returned after the trial period?
• How long is the warranty? Can it be extended? Does the warranty cover future maintenance and repairs?
• Can the audiologist or hearing instrument specialist make adjustments and provide servicing and minor repairs? Will loaner aids be provided when repairs are needed?
• What instruction will be provided?

Hearing aids take time and patience to use successfully. Wearing your aids regularly will help you adjust to them

Become familiar with your hearing aid’s features. With your audiologist present, practice putting in and taking out the aid, cleaning it, identifying right and left aids, and replacing the batteries. Ask how to test it in listening environments where you have problems with hearing. Learn to adjust the aid’s volume and to program it for sounds that are too loud or too soft. Work with your audiologist until you are comfortable and satisfied.

You may experience some of the following problems as you adjust to wearing your new aid.

• My hearing aid feels uncomfortable. Some individuals may find a hearing aid to be slightly uncomfortable at first. Ask your audiologist how long you should wear your hearing aid while you are adjusting to it.
• My voice sounds too loud. The “plugged-up” sensation that causes a hearing aid user’s voice to sound louder inside the head is called the occlusion effect, and it is very common for new hearing aid users. Check with your audiologist to see if a correction is possible. Most individuals get used to this effect over time.
• I get feedback from my hearing aid. A whistling sound can be caused by a hearing aid that does not fit or work well or is clogged by earwax or fluid. See your audiologist for adjustments.
• I hear background noise. A hearing aid does not completely separate the sounds you want to hear from the ones you do not want to hear. Sometimes, however, the hearing aid may need to be adjusted. Talk with your audiologist.
• I hear a buzzing sound when I use my cell phone. Some people who wear hearing aids or have implanted hearing devices experience problems with the radio frequency interference caused by digital cell phones. Both hearing aids and cell phones are improving, however, so these problems are occurring less often. When you are being fitted for a new hearing aid, take your cell phone with you to see if it will work well with the aid.

Proper maintenance and care will extend the life of your hearing aid. Make it a habit to:

• Keep hearing aids away from heat and moisture.
• Clean hearing aids as instructed. Earwax and ear drainage can damage a hearing aid.
• Avoid using hairspray or other hair care products while wearing hearing aids.
• Turn off hearing aids when they are not in use.
• Replace dead batteries immediately.
• Keep replacement batteries and small aids away from children and pets.

Although they work differently than the hearing aids described above, implantable hearing aids are designed to help increase the transmission of sound vibrations entering the inner ear. A middle ear implant (MEI) is a small device attached to one of the bones of the middle ear. Rather than amplifying the sound traveling to the eardrum, an MEI moves these bones directly. Both techniques have the net result of strengthening sound vibrations entering the inner ear so that they can be detected by individuals with sensorineural hearing loss.

A bone-anchored hearing aid (BAHA) is a small device that attaches to the bone behind the ear. The device transmits sound vibrations directly to the inner ear through the skull, bypassing the middle ear. BAHAs are generally used by individuals with middle ear problems or deafness in one ear. Because surgery is required to implant either of these devices, many hearing specialists feel that the benefits may not outweigh the risks.

Hearing aids are generally not covered by health insurance companies, although some do. For eligible children and young adults ages 21 and under, Medicaid will pay for the diagnosis and treatment of hearing loss, including hearing aids, under the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) service. Also, children may be covered by their state’s early intervention program or State Children’s Health Insurance Program.

Medicare does not cover hearing aids for adults; however, diagnostic evaluations are covered if they are ordered by a physician for the purpose of assisting the physician in developing a treatment plan. Since Medicare has declared the BAHA a prosthetic device and not a hearing aid, Medicare will cover the BAHA if other coverage policies are met.

Some nonprofit organizations provide financial assistance for hearing aids, while others may help provide used or refurbished aids. Contact the National Institute on Deafness and Other Communication Disorders (NIDCD) Information Clearinghouse with questions about organizations that offer financial assistance for hearing aids.

Researchers are looking at ways to apply new signal processing strategies to the design of hearing aids. Signal processing is the method used to modify normal sound waves into amplified sound that is the best possible match to the remaining hearing for a hearing aid user. NIDCD-funded researchers also are studying how hearing aids can enhance speech signals to improve understanding.

In addition, researchers are investigating the use of computer-aided technology to design and manufacture better hearing aids. Researchers also are seeking ways to improve sound transmission and to reduce noise interference, feedback, and the occlusion effect. Additional studies focus on the best ways to select and fit hearing aids in children and other groups whose hearing ability is hard to test.

Another promising research focus is to use lessons learned from animal models to design better microphones for hearing aids. NIDCD-supported scientists are studying the tiny fly Ormia ochracea because its ear structure allows the fly to determine the source of a sound easily. Scientists are using the fly’s ear structure as a model for designing miniature directional microphones for hearing aids. These microphones amplify the sound coming from a particular direction (usually the direction a person is facing), but not the sounds that arrive from other directions. Directional microphones hold great promise for making it easier for people to hear a single conversation, even when surrounded by other noises and voices.

HearingTracker.com maintains a hearing aids pricing list for various makes and models. Please note the pricing listed should be considered as a general guideline only.

• Were you given a hearing screening¹ or a full hearing exam²?

  • Were you given a copy of the audiogram and any other test results?
  • Were you given a full explanation of all tests?
  • Were you charged for the examination?

• Were you told what type of hearing loss you have?

  • What your audiogram means
  • Why you sometimes can “hear” but not “understand”
  • What a hearing aid can and can’t do for you

• Were you asked about the effect of hearing loss on your life at home, work, school, using the phone, etc.?

• Did a “significant other” have an opportunity to express the effect of your hearing loss on them?

¹Hearing screenings are quick and cost effective pass/fail tests to find out if you need an in-depth evaluation for hearing loss.

²Hearing exams (assessments) determine the degree of hearing loss, the type of hearing loss, and the configuration of hearing loss and are conducted in a soundproof booth.

• Do you know why a particular type of hearing aid was recommended?

  • Behind-the-ear, in-the-ear, in-the-canal, completely-in-the-canal, or open fitting
  • Were your personal preferences considered regarding style, cost, or remote control?

• Were hearing aid features explained to you?

  • Directional microphones, number of microphones, self-adjusting volume control, etc.
  • Information about the telecoil³ and its uses

• Do the aids fit comfortably?

• Were you able to insert the hearing aids in your ears by yourself?

• Was the following information concerning batteries explained to you?

  • How to put batteries in the hearing aid—can you put them in by yourself?
  • Where you can buy batteries, how much they cost, keeping spare batteries handy

• Were all the controls explained to you?

  • Can you operate all the programs yourself?
  • Do you have the dexterity to operate the controls for your hearing aid?
  • Do you have the vision to operate the controls and put in batteries?

• Was the following information regarding the care of the hearing aids and earmolds explained to you?

  • How to keep earwax out of the sound bore of the hearing aid
  • Using a dehumidifier box for night storage
  • How often to return for regular checkups and cleaning

• Did you receive written material on the information you received?

• Were the following covered at the time of your first follow-up visit?

  • Your listening experiences with hearing aids (in noise, feelings of loudness, discomfort, etc.)
  • Fit of earmolds (comfort, “whistling” noises)
  • How to troubleshoot problems
  • “Real-ear”⁴ hearing aid measures rechecked

• Were you asked to evaluate any improvement on the effect of hearing loss on your life, at home, at work, at school, when going out, etc.?

• Did you receive information about using telephones and assistive listening and alerting devices with your hearing aids?

  • M or T ratings for hearing aids, cell phones; labeling for cordless phones
  • Assistive listening devices using telecoils with audio loops, FM and infrared systems
  • Devices that alert for fire and safety, phones and doorbells

• Were group hearing aid orientation sessions provided?

  • Did you attend?

• Did you receive information about helpful resources such as speechreading classes and support groups such as the Hearing Loss Association of America (HLAA)?

³The following states have laws that require consumers to be told about telecoils in hearing aids and/or assistive listening devices when they purchase the hearing aid: Arizona, Florida, New York, Rhode Island, Utah, as of 4/2016.

⁴“Real-ear” measures use a probe-tube system that reveals the actual output of the hearing aid while a person is wearing the hearing aid.

• Did you receive a written contract detailing the services to be provided?

  • Cost of the hearing aid
  • Cost of the dispenser’s services and number of follow-up visits included in the cost
  • Date and place of sale

• Did your dispenser check your insurance status?

  • Call the insurer to verify benefits
  • Explain the coverage to you
  • Explain insurance coverage provided by state law, if applicable
  • Explain any tax credits, if applicable

• Did the dispenser provide information about the hearing aid manufacturers he or she works with?

  • Disclose how many and which manufacturers he or she works with
  • Recommend models in different price ranges

• Did the dispenser provide written information on any warranties provided by the manufacturer?

• Did the dispenser provide written information about the trial period and refund policy?

  • Trial period, return time limits by state law, and by office practice
  • Fees charged if the hearing aid is returned within the trial period
  • Whether the trial period is suspended if the aid malfunctions during the trial period and needs to be returned for repairs

• Consumer Protection Laws

• See what laws are in your state for trial periods, refunds and complaints.