If you're older than 45, there's about a one in five chance you suffer from some amount of hearing loss—and that rate climbs steadily as you age. 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.
Hearing loss can wreak havoc with your social life, but it can also increase your risk of falls, by making you less aware of your surroundings and impairing balance. Plus it can make driving dangerous.
Causes of Hearing Loss
Most cases of hearing loss in adults stem from damage to the inner ear, where tiny hair cells turn sound vibrations into impulses that nerve cells then carry to the brain. The most common causes of that damage are aging and chronic exposure to loud noises. A family history of severe hearing loss could signal that you're at increased risk. So does being male.
A second, easier-to-treat type of hearing loss originates in the middle or outer ear and stems from reversible problems such as impacted earwax, fluid buildup from an infection, or the use of certain medications. Older adults often have a mix of both types of loss.
If you're experiencing signs of hearing loss, see a board-certified otolaryngologist who will check for impacted earwax and other reversible causes. If none are found, the doctor will probably refer you to an audiologist.
Hearing Helpers
Once hair cells in the inner ear are dead, there's no bringing them back. But hearing aids and other devices can dramatically improve your ability to hear and carry on a normal life. We scanned the marketplace and consulted hearing experts to help you determine which are worth considering.
Digital Hearing Aids
Digital models have microphones that transmit sound to a computer chip, which moderates the volume and amplifies the frequencies needed to help improve your hearing. They can be programmed to filter out wind and other background noises, and some can sync to your smart phone, enabling you to hear calls through the hearing aid and to use your phone to adjust the hearing aid settings. Some accessories also allow you to stream audio from an MP3 player, laptop, or TV into your hearing aid.
Another technology is the Hearing Loop. It provides a magnetic signal that's picked up by a tiny coiled wire in the hearing aid, which transmits the sound into your ear (available in some sports and concert venues).
Personal Sound Amplifiers (PSAPs)
These over-the-counter products generally have fewer features and less functionality than hearing aids, and can be a lower-cost solution for people with mild hearing loss. These are designed for people who want to amplify certain sounds—and they aren't subject to the same safety and effectiveness standards that hearing aids are.
Assistive Listening Devices
If you need just a little help with hearing, there are a number of low-cost listening devices to aid you. They include apps that let you amplify sound with your smart phone 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.
Digital hearing aids come in five major types. Sound goes in the microphone, where it's processed by a chip, amplified, and delivered into the ear. These have features to modify that sound, making it more lifelike and correcting for other problems.
Because individuals' sound perception is different a hearing aid that one person likes might not impress someone else even if they have almost identical hearing-test results. Plus, within brands, there can be several versions of a model. That kind of variation makes judging hearing-aid models and brands almost impossible.
Our 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 pay, and you might not need every one.
Even with features appropriate for you, you might need to temper your expectations. In crowds your digital hearing 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.
The right hearing aid for you depends on the severity of your hearing loss, your lifestyle, and your manual dexterity. Hearing aids are categorized by where on the ear they're worn, and possibly by the number of pieces: Behind-the-ear hearing aids are two pieces, an in-the-ear aid is one piece.
Smaller aids offer fewer features and might be more difficult to manipulate. People with more severe hearing loss might get better results with a behind-the-ear model with earmolds or an in-the-ear model. In our survey, owners of behind-the-ear, open-fit designs reported the most improved hearing in loud social settings.
The receiver is inside the ear canal. It goes by various acronyms: behind-the-ear (BTE), receiver in the ear (RITE), receiver in the canal (RIC or RITC), and canal receiver technology (CRT). Behind-the-ear hearing aids attach to the ear via a custom-made earmold that fits snugly in the ear, or a "dome style" or non-custom canal piece.
Pros: Comfortable, barely visible. Prevents a plugged-up feeling, easy to insert, and compatible with telephones.
Cons: Wax and moisture may limit life of receiver. Does not allow for significant amplification in the low frequencies. Limited in terms of the potential to add amplification.
Pros: Also called receiver in the aid, or RITA, it 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.
Pros: This hearing aid does not need telecoil. Because it's in the canal it has low visibility, and is easy to insert and remove. Plus this style of hearing aid is insensitive to wind noise.
Cons: Too small to include a directional microphone. Ear might feel plugged up unless hearing aid is vented. Vulnerable to wax and moisture. Because the receiver is in the ear canal, it could be difficult to control. It can only accommodate a small battery, so battery life is relatively short. In addition, the batteries can be more difficult to insert and remove.
Pros: Barely visible and easy to insert, it can build up volume control to increase ease of use. Larger units can include directional microphones.
Cons: Same issues as with completely-in-the-canal models, though less severe. Telecoil selector switch makes manipulation more difficult. These models are susceptible to moisture and wax buildup. Battery tends to be smaller, so battery life is relatively short.
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. Vulnerable to wax build-up and moisture.
We evaluated major features of 44 hearing aids of varying styles and brands. We also asked our 1,100 survey respondents which hearing-aid features they had and how well their hearing aids worked in various settings. Selected features may increase the price of a hearing aid.
Telecoil
A telecoil is a small wire that enables the hearing aid to pick up signals from the telephone. Our survey suggested it helped. Our tests, performed in an outside lab, found all telecoils were effective.
Telecoils also can be used in rooms equipped with an audio induction loop, which is a cable that circles a room and emits a magnetic signal to the hearing aid. They help reduce noise and reverberation, and can enhance the ability of people with moderate to profound hearing loss to understand what they're hearing.
A telecoil can be manual or automatic, but to use it with a loop, it must be manual. Look too, for a program selector on the hearing aid to allow users to switch between the acoustic signal from phones to the magnetic signals of room loops.
Directional Microphone
A directional microphone 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. Many hearing aids come with switchable directional and omnidirectional modes; that's a plus unless the user has difficulty switching between the two. A negative: It's prone to wind noise. Survey results show it helps for hearing household noises; in loud social settings; and while listening to the TV or radio when there's noise in the rear or off to the sides.
Feedback Suppression
Feedback suppression, or digital feedback reduction, uses a power-on delay to help quell squeals when inserting the hearing aid. Most aids have this feature. It's useful if the hearing aid is close to the telephone, or if the hearing aid displaces slightly when you move your jaw. Another advantage: You can raise the volume without having to worry about feedback.
Other Hearing-Aid Features Worth Noting
• Digital noise reduction improves listener comfort and sound quality in noisy environments. For many, it also may improve speech understanding in noise.
• Low-battery indicator sound—most newer hearing aids have this.
• Wax guards help keep hearing aids free of ear wax, which can cause malfunctions and is a major complaint of our survey respondents. Ask the hearing-aid dispenser to teach you how to remove and replace the wax guard, and how often you'll need to change it.
• Automatic volume control (compression) provides more amplification for low sound levels than high sound levels, which prevents high sound levels from being intrusively loud. Most aids had this feature.
• Vents are tiny tunnels in ear molds or the one-piece hearing aids that sit in the ear. They minimize the stuffed-up sensation, and can contribute to improved speech understanding, depending on the vent size.
• Manual volume control lets you make adjustments in a given environment. Some hearing aids have a self-learning feature that automatically adjusts amplification based on how they're typically used.
Behind-the-Ear Models Only
• Bluetooth capability for hands-free use of cell and regular phones, and streaming TV.
• Direct audio input allows the aid to be connected by cable to FM systems (effectively, mini-radio stations used in an enclosed space, specifically for hearing-aid users); MP3 players; and other audio devices.
If you're a veteran, determine whether you're eligible to get hearing aids at a Veterans Affairs facility. For everyone else, go to a medical office headed by an otolaryngologist who employs an audiologist.
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 that might be affecting your hearing. They can also clear your ears of wax so you're ready for your hearing test.
If you can't find a doctor's office that dispenses hearing aids, consider an independent hearing-aid provider. Thirty percent of our survey 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 professionals you might encounter at independent hearing-aid providers could fall into two categories: Audiologists or hearing-aid specialists (also called hearing-instrument specialists). Both types of professionals can evaluate your hearing and fit your hearing aids. But their training varies significantly. Audiologists must have a doctoral degree (Au.D.), and more than 1,000 hours of clinical training. Hearing-aid specialists generally have six months to two years of supervised training or a two-year college degree.
You might not know when you walk in the door which professional you're 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; 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? 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.
You can check with your state to make sure a provider's license is current, and with the Better Business Bureau or state attorney general's office for complaints.
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.
If you're not thrilled with the a provider's evaluation or personality, or want to see what others offer, you're entitled to a copy of your audiogram.
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.
The checklist below is drawn from our testing and shopping experience, our audiology consultants, and from the resources of the Hearing Loss Association of America.
Initial Visit to 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.
Medical Clearance
• The provider should require a medical examination. Or have you sign a waiver required by the FDA in lieu of a medical exam.
Testing and Lifestyle
• 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 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.
Styles, Features, and Controls
• The provider should say which hearing-aid brands they work with, and why they recommend a particular brand for you. Plus they should review the pros and cons.
Picking Up Your Hearing Aid
• The provider should do a real-ear test to adjust the hearing aid, and also test hearing and understanding speech in both quiet and noisy areas.
• The provider should ask you if the aid is comfortable, and make any adjustments while you wait. You should practice talking on the phone (Most of our shoppers got no phone training or help with volume controls.)
• They should also discuss the battery type for your hearing aid, battery life, the handling of batteries, where to buy them, where to store them, and the importance of spares.
• They should explain all controls and have you practice using them, plus go over how to handle squeeling/feedback. You should also be shown how to clean and store the hearing aids and keep them free of wax.
• The provider should also explain precautions, such as not getting the units wet and removing them during radiological and other diagnostic testing.
Financial Issues and Contract Details
• Get a written contract that details everything.
• Try bargaining or ask for a lower-priced model.
• The provider should help you determine what your health insurance will pay, and explain the length of the warranty period and what is covered. They should also be flexible about the trial period and/or other aspects of purchase, and give you the product brochure and review its contents with you.
• The office should schedule a follow-up, and call you a few days after the fitting to see how you're doing.
Proper Fitting, Adjustment
• Your provider should conduct verification tests, including a real-ear test. This test, also called a real-ear measure, involves placing a thin probe in your ear while you're wearing your hearing aid to measure the match between your hearing loss and the response of your hearing aid.
• They should also ask how the hearing aids improve your understanding of others at home, at work, in meetings, in restaurants, and in other quiet and noisy situations.
• They should answer your questions/concerns about discomfort or difficulty of use.
• And make adjustments based on your comments, show you troubleshooting strategies, and review use and maintenance tips.
Hearing Aids With Other Technologies
• Your provider should go over compatibility of your hearing aids with cell phones and cordless phones; discuss using or supplementing your hearing aid with assistive listening devices such as FM and infrared systems, and audio loops; and mention other assistive and safety devices—light-up doorbells, special smoke alarms, vibrating alarm clocks, etc.
Practice and Follow Up
Practice everyday activities using your new hearing aids. And note any environments where you have problems. 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."
Paying for Your Hearing Aid
Unless you're a veteran, you'll have to find a way to pay for them yourself. Medicare excludes the price of hearing aids, but, like many private insurers, will pay for the doctor's exam. Medicare will also pay for an audiologist's hearing tests, if prescribed by a physician. Private Medicare Advantage plans have varied coverage. Your private health insurance may pay nothing toward hearing aids or batteries, or it may reimburse a portion.
