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Hearing Aid Dispensers (From CHECKBOOK, Fall 2013/Winter 2014)
 
Go to Ratings of 18 Twin Cities Area Hearing Aid Dispensers

Checklist

Hearing Aids

Most individuals who would benefit from hearing aids never get them. Many who do are amazed at how much they improve their lives. 

Don’t get a hearing aid before first having a medical doctor determine that a hearing aid will improve your hearing—and that medical or surgical treatment won’t help. 

You have to decide what matters to you in a hearing aid. The advanced features of some aids may make them adapt better to varying hearing environments than basic models, but these features cost more. 

In shopping for hearing aids, consider only businesses that have staff who offer thorough advice and clearly explain your options, provide a wide variety of styles and brands of aids, and have flexible policies that allow you to test out aids and return them at little or no cost if you are not satisfied. 

Our Ratings Tables show how area hearing centers were rated by their surveyed customers. For advice, a few sellers were rated “superior” by more than 90 percent of their surveyed customers, while a few others received such favorable ratings from 60 percent or fewer. 

It is essential to get the dealer to put in writing how long you have to test out any aid you purchase; what charges, if any, you have to pay if you return it; and whether the test period will be extended if, instead of returning the aid, you agree to let the dispenser first try to adjust it to suit you better. 

And be sure to shop for price. For one model of hearing aid we found prices among local sellers ranging from $1,700 to $2,805. For another, prices ranged from $2,868 to $3,905. 

If you are hearing less than you used to, take a measure of comfort in knowing that you’re not alone. About 10 percent of Americans have some hearing loss, and the figure is more than 30 percent for persons over age 65. 

Hearing aids can benefit the vast majority of people with hearing loss. But most go without these helpful devices either because they are hesitant to acknowledge a handicap and/or they don’t believe the benefits will justify the trouble and cost. 

It is true that hearing aids can’t fully compensate for hearing loss to the same degree that eyeglasses restore 20/20 vision. They are rehabilitative devices that, when properly programmed and fitted, help wearers fulfill their best hearing potential. But this potential varies from person to person, depending on the nature and extent of their hearing loss. Some persons who wear hearing aids can hear sound but can’t always understand the words being spoken. This is particularly the case for those who suffer from high-frequency hearing loss or who have damage to their auditory system. For these people, the benefits of hearing aids are often limited. 

Although hearing aids can’t restore normal hearing, they have improved the lives of millions of people—enabling them to use their senses more fully and communicate more effectively with others. Many first-time hearing-aid wearers are surprised at the improved quality of their lives. An AARP study of hearing aids reported hearing-aid-user comments such as the following: “It’s such a joy to go for my walk in the early morning and hear the birds singing, which I could not hear before. It is also a pleasure to hear all of a sermon at church or someone’s conversation rather than parts.” 

Hearing aids have come a long way from the ear trumpets of the early 1800s—and even from the devices available just a few years ago. Today’s hearing aids can do much to meet the needs of their wearers in the complex and varying listening environments they encounter. 

As hearing aids grow smaller and more technologically advanced, they have also become more convenient and less obtrusive to wear. Today, those with hearing loss can choose from hundreds of hearing aids of various sizes and degrees of sophistication. 

How We Hear 

The ear consists of three parts: outer ear, middle ear, and inner ear. 

Figure 1—Diagram of the Ear

Ear

Sound enters the outer ear canal and strikes the eardrum, which is the outer boundary of the middle ear. A chain of three tiny bones in the middle ear receive sound vibrations from the eardrum and transmit them to the inner ear. The inner ear includes a snail-shaped chamber called the cochlea, which is filled with fluid. The vibrations transmitted by the bones of the middle ear cause movement in the fluid of the inner ear. Thousands of hair cells in the inner ear are stimulated by the movement of the cochlear fluid, sending impulses along the fibers of the auditory nerve, which goes to the brain. The brain processes this information, providing awareness of speech, music, annoying cell-phone ringtone jingles—everything we hear. 

How Hearing Loss Occurs 

Hearing loss is extremely common. It can be a normal part of the aging process and, for many, an inevitable result of living in a noisy society. There are two primary types of hearing loss: sensorineural loss and conductive loss

Ninety-five percent of all hearing aid wearers have sensorineural hearing loss, which is characterized by impairment of the inner ear or the neural pathways from the inner ear to the brain. 

Most sensorineural loss comes about when the tiny hair cells that line the inner ear become damaged and can no longer transmit signals accurately to the auditory pathway and the brain. Aging is by far the most common cause of this damage, but other causes include infection, high fever, trauma, noise exposure, genetics, and use of certain prescription drugs. 

In rare cases, hearing loss results from damage to the auditory nerve. For example, benign tumors can compress the nerve. If detected early, these conditions are often treatable. 

Conductive hearing loss, which often can be treated medically or surgically, occurs when something interferes with sound vibrations as they pass through the outer and middle ear. A common cause is a blockage of wax buildup, which can be addressed by using an earwax softener and then flushing out the wax using a kit (both available at drug stores). A physician or audiologist can also remove the wax. 

Conductive hearing loss can also result from the presence of fluid in the middle ear. The fluid disrupts the middle ear’s ability to conduct vibrations to the inner ear. This can occur when the Eustachian tube (a tiny tube connecting the middle ear to the back of the throat) is not functioning properly, often due to inflammation. This sort of hearing loss, common in children, usually can be treated medically. 

A punctured eardrum or problems with the functioning of the small bones in the middle ear can also cause conductive hearing loss. These types of problems are often partially or completely treatable with surgery, but hearing aids may be used if hearing loss remains following the completion of medical intervention. 

A combination of conductive and sensorineural hearing loss, called mixed loss, is also possible. 

How It Is Diagnosed 

If you suspect that you have hearing loss, first consult with a physician. Choose a physician—such as an otolaryngologist—who is knowledgeable about hearing loss and treatments. The right physician can detect medical causes of hearing loss (such as fluid buildup in the middle ear, disease, or a tumor), treat them, and recommend hearing aids when that is the best treatment approach. For a list of area otolaryngologists most often recommended by their peers in CHECKBOOK surveys, see our "Top Doctors" section. 

It is important to rule out curable medical problems before investing in a hearing aid. Some hearing-aid dispensers often sell aids to individuals who don’t need them or would be better served by other treatments. The U.S. Food and Drug Administration (FDA) prohibits the sale of a hearing aid to anyone who does not present a written statement signed by a licensed physician saying that the patient’s hearing has been evaluated. A hearing-aid dispenser may lawfully sell an aid to someone who possesses no such statement only if the seller has informed the consumer that getting a medical examination is in the best interest of the consumer’s health and the consumer has signed a waiver of the right to a medical examination. An AARP study conducted in Florida found that dispensers often ignored the FDA requirement, but you’d be wise not to: Before getting a hearing aid, get a physician checkup. 

If the physician advises you to obtain a hearing test to determine the type and degree of your hearing loss, and whether you are a candidate for a hearing aid, an audiologist or a “hearing aid specialist” can administer one. 

Audiologists have extensive training and usually hold a clinical doctor of audiology (Au.D.) degree but may hold a Sc.D. or Ph.D. Audiologists may also be identified by the letters CCC-A (denoting a Certificate of Clinical Competence in Audiology from the American Speech-Language-Hearing Association) or FAAA (Fellow of the American Academy of Audiology). In addition to administering hearing tests, audiologists can provide complete diagnostic evaluations of hearing loss. After hearing tests, audiologists usually help patients select and purchase hearing aids. 

Unlike audiologists, hearing-aid specialists are not required to have degrees in the field of hearing. You can see whether a hearing-aid specialist has voluntarily been certified by the National Board for Certification in Hearing Instrument Sciences, as indicated by the letters NBC-HIS. To receive certification, applicants must have two years of experience selling hearing aids and pass the National Competency Exam. 

The Hearing Test 

A complete hearing examination must consist of at least the following tests: pure tone air conduction test, pure tone bone conduction test, speech recognition threshold test, and speech discrimination test. Additional tests may be administered depending on the examiner and the patient’s specific needs. 

The pure tone air conduction test determines how well a person hears at different frequencies, or “pitches.” Hearing threshold is determined by presenting tones at different pitches through headphones or inserting earphones and asking the patient to signal when he or she hears the tone. 

The pure tone bone conduction test helps determine the nature of the hearing loss (sensorineural, conductive, or mixed). During this test, a bone vibrator is placed against the mastoid bone, located behind the ear. Again, the patient tells the examiner the tones he or she is able to hear. 

Comparing the results of the air and bone conduction tests helps localize the hearing mechanism responsible for the hearing loss. Air and bone conduction thresholds that are the same suggest that the hearing loss is sensorineural. If bone conduction thresholds are better than air conduction thresholds, then there is reason to suspect the loss is conductive—that the hearing function is failing in the outer or middle ear, before it reaches the inner ear. 

The speech recognition threshold test determines the softest level of speech that can be heard and repeated. Ten to 15 two-syllable words (with equal stress on both syllables) are delivered to the listener at progressively softer volumes. The threshold is the softest point at which the patient is able to repeat words correctly 50 percent of the time. This test is a way to check the reliability of the pure tone air conduction tests. 

In the speech discrimination (word recognition) test, 25 to 50 words from a standardized list are presented to the patient at a level identified as “comfortable” for listening. The patient is asked to repeat the words. This test assesses a patient’s ability to discriminate speech at his or her most comfortable level for listening. The results can provide an indication of how well a person can be expected to understand words when wearing a hearing aid. 

Testing may also determine most comfortable level and uncomfortable level, subjective measures that a listener determines based on the level of sound intensity that feels comfortably loud or uncomfortably loud. 

Other additional tests might include hearing in noise measures that evaluate how well the listener hears speech in various noisy environments. And for immittance testing a probe tip is inserted into the ear to measure the eardrum’s mobility and middle ear functions. This test helps rule out conductive hearing loss. 

The examiner should also check a patient’s ears to ensure that hearing loss is not caused by a physical condition of the ear. This is especially important in cases where the patient has waived a medical evaluation. Ears should be checked for visible signs of drainage, blood, wax blockage, or other problems. The examiner should ask the patient about dizziness, tinnitus (ringing in the ears or other “head” sounds), discomfort, and any sudden hearing loss he or she has experienced. 

If you do buy a hearing aid, have your hearing retested periodically to determine if adjustment might help. How often you have your hearing retested depends on the extent of your hearing loss and other factors; most hearing-aid wearers should be retested at least every other year, but some may need to be retested every six months. 

The Audiogram 

The results of a hearing test are recorded on an audiogram, a graph showing the patient’s thresholds for hearing sensitivity. Several examples are shown in Figure 2. 

Figure 2—Your Audiogram Shows, for Various Pitches, How Loud a Sound Must Be for You to Hear It

Audiogram

The horizontal axis of the graph shows frequency, or pitch, measured in hertz (Hz). The measurement progresses from low pitch to high pitch, left to right, like a piano keyboard. 

The vertical axis, often labeled “HL” for “hearing level,” graphs the loudness of the test signal, measured in decibels (dB). Softer levels are recorded toward the top of the graph, and louder levels at the bottom. 

The plots on the audiogram indicate the configuration and degree of hearing loss. For example, if the markings are farther down on the graph at higher frequencies, this means the patient has more difficulty hearing high-pitched sounds than low-pitched sounds. This information helps determine what hearing aids will be most appropriate for the patient and also is used later during the programming and adjustment process. 

Levels of Loss 

The severity of hearing loss is determined by how loud the tone needs to be at various pitches for the patient to hear it. The standard used is: 

0—15 dB    Normal hearing 

16—25 dB    Slight hearing loss 

26—40 dB    Mild hearing loss 

41—55 dB    Moderate hearing loss 

56—70 dB    Moderately severe hearing loss 

71—90 dB    Severe hearing loss 

91 and above    Profound hearing loss 

When hearing is impaired, some pitches can often be heard better than others. You might have normal or near-normal hearing for low-pitched sounds but worse hearing loss for high-pitched sounds. Age-related hearing loss often creates these types of patterns. Hearing deficiencies with varying degrees of loss are given labels such as “mild-to-moderate loss” or “moderate-to-severe loss.” 

For example, in normal speech, vowel sounds tend to be stronger in presentation than many consonant sounds. Vowel sounds also tend to have most of their energy in the lower pitches (toward the left side of the audiogram). Softer consonant sounds, on the other hand, such as “s,” “t,” “f,” and “th,” tend to be higher pitched sounds (toward the right side of the audiogram). So if you have mild-to-moderate hearing loss, you may have little or no difficulty hearing vowel sounds but can’t hear many of the softer consonants, making it difficult to distinguish between words like “top” and “stop,” particularly in the presence of background noise. Knowing these configurations helps describe—and treat—the problems patients have. 

How to Select the Right Hearing Aid 

Hearing aids consist of three main parts: a microphone that takes in sound; a circuit that processes and amplifies sound; and a speaker that conveys sound to the wearer’s ear. All these components are powered by a small battery. All new hearing aids use digital processing technology. 

Hearing-Aid Styles 

Hearing aids vary in shape, size, and how they are worn. They range from tiny devices that nestle completely within the ear canal to larger, more visible models that sit behind the ear. Although any style many include many technologies, the smallest aids tend to have less power to address severe hearing loss. 

The two general categories of hearing-aid styles are behind-the-ear (BTE) and in-the-ear (ITE). Within these two categories are a number of subcategories. 

Behind-the-Ear 

As Figure 3 illustrates, a BTE hearing aid is so named because part of the device—the casing that holds microphone and circuitry components—sits behind the ear. A traditional BTE model consists of the behind-the-ear component and a custom-made “earmold” that occupies the entire ear opening to deliver the sound; the two components are linked by a tube. 

Figure 3—Hearing Aid Types

ITE Models

An “open-fit,” or “open-ear,” BTE model is like a traditional BTE model, with components that sit behind the wearer’s ear, a speaker placed in the ear opening to deliver sound, and a tube that connects the behind-the-ear piece to the speaker. But instead of using an earmold that occupies the entire ear opening, the microphone for an open-fit model is smaller, leaving the ear opening largely unobstructed and allowing unaltered sounds to enter the ear. These models are particularly useful choices for users who have good or fairly good hearing in certain pitches, but need help in others. Filling these users’ ears with earmolds would block natural sounds that could be heard without hearing aids—often contributing to a disconcerting inside-a-barrel sensation called “occlusion.” Open-fit BTEs facilitate a more normal mixture of amplified and natural sound, and a more comfortable, less occluded experience for the wearer. 

Some open-fit hearing aids simply guide processed sound into the ear canal through a very thin tube that usually ends in a rubber tip. Other open-fit models use a wire instead of a tube, and position the speaker (or receiver) at the end of the wire in the ear canal. These “receiver-in-the-canal” or “receiver-in-the-ear” models are currently a very popular style. 

In-the-Ear 

With ITE models, the entire aid is worn within the ear opening or entirely within the ear canal. Impressions of patients’ ears are sent to hearing-aid manufacturers, which custom-mold the aids. As Figure 3 shows, styles of ITE models range in size from “full-shell,” which fill the concha (bowl) of the ear, to “completely-in-the-canal” (CIC) styles, which are almost completely hidden inside the ear canal. “Half-shell” styles are a bit smaller than full-shell styles, and “in-the-canal” (ITC) styles are a bit larger than CICs. 

A new variation of ITE aids is the extended-wear device. An audiologist or physician places this hearing aid into the ear canal, where it remains until the battery expires two or three months later or fails for some other reason. It is then replaced with a new device. But not all patients are good candidates for this option; if you’re interested, discuss it carefully with your physician or audiologist. 

Choosing a Style 

Since ITE aids are smaller than BTE models, they are popular with patients who want a less visible hearing aid. But newer BTE models are now smaller than in the past, and open-fit technology makes BTE aids more appealing than before. On the other hand, some patients prefer ITE aids because they are compact and keep everything contained within the ear. 

If you have severe hearing loss, you’ll probably buy a BTE style, since ITE aids can’t deliver the power you’ll need. Also, BTE aids tend to be more reliable than ITE models, and BTE aids have space for larger, easier-to-operate controls. 

Regardless of preference, some patients are limited to one style because of the shape of their ear openings or because their ears secrete excessive wax. 

Features to Consider 

Most new hearing aids come with a number of features, some of which have hefty price tags. Features on basic new models include: 

  • Directional microphones allow hearing aids to take into account direction and timing cues for sound reaching them. This feature enhances speech sounds and reduces noise. It allows the user to control what gets amplified by facing the source of the sound. 
  • Automatic volume control provides different levels of “gain” for different inputs. In other words, the hearing aid can sense the level of the sound reaching the microphone and adjust amplification accordingly. Most hearing aids also include an option that lets wearers manually control volume. 
  • Feedback cancellation reduces the incidence of whistling or squealing coming from a hearing aid which occurs when a hearing aid re-amplifies sound coming from its own speaker. More expensive models often have more sophisticated controls for this feature, but even modestly priced hearing aids should have some mechanism for reducing feedback. 
  • Multiple processing channels allow a hearing aid to divide sound processing into separate frequency regions. This facilitates more flexibility for programming the hearing aid to take into account different degrees of hearing loss at different frequencies. In general, the more channels, the more advanced the aid, both in terms of performance and price. But even fairly low-priced hearing aids provide processing in at least a few separate channels, and often more. 
  • Telephone coils (T-coils) allow hearing-aid wearers to use a phone without getting feedback. The coils in the hearing aid pick up the signal from the phone in the form of a magnetic field transmitted by the phone. This feature is now used with many other forms of assisted living technologies, such as listening systems for TVs and audio equipment. Many ITE models include T-coils, and, except for the smallest BTE hearing aids because of size limitations, virtually all BTE models offer the feature. 
  • Multiple programs allow the hearing aid to react to sound differently to accommodate different listening environments. Because no single type of signal processing is ideal for every listening situation, multiple programs are like having several hearing aids in one. Examples of different listening environments in which a user might benefit from different programs are noisy restaurants, meetings, and watching TV at home. Switching among programs may be performed manually or automatically in more advanced aids. 

More advanced hearing aid features usually mean more advanced prices—with the most expensive models at $5,000 or more per hearing aid—so think carefully about whether or not the special feature’s added benefit is worth the added cost. Factors to consider include the severity of your hearing loss and your lifestyle. For example, if you lead a relatively quiet life and won’t often benefit from an aid with advanced sound processing, your needs will be different from someone who regularly goes to noisy parties, conferences, or business dinners in restaurants. 

Non-basic features usually available for extra cost include: 

  • Remote microphones let hearing aids receive a Bluetooth or other signal. This is nice for cell phone use, of course, but some manufacturers also offer systems that allow you to use a remote signal with a TV or landline phone. 
  • Remote controls allow wearers to manually adjust volume, program switching, and other settings with a small remote rather than fiddle with controls on the aid itself. 
  • Communication between hearing aids enables right- and left-side aids to share information that can optimize hearing response in certain settings, particularly in noisy environments. Some hearing aids use this communication to synchronize manual volume adjustments and program changes, so when the wearer changes a setting on one ear it will automatically make the same change to the other. 
  • CROS (contralateral routing of signal) adaptation is a system used by persons who have unilateral hearing loss (hearing loss primarily in one ear) whereby a microphone for the ear with poor hearing sends sound it receives to the other ear. Instead of trying to compensate for hearing loss on one side by amplifying sound on that side, sounds that ear should hear are delivered largely unchanged to the ear that can hear them. But this set-up requires wearers to be patient—and highly motivated—to get used to a new way of listening. 
  • Additional features—Other features that can make life with hearing aids easier include a low-battery indicator and a mute feature to reduce feedback during insertion and removal of the aid. 

One Aid or Two? 

If you have hearing loss in both ears, you probably need to purchase aids for both ears. It will cost twice as much, but the benefits are significant: Two aids will improve your balance and safety by letting you more easily localize and differentiate sounds. They’ll also make it easier for you to understand speech in noisy environments and sort out which sounds are important. 

Some patients find it difficult to maintain and manage two hearing aids. Others who want to minimize the appearance of a handicap feel one aid is less noticeable than two. But most persons with hearing loss in both ears benefit from using two hearing aids. 

There are, however, some uncommon instances where using just one hearing aid is preferable; for example, when one ear has difficulty discriminating speech, or when one ear has a medical condition that contraindicates the use of amplification. 

How to Avoid Being Stuck with the Wrong Aid 

Most hearing-aid purchases go off without a hitch. But some don’t. It’s not easy to get it right because each patient’s hearing loss is unique and every patient has different expectations. Even two patients who seem to have the same hearing loss on paper may have very different rehabilitative needs. 

Dispensing hearing aids is also tricky because most hearing aids are custom-molded, so patients can’t feel exactly how various makes and models would fit in their ears. But it is possible to try different technologies. Many BTE models can be fitted with special pliable earpieces and then set up for tests. The sound quality in the test should be fairly close to what you’ll get with your own customized device. 

Such demonstrations can help you make your selection, but no in-store demonstration can duplicate your experience with a particular technology in real-life listening environments. Too much depends on your specific hearing loss, and a sample hearing aid will sound different from a custom-fitted one. For this reason, some audiologists prefer not to perform these demonstrations, and instead respond to the client’s real-life experiences by making adjustments as necessary. Ultimately, time and experience with a particular hearing aid are the only ways to determine how well it works for you. 

When purchasing a hearing aid, you can take steps to protect yourself from bad choices. There are also laws to protect you from being locked into a hearing-aid purchase that does not meet your needs. 

According to Minnesota law, if requested to do so by the buyer, for 45 days after selling a hearing aid the dispenser is obligated to accept the hearing aid as a return and refund the total amount paid for the product and service, including the cost of an exam, fitting, or other services connected to the sale of the hearing aid, minus a fee of up to $250. Be sure to get the dispenser’s return fee written into the bill or sale. 

Some dispensers offer trial periods more generous than 30 days. It is not unusual for a dispenser to allow 60 days or more for wearers who have special needs or who have bought particularly complicated hearing aids. Dispensers’ flexibility is generally dependent on their willingness and ability to convince the manufacturer to take back aids beyond the usual 30 days. If you feel you might need extra time to decide about an aid, ask the dispenser if an extension is possible and get the dispenser’s promise in writing. 

Hearing aid dispensers usually offer a free adjustment period during which the dispenser will provide assistance after your purchase. This period varies from seller to seller, with some offering free adjustments for six months and others for the life of the aid. If you are buying a hearing aid for the very first time, or trying a new type of aid, find out about the dispenser’s policy regarding follow-up appointments. 

Also, find out whether your return period will be extended if adjustments are necessary and, if so, get this promise in writing. You don’t want to lose your right to return an aid simply because you’ve spent weeks or months trying to get it adjusted to meet your needs before concluding that it just doesn’t suit you. 

To back up newly purchased aids, most manufacturers provide a minimum warranty of one year. Some warranties cover two years or even longer. In most instances, you can buy an extended warranty that keeps the normal warranty in effect for an extra year. 

You can also buy hearing-aid insurance to cover an aid for damage or loss, either as an add-on to a manufacturer’s warranty or as a separate policy. A hearing-aid dispenser should be able to provide information about insurance; also check with your homeowners insurance carrier, as you may be able to purchase a personal articles floater for hearing aids as part of your policy. Before buying any insurance, compare its premiums to the price of the aid. Usually, these types of insurance policies aren’t worth their premiums. 

With luck, and some effort, you won’t need to buy new hearing aids that often. One way to expand your hearing aid’s lifespan is to keep it clean. The industry standard for a hearing aid’s lifespan is about four years, but it is not uncommon for hearing aids to last much longer—sometimes 10 years or more. On the other hand, hanging on to the same aid that long may deprive you of opportunities to take advantage of new technologies. 

How to Find Great Sellers 

Two words of advice for those seeking a good place to purchase a hearing aid: be wary. Because of the “scientific” nature of the purchase, consumers are often vulnerable to misinformation and bad deals. 

An AARP study conducted in Florida revealed many shoddy sales practices. AARP had consumer testers make 169 visits to 23 different hearing-aid dispensers. The study revealed that half of the dispensers failed to follow the state’s minimum hearing evaluation standards before recommending a hearing aid. Of the consumer testers who had not visited a physician prior to their appointment, only 14 percent were advised that it was in their best interest to see a physician before purchasing an aid, despite the federal law requiring that they be so advised. The consumer testers at 11 of the 23 sites complained of being tested in “noisy” rooms. In many instances, sellers recommended hearing aids for persons who did not need them. Overall, dispensers told 57 percent of the consumer testers that they needed a hearing aid, compared to 45 percent judged to need an aid by the audiologist AARP hired to evaluate the study participants. Some dispensers recommended aids to as many as 90 percent of the consumer testers. 

The AARP Florida study also found many instances of deceptive sales statements. The most common was claiming that a hearing aid would help slow down hearing loss or ear damage. This is completely misleading, since hearing aids can only make you hear better and have no impact on your natural hearing capacity. The study also found instances of vague pricing policies, with some dispensers advertising sale prices identical to the regular prices. Others advertised free hearing evaluations, only later stipulating that the test was free only if a hearing aid was purchased the same day. 

In our own surveys, hearing-aid buyers for the most part rated sellers favorably. But the ratings and comments we received from customers of some establishments echoed the problems cited in AARP’s study. 

To help you get advice you can trust, our Ratings Tables show how area hearing centers were rated by area consumers (primarily CHECKBOOK and Consumer Reports subscribers). We asked consumers to rate hearing aid dispensers “inferior,” “adequate,” or “superior” on questions such as “advice on choice and use of products,” “reliability (standing behind products and delivering on time),” and “overall quality.” Our Ratings Tables report, for businesses that received at least 10 ratings, the percent of each company’s surveyed customers who rated it “superior” on each question. We further describe our customer survey and other methods here

When shopping, find out as much as possible about the purchase you are about to make, prepare good questions, and shop around. 

Check the dispenser’s credentials. You can be sure dispensers have had substantial training and have demonstrated some level of competence if they are a Doctor of Audiology (Au.D.) and/or hold a Certificate of Clinical Competence in Audiology (CCC-A) or are a Fellow of the American Academy of Audiology (FAAA). If not, look for other evidence of training and several years of experience. 

Check the facilities. The room in which a hearing test is administered needs to be quiet. Most hearing-test rooms are not actually soundproof, but they are “sound treated.” To block out office noise and increase sound absorption, extra drywall, insulation, and sealant may be used in the construction of the room. The best way for a hearing center to ensure the room is properly soundproofed is to install an audiometric testing room or “sound booth.” Specialized companies that build on-site sound booths offer a variety of sizes and sound-absorption levels. While hearing centers can also construct their own booths, or sound-treat existing rooms, this does not ensure the reliable construction offered by professionally built booths. Ask about the nature of the testing room at a facility you might use. While the type of test room does not determine whether a hearing test will be performed properly, the presence of a professional sound booth at least demonstrates that the office is equipped to obtain the most accurate results. 

Make your own judgment about the quality of advice the staff provides. Do they seem interested in you? Do they ask detailed questions about problems your hearing causes and when you would most benefit from hearing aids? Do they thoroughly explain the testing process and their diagnosis? Do they present several options? Do they provide easy-to-understand explanations for any recommendations they make? Are important choices, such as buying one aid versus two, discussed in ways you can understand? 

Once you order your hearing aid, make sure it is properly fitted. Be concerned if staff simply asks “How does it sound?” or if you can hear whispered voices from behind you. Such unscientific tactics can’t determine how much you’re benefiting from hearing aids. Instead, the staff should use “real ear” measurements, a process that monitors the response of the hearing aid in the ear canal as adjustments and decisions about hearing-aid settings are made. This requires special equipment distinct from the fitting software and equipment used to program the hearing aid. Real ear measurement can use a variety of stimuli to view and actively manipulate the response of the hearing aid to maximize access to speech and ensure overall listening comfort. This takes time and expertise, but it is critical because simply programming the hearing aid using the manufacturer’s software cannot ensure proper hearing-aid settings. 

The staff can also verify that the hearing aid is working optimally with more traditional testing in the sound booth (by repeating portions of the hearing test while the patient wears aids), although such testing provides less specific information. 

Staff should also provide a full orientation to your new aids, showing you how to insert them, work controls, maintain and care for them, store them, and replace batteries, and they should suggest strategies to help you get used to hearing with them. 

The trial period and refund policy is, of course, critical, as is the period for obtaining free adjustments. 

How to Save Money 

The cost of a hearing aid is not an important consideration for some people, because some health insurance policies cover them. But because most health insurers and Medicare don’t cover hearing aids, you’ll probably have to pay out of pocket from $1,500 to $5,000 or more for each hearing aid. 

Our Ratings Tables will help you find a seller that’s a good bet on price. The table includes a price comparison score for each company (that was evaluated in our last full, published article), which indicates how the company’s prices, as quoted to our mystery shoppers, compared to the average prices for the same aids quoted by all the companies for the same aids. The scores are based on prices for a hearing test, fitting, and one hearing aid. Our shoppers (who did not reveal their affiliation with CHECKBOOK) priced 12 hearing-aid models. A price comparison score of $110 means a company, on average, quoted prices 10 percent higher than the average of all the companies on the same models. Price comparison scores ranged from a low of $76 to a high of $115. 

The prices quoted for the same aid varied widely, as you can see on Table 1. 

Table 1—Low, Average, and High Prices Quoted by Sellers for Illustrative Hearing Aids
 

Low, Average, and High Prices Quoted by Sellers for Illustrative Hearing Aids.1
DescriptionLow priceAverage priceHigh price
GN ReSound Alera 7 open-fit mini behind-the-ear$2,119$2,443$2,838
GN ReSound Verso 7 open-fit mini behind-the-ear$2,166$2,490$2,850
Starkey X Series 90 open-fit mini behind-the-ear$2,199$2,604$3,000
Starkey S Series 3 i90 open-fit mini behind-the-ear$2,350$2,634$3,200
Phonak Quest Bolero Q70 open-fit mini behind-the-ear$1,700$2,375$2,805
Phonak Audeo Q70-312 receiver-in-the-canal$1,700$2,346$2,805
Siemens Motion Micon 701 behind-the-ear$2,868$3,249$3,905
Siemens Life 301 receiver-in-the-canal$2,868$1,763$3,150
Widex Passion 440 receiver-in-the-canal$2,868$3,207$3,500
Widex Dream 110 behind-the-ear$1,268$1,577$1,950
Oticon Alta Pro receiver-in-the-canal$2,868$3,284$3,805
Oticon Ino mini receiver-in-the-ear$1,368$1,545$1,775
1 Prices include the cost of one hearing aid, a hearing exam/audiogram, and fitting.

While the price comparison scores on our Ratings Tables are a helpful starting point, to get the best price you need to shop. We recommend the following steps: 

  • For your hearing test, consider only businesses that give you a full written copy of the results. 
  • Find out how much providers charge for hearing testing if you don’t buy a hearing aid from them. Find out if providers charge for the test if you don’t obtain a copy of the test results and if you do. But be wary of businesses that heavily advertise “free hearing screening”; these providers usually aren’t in the business of providing full evaluative examinations. 
  • After the hearing test, get the seller’s price for the aid it recommends and full specifications for the device. Also get a full description of return privileges and any follow-up services included. 
  • Call or visit other companies to get their prices based on your test results. Compare prices for the hearing aid recommended by the testing company, but also solicit the other companies’ recommendations. 

The cost of hearing tests alone varies from provider to provider. Many charge nothing, but some charge $100 or more. While we here at CHECKBOOK usually adore the word “free,” in this case it’s not necessarily the best choice. A free screening may not be equivalent to the full evaluation you need. Also, make sure that the “free” dispenser does not charge a “consultation” or “fitting” fee, thereby negating any real savings. And be aware that a dispenser that charges nothing for a test may pressure you into buying something and might not be willing to give you a copy of test results. 

You can keep costs down by buying via an online seller or mail order. You can send an impression of your ear and a recent audiogram. This purchase option, however, offers none of the support offered by a local dispenser. With a local company, you get to meet with a specialist before the purchase and afterwards to ensure that your aid works well. Most hearing-aid purchases require several follow-up appointments before customers are comfortable and satisfied with their new aids. 

How to Maximize the Benefits 

You want to make sure your hearing aid works properly, maximizes the benefits it offers, and lasts a long time. 

Judging How Well It Workse 

Once your hearing aid has been properly fitted and adjusted, hold off on any snap judgments about how well it works until you have had time to get used to the new sounds. At first, wear your aid for short periods of time or in non-taxing listening environments. You’ll have to learn to integrate background noises—such as the hum of a refrigerator—into the spectrum of other noises you process. You may need to adjust to the sound of your own voice, which can sound much different when heard through your hearing aid. You may even have to relearn certain forgotten sounds. 

After two or three weeks, answer the following questions to determine whether it is functioning optimally: 

  • Overall, does the hearing aid seem to be helping you hear better? 
  • Does the hearing aid feel comfortable when you wear it? 
  • Are the sounds that enter your ear from the aid comfortable? Are soft sounds audible? Are loud sounds too loud? 
  • Can you adjust to any new sounds you hear from the aid? Does there seem to be an echo or hollow or tinny noises? 
  • Have you been able to insert the aid, clean it, and change the battery? 

If, at this point (or at any other time), you feel the aid does not meet your reasonable expectations, return to the dispenser. Good sellers are willing to help. Minor complaints about sound quality or fit can usually be resolved easily. More serious problems may require remaking a mold or delivering sound to the ear differently—maybe with a different type of hearing aid. 

If the dispenser is willing to make adjustments, get the dispenser to put in writing that it is extending the return period to allow you time to decide whether it needs further adjustment. 

If things just don’t work out within the return period, decide whether you want to return it. 

Caring for Your Aid 

Proper care will prolong the life of your hearing aid and keep it functioning properly. 

First, avoid damaging your aid. Although they are built to be durable, hearing aids can be damaged if they are dropped on hard surfaces or become wet—remove them when swimming or showering. Dogs enjoy chewing on hearing aids, so keep them in a secure place when not in use. Doors for batteries and access to controls should open easily; if you’re having trouble, don’t force the issue. 

Keep your hearing aid clean. Moisture and wax can clog and damage components. If possible, remove your hearing aid during any activity that causes excessive perspiration. Follow the seller’s and manufacturer’s directions on how to clean the aid—and make a habit of actually doing it. Most aids need to be cleaned every day. 

Take your aid to the seller periodically for more thorough cleaning and maintenance. Some aids will need tune-ups every three months, others only once per year. 

Hearing and Listening Training 

Purchasing a hearing aid is one aspect of an overall treatment plan. Other steps—including hearing and listening training and counseling—can help integrate those with hearing loss into the hearing world by taking full advantage of their existing hearing resources. These steps can include learning to use speech reading and other visual cues, understanding how to position oneself in hard-to-hear situations, and learning how to assert one’s needs in different hearing environments. Family members can be an integral part of this process. 

Your hearing specialist may be able to provide these services, but other sources can also help. Community colleges and universities often offer classes in hearing training and aural rehabilitation. 

And consider joining a support group for hearing-aid wearers. In addition to providing moral support, groups share ideas about what works and what doesn’t when wearing an aid. Contact the Hearing Loss Association of America (HLAA) at 301-657-2248 for information about the national organization and groups in your area. More information about publications and membership is available at HLAA’s website (www.shhh.org). 

Extra Advice:
Signs that You May Have Hearing Loss 

If you answer “yes” to some of these questions, it’s time to get your hearing checked. 

  • Do I often ask people to repeat themselves? Do people often seem to be mumbling? 
  • Do I often feel tired or stressed during conversations? 
  • Do I often misunderstand conversations? Do I not get jokes because I miss too much of the story? 
  • Do I turn up the volume on TVs and radios so high that others complain? 
  • Do I have trouble understanding speech in noisy places? 
  • Do I find that when I look at people I can more easily understand what they are saying? 

Extra Advice:
Hearing Health Resources 

AARP
www.aarp.org/health

Academy of Doctors of Audiology
866-493-5544
www.audiologist.org 

Alexander Graham Bell Association for the Deaf and Hard of Hearing’s Listening and Spoken Language Knowledge Center
202-337-5220
www.listeningandspokenlanguage.org 

American Academy of Audiology
800-222-2336
www.audiology.org 

American Academy of Otolaryngology
703-836-4444
www.entnet.org 

American Speech-Language-Hearing Association (ASHA)
800-638-8255
www.asha.org 

Better Hearing Institute (BHI)
800-327-9355
www.betterhearing.org 

Hearing Industries Association (HIA)
202-449-1090
www.hearing.org 

Hearing Loss Association of America (HLAA)
301-657-2248
www.shhh.org 

International Hearing Society (IHS)
734-522-7200
www.ihsinfo.org 

Lions Club Sight and Hearing Foundation
630-571-5466
www.lionsclubs.org 

Extra Advice:
Listening Strategies 

There is only so much that hearing aids can do to improve your ability to hear. The rest is up to you. You can use a number of tactics to improve your hearing in difficult listening environments. They require analyzing the situation and taking steps to create a more listening-friendly environment. 

  • Reduce background noise. Create the best listening environment wherever you go. Have loud music and TVs turned down if they are competing with people for your attention. At restaurants, request a quiet table. At a friend’s house, suggest that the conversation be moved into another room if kids are playing games nearby. At the office, move away from the air-conditioning unit when you need to have a conversation. 
  • Find a good spot. Position yourself in rooms to minimize the distance between yourself and the speaker. In groups, seat yourself in the center where you can see and hear everyone. In large group listening situations, show up early so you can choose a good position in the room. 
  • Turn the lights on. To the extent possible, make sure rooms where you will be listening are well lit. In poorly lighted rooms, find a bright area and ask your speaker to stand there. 
  • Plan ahead. If you know you will be in a particularly difficult listening environment, take steps beforehand to make sure you won’t be wasting your time by showing up. Call ahead and talk to someone who knows the environment. Are there quiet tables? Is front-row seating available? Will a light be shining on the speaker? In large group listening situations (such as places of worship and concert halls), call ahead to see if assistive listening devices will be available. These devices transmit sound to a special receiver that you wear, reducing the loss of clarity that occurs when sound travels through the air. 
  • Ask for it. Don’t be afraid to politely but firmly assert your needs. Call out from the audience for the speaker to speak into the microphone. If the audience is asking unamplified questions, ask the speaker to repeat them before answering. In restaurants where the music is too loud, ask your waitperson to turn the volume down. If necessary, ask people to face you head-on when they speak to you. They will appreciate your candor and your hearing will benefit tremendously. 


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