Most individuals who would benefit from hearing aids never get them. Many
who do are amazed at the resulting improvement in their lives. But hearing
aids can't fully make up for hearing loss in the same sense that eyeglasses
can restore 20/20 vision.
Don't get a hearing aid without first consulting with a medical doctor
to be sure your hearing loss is of a type that can be helped by a hearing
aid—and that it can't be assisted by medical or surgical treatment.
You will have to decide what matters to you in a hearing aid. Some aids
have advanced features that may make them more adaptable to varying hearing
environments than basic models, but these features cost more.
In shopping for hearing aids, you will want to consider only businesses
that have staff who offer thorough advice and explanations of your options,
offer a wide variety of styles and makes of aids, and have flexible policies
allowing you to test out aids and return them with little or no fee if
you are not satisfied.
our Ratings Tables show how area hearing centers were rated by their
surveyed customers. For our survey question on "advice," one firm was rated
"superior" by only 15 percent of its surveyed customers; another firm by
94 percent. For our question on "variety of products" offered, scores ranged
from 38 percent to 81 percent.
It is essential to get in writing how long you have to test out any aid
you purchase; what charges, if any, you will 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
Be sure to shop for price. For one hearing aid model, we found that prices
among local sellers ranged from $1,400 to $3,100. For another, prices ranged
from $1,595 to $3,445.
Is it difficult to hear the TV or radio, so much so that family members
often ask you to turn it down? Do you struggle to understand the cashier
at the grocery store? Is it difficult to follow conversations at large
gatherings? If so, it might be time to get your hearing checked.
Most of us are guilty of "selective hearing" from time to time. But not
listening to what you don't want to hear is one thing—not hearing what
you want to is another. That's when a hearing aid might be in order.
If you are hearing less than you should be, you can take a measure of comfort
in knowing that you're not alone. About 10 percent of Americans have some
hearing loss. The figure is more than 30 percent for persons over age 65.
The vast majority of those with hearing loss would benefit from using hearing
aids. But most go without these helpful devices either because they are
hesitant to acknowledge a handicap or because they don't think the benefit
will justify the trouble and cost.
It is true that hearing aids don't fully make up for hearing loss in the
same sense that eyeglasses can restore 20/20 vision. They are rehabilitative
devices that, when properly programmed and fitted, help their wearers attain
their best hearing potential. But this potential varies from person to
person, depending on the nature and extent of their hearing loss. Sometimes,
persons who wear hearing aids find they can hear sound but they can't always
understand the words being spoken. Often this type of experience is caused
by damage to the auditory system that can't be helped by a hearing aid.
Although hearing aids can't restore normal hearing, they have still improved
the lives of millions of people—enabling them to enjoy their senses more
fully and to communicate more effectively with others. Many first-time
hearing aid wearers are surprised at the improved quality of their lives.
In a study of hearing aids, the American Association of Retired Persons
(AARP) reported hearing aid user comments like 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" manufactured
in 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 are
also more convenient and less obtrusive to wear. Today, if you have a hearing
loss, you can choose from hundreds of hearing aids with varying degrees
of size and sophistication.
The ear is made up of three parts: the outer ear, the middle ear, and the
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.
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
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 results from when the tiny hair cells that line
the inner ear become damaged and are no longer able to 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 can be the result of damage to the auditory
nerve. For example, benign tumors can compress the nerve. If found 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 the softener and kit can be purchased from 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.
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 will be able to detect
medical causes of hearing loss (such as, fluid buildup in the middle ear,
a disease, or a tumor), will often be able to treat them, and will be able
to recommend hearing aids in cases where that is the best treatment approach.
For a list of area otolaryngologists who were most often recommended by
their peers in surveys CHECKBOOK conducted, visit the "Top Doctors" section of our website.
It is important to rule out medical problems that may be curable before
investing in a hearing aid. Some hearing aid dispensers have been known
to sell aids to individuals who did not need them or who would have been
better served with 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 without such a 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 if 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. You'll be wise not to;
before getting a hearing aid, be sure to have a physician checkup.
If the physician advises that a hearing test is in order to determine the
type and degree of your hearing loss and whether or not you are a candidate
for a hearing aid, an audiologist or a "hearing aid specialist" can administer
An audiologist has extensive training and usually holds a clinical doctor
of audiology (AuD) degree but may hold a ScD or PhD. Audiologists may also
be identified with the letters CCC-A (Certificate of Clinical Competence
in Audiology from the American Speech-Language-Hearing Association). In
addition to administering hearing tests, audiologists can give complete
diagnostic evaluations of hearing loss. After the hearing tests, audiologists
usually help patients select and purchase hearing aids.
Unlike an audiologist, a "hearing aid specialist" is not required to have
a degree in the field of hearing. You can check to see that a hearing aid
specialist has voluntarily been certified by the National Board for Certification
in Hearing Instrument Sciences, indicated by the letters BC-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 word discrimination test. Additional tests may be given
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 insert 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.
A comparison of 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 sound
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
Testing may also be given to determine most comfortable level and uncomfortable
level. These are subjective measures that a listener determines based on
the level of sound intensity that feels comfortably loud or uncomfortably
Additional testing includes immittance testing, in which 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 assure that hearing
loss is not due to 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 visible problems in the ear. 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 buy a hearing aid, you should have your hearing retested periodically
to determine if any adjustments might help. How often you should 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 results of a hearing test are recorded on an audiogram, a graph showing
the patient's thresholds for hearing sensitivity. Several examples are shown here.
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 the
hearing loss. For example, if the markings are farther down on the graph
at higher frequencies, this means that 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 in 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 to 15 dB||Normal hearing|
|16 to 25 dB||Slight hearing loss|
|26 to 40 dB ||Mild hearing loss|
|41 to 55 dB||Moderate hearing loss|
|56 to 70 dB||Moderately severe hearing loss|
|71 to 90 dB||Severe hearing loss|
|91 and above||Profound hearing loss |
When hearing is impaired, often some pitches can 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
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 may lack the ability to 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 in describing—and treating—the problems
Hearing aids have 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 of these components are powered by a small
battery. Almost all new hearing aids use digital processing technology.
Hearing aids vary in shape, size, and how they are worn. They range from
tiny devices that nestle completely in the ear canal to larger, more visible
models that sit behind the ear. Although many technologies can be put into
any style, the smallest aids tend to have less power to address severe
The two general categories of hearing aid styles are behind-the-ear (BTE)
and in-the-ear (ITE). Within these two categories, there are a number of
As this figure 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 is comprised 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.
A relatively new concept for BTE aids is "open-fit," or "open-ear," models.
Like a traditional BTE model, an open-fit aid is comprised of 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 takes up 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 mean taking away natural sounds that could
be heard without the help of hearing aids—often contributing to a disconcerting,
inside-a-barrel sense, called "occlusion." Open-fit BTEs allow for 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, usually ending in a rubber tip. Other open-fit
models use a wire instead of a tube, and contain the speaker (or receiver)
at the end of the wire, in the ear canal. These aids are referred to as
"receiver-in-the-canal" models, and are currently a very popular hearing
With ITE models, the entire aid is worn within the ear opening, or even
entirely within the ear canal. Impressions of patients' ears are made and
sent to the hearing aid manufacturers, and the aids are custom-molded.
As this figure shows,
there are several styles of ITE models, ranging 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. This hearing aid
is placed into the ear canal by an audiologist or physician and remains
there until the battery expires two or three months later or it fails for
some other reason. It is then replaced with a new device. But not all patients
are good candidates for this option; so if you're interested in it, you'll
want to 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 they once were, and also because of the benefits of open-fit technology,
BTE aids are more appealing than before. On the other hand, some patients
still prefer ITE aids because they are compact and keep everything contained
within the ear.
If you have severe hearing loss, you'll likely be buying 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
Regardless of preference, some patients are limited to one selection over
another because of the shape of their ear openings or because their ears
secrete too much wax.
Most new hearing aids come with a number of features, some of which used
to come with a hefty price tag. Features you should expect with even a
basic new model:
Directional microphones allow hearing aids to take into account direction
and timing cues for sound reaching them. This feature helps enhance speech
sounds and reduces noise. It gives the user control over what gets amplified
by facing the source.
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 come with an option that lets wearers manually control volume.
Feedback cancellation reduces the likelihood of getting that whistling
or squealing sound you may have heard coming from a hearing aid at some
time. This sound results 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 a modestly priced hearing aid should have some
mechanism for reducing feedback.
Multiple processing channels allow a hearing aid to divide up sound processing
into separate frequency regions. This allows for more flexibility for programming
the hearing aid specifically to take into account a user's 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 put out by the phone. This feature
now is used with many other forms of assisted living technologies, such
as TV and audio equipment listening systems. Many ITE models come with
T-coils, and virtually all BTE models have the feature, but the smallest
hearing aids can't carry the feature because of size limitations.
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, where the user might benefit from different programs, are
a noisy restaurant, a meeting, or watching TV at home. Switching among
programs may be performed manually by the user or in more advanced aids
may be performed automatically.
The more advanced hearing aid features usually mean advanced prices—the
most expensive models can cost $5,000 or more per hearing aid—so you'll
want to think carefully about whether or not the added benefit of special
features is worth the 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 that has advanced sound
processing, your needs will be different from someone who regularly attends
noisy parties, attends conferences, or has business dinners in restaurants.
Some of the non-basic features available (usually for extra cost) include—
Bluetooth connectivity lets the hearing aid receive a Bluetooth signal.
This is nice for cell phone use, of course, but some manufacturers also
offer systems allowing you to use the Bluetooth signal with a TV or landline
Remote controls allow wearers manually to adjust volume, program switching,
and other settings using a small remote rather than having to fiddle with
controls on the aid itself.
Communication between hearing aids is a feature that enables right- and
left-side aids to share information that can optimize hearing response
in certain settings. Some hearing aids use this communication simply to
synchronize manual volume adjustments and program changes, so if the wearer
changes a setting on one ear, it will automatically make the same change
to the other.
CROS 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. The idea is
that 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 patience—and motivation—from
the wearer to get used to a new way of listening.
Additional features—There are other features available to make life with
hearing aids easier, such as a low battery indicator and a mute feature
to reduce feedback during insertion and removal of the aid.
If you have hearing loss in both ears, it is generally considered a good
idea to purchase aids for both ears. Buying two aids will mean you'll probably
have to pay twice as much. But the benefits of two aids are significant:
they will improve your balance and safety because you'll be more easily
able to localize and differentiate sounds, and they'll make it easier for
you to understand speech in noisy environments because each aid can be
used at lower listening levels.
On the other hand, if most of your hearing aid use will be in a quiet home
environment and in one-on-one conversation, you may not benefit much by
the extra sound information two aids would supply and you might reasonably
decide to just buy one aid. Some patients find it difficult to maintain
and manage two hearing aids. Others simply want to minimize the appearance
of a handicap, and feel one aid will be less apparent than two.
There are some uncommon instances where using just one hearing aid is preferable;
for example, if one ear has poor ability to discriminate speech or if one
ear has a medical condition that contraindicates the use of amplification
for health reasons.
Most hearing aid purchases go off without a hitch. But some don't. It's
not easy to get it right since each patient's hearing loss is unique and
the expectations of each are different. Even if two patients have the same
hearing loss on paper, their rehabilitative needs may be very different.
Dispensing hearing aids is also difficult because most hearing aids are
custom-molded, so patients can't try out various makes and models exactly
as they 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 you get in the test should be fairly close
to what you will get when fitted with your own device.
Such demonstrations might be helpful in making your selection. But no in-store
demonstration will show you what your experience with a particular technology
will be once you are in real-life listening environments. Too much depends
on your specific hearing loss, and a sample hearing aid will likely sound
different from one that is custom-fitted for you. For this reason, some
audiologists prefer not to perform these demonstrations, and instead rely
on the real-life experiences of the client, making adjustments as necessary.
Ultimately, time and experience with a particular hearing aid may be the
only way to determine how well it works for you.
When purchasing a hearing aid, you can take steps to protect yourself from
bad choices. Fortunately, 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 will extend the mandatory 45-day trial period if more time
is needed—it is not unusual for a dispenser to allow 60 days or more days
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 negotiate with the manufacturer to take back aids beyond
the usual 45 days. If you feel you might need extra time to decide about
an aid, you should 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. We found that
this period varies from seller to seller, with some giving 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, be particularly
aware of the dispenser's policy regarding follow-up appointments.
Also, find out whether your return period will be extended if you need
to have adjustments made, and get this promise in writing. You don't want
to lose your right to return an aid simply because you have spent weeks
or months trying to get it adjusted to meet your needs before determining
that it just won't suit you.
To back up newly purchased aids, most manufacturers provide a minimum warranty
of one year. Warranties from some manufacturers last two years and for
some aids the warranty period is even longer. In most instances, you can
buy an extended warranty that keeps the normal warranty in effect for an
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;
check also 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 the cost of it against the price of
the aid. Usually, these types of insurance policies aren't worth their
With luck and a little effort, you can avoid having to buy new hearing
aids 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 a person to use the same hearing aid
for much longer than that—sometimes ten or more years. On the other hand,
hanging onto the same aid for so long may mean missing out opportunities
to try new technologies.
Two words of advice for those looking for 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 a total of 169 visits to 23 different hearing
aid dispensers. The study revealed that half of the dispensers in the study
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 complained of being tested in "noisy" rooms in 11 of the 23 sites.
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. This compares with the 45 percent judged
to need an aid by the audiologist hired by AARP to evaluate the study participants.
Some dispensers recommended aids to as many as 90 percent of the consumer
The Florida study also found many instances of deceptive sales statements.
The most common was the claim 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 will have no impact on your natural hearing
capacity. The study also found instances of vague pricing policies. Some
dispensers advertised that a hearing aid was on sale, only to reveal a
"sale" price that was the same price that the dispenser always charged
for the hearing aid. Others advertised "free" hearing evaluations, later
adding the caveat that the test was free only if a hearing aid was purchased
the same day.
In our own surveys of hearing aid buyers, sellers were for the most part
rated favorably by their customers. But we did receive several comments
that echo the problems cited in AARP's study:
"Very pushy people... Hearing test done in five minutes only, very amateurish.
I did not feel comfortable with recommendations. Also prices are very high."
"Attitude of staff seemed more like sales personnel than hearing specialists.
I always felt like I was being sold a product rather than feeling that
they were trying to help me hear better."
"Complete used-car sales pitch, taking control of communication to get
me to upgrade to a more expensive hearing aid. When I resisted, she got
"Pushed me into a product which may or may not be the right product...
[O]ffered free hearing test which was perfunctory, done using a portable
desktop unit and not conducted by an audiologist."
"Over-promised the improvement my wife would experience with new digital
technology which ultimately showed no benefit for her."
"I didn't feel that the technician tried to understand what I was telling
her and she continued to make things worse. I went back to my 20-year-old
To help you find advice you can trust, our Ratings Tables show how
area hearing centers were rated by CHECKBOOK and Consumer Reports subscribers.
(For more information on our customer survey and other research methods,
When shopping, it is important to know as much as possible about the purchase
you are about to make, arrive equipped with good questions, and shop around.
Check the dispenser's credentials. You are assured that the person has
had substantial training and has demonstrated some level of competence
if he or she is a Doctor of Audiology (AuD) and/or holds a Certificate
of Clinical Competence in Audiology (CCC-A). 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 "sound proof"
but they are "sound treated." In order to block out office noise and increase
the sound absorption of the room, 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 a "sound
booth." There are companies that specialize in the construction of audiometric
testing rooms, or sound booths, which can be ordered in a variety of sizes
and sound absorption levels and built on-site. 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.
It is worth asking about the nature of the testing room used by a facility
you might use. While the type of test room is not a definitive indication
of whether a hearing test will be performed properly or not, the presence
of a professional sound booth at least demonstrates 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 the
problems your hearing causes you and the circumstances in which you would
most benefit from hearing aids? Do they provide a thorough explanation
of the testing process and their diagnosis? Do they present several options?
Do they give easy-to-understand explanations for any recommendations they
make? Are important choices like buying one aid versus two discussed in
ways you can understand?
Once your hearing aid has been ordered, make sure it is properly fitted.
You should be concerned if staff simply asks "how does it sound?" or asks
if you can hear voices from behind you that are whispered. Such tactics
are unscientific and 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 independent of the fitting software and equipment that are used
to program the hearing aid. Real ear measurement can use a variety of stimuli
to view and manipulate actively the response of the hearing aid in order
to maximize access to speech and ensure overall listening comfort. This
takes time and expertise, but is critical because simply programming the
hearing aid using the manufacturer's software cannot adequately ensure
proper hearing aid settings.
The staff can also verify the hearing aid is working optimally using more
traditional testing in the sound booth (by repeating portions of the hearing
test while the patient wears aids), but the results of such testing provide
less specific information.
Staff should also provide you with a full orientation on your new aids,
showing you how to insert them, work controls, maintain and care for them,
store them, and replace batteries, and should give you strategies to help
you get used to hearing with them.
The trial period and refund policy will, of course, be critical, as will
the period for you to get free adjustments.
For some, the costs of buying a hearing aid might not be an important consideration,
since some health insurance policies have coverage for hearing aids. But
most health insurers don't provide such coverage, and neither does Medicare.
So it's likely that you'll have to pay out of your own pocket, probably
from $1,500 to $5,000 or more for a single hearing aid.
our Ratings Tables will help you find a seller that's a good bet on
price. The table includes a price index score for each firm that was evaluated
in our last full, published article. These scores are intended to show
how the firm's prices quoted to our shoppers compared to the average prices
for the same aids quoted by all the firms that quoted on those aids. The
scores are based on prices for a hearing test, fitting, and one hearing
aid. CHECKBOOK's shoppers (who did not reveal their affiliation with CHECKBOOK)
asked for prices for 12 hearing aid models. A price index score of $110
means a firm, on average, quoted prices ten percent higher than the average
of all the firms quoting on the same models. Price index scores ranged
from a low of $82 to a high of $127.
The prices quoted for the same aid varied widely, as you can see on Table 1.
While the price index scores on our Ratings Tables are a helpful starting
point, to get the best price, you will need to shop. We recommend the following:
For your hearing test, consider only businesses that will allow you to
keep a full, written copy of the results.
Find out how much the provider charges for hearing testing if you choose
not to buy a hearing aid from it. Find out if the provider charges for
the test if you don't keep the written test results or if you do. But be
wary of businesses that market heavily using "free hearing screening" ads;
these providers usually aren't in the business of providing full, evaluative
After the hearing test, get the seller's price for the aid it recommends
and get the full specifications for the device. Also get a full description
of return privileges and any follow-up services included.
Call or visit other firms to get their prices based on your test results.
Compare prices for the hearing aid recommended by the testing firm, but
also seek the other firms' recommendations.
The cost of a hearing test alone will vary from firm to firm. Many firms
charge nothing, but some charge $100 or more. While we here at CHECKBOOK
usually adore the word "free," in this field it's not necessarily the best
choice. A free screening may not be the equivalent of the full evaluation
you need to get. Also, be sure that the "free" firm will 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 feel pressure to sell you
something and might not be as flexible as you would like about giving you
a copy of test results.
In an effort to keep your costs down, you might consider buying via mail
order or the Internet. You can send an impression of your ear and a recent
audiogram. This purchase option, however, offers little of the support
you can get when buying from a local firm. With a local firm, you get to
meet with a specialist before and after your aid purchase to ensure that
your aid works well. Most hearing aid purchases require several follow-up
appointments before customers are comfortable and satisfied with their
You want to make sure your hearing aid works properly, that you get the
maximum benefit it has to offer, and that it lasts a long time.
Judging How Well It Works
Once your hearing aid has been properly fitted and adjusted, it is probably
a good idea to hold off on any immediate judgments about how well it works
until you have had some time to get used to the new sounds you are experiencing.
At first, you might want to wear your aid for short periods of time or
in listening environments that aren't taxing. You'll have to learn to integrate
background noises—such as the hum of a refrigerator—into the spectrum of
other noises you will process. You may need to adjust to the sound of your
own voice, which might seem much different when heard through your hearing
aid. You may even have to relearn what certain sounds are that you've forgotten.
Once you have given yourself two or three weeks to adjust to your new aid,
the following might help you determine whether it is functioning optimally:
Overall, does the hearing aid seem to be helping you hear better?
Does the hearing aid physically 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?
Have you been able to adjust to any new sounds you hear from the aid? Does
it seem there is an echo or that there are hollow or tinny noises?
Have you been able to insert the aid, clean it, and deal with battery changes?
If at this point (or any other time) you feel the aid is not meeting your
reasonable expectations, return to the dispenser. Good sellers will be
willing to help. Minor complaints about sound quality or fit usually can
be resolved easily. More serious complaints may require that a mold be
remade or that sound needs to be delivered to the ear in a different way—maybe
by using a different hearing aid model.
If the dispenser wants to make some adjustments, get the dispenser to put
in writing that its return period will be extended to allow you time to
decide whether any adjustment makes the aid acceptable.
If things just aren't working out and you are still within the period when
you are allowed to return the aid, decide whether that is what you want
Caring for Your Aid
Proper care will prolong the life of your hearing aid and keep it functioning
as it should.
First, avoid damaging your aid. Although they are built to be durable,
hearing aids can be damaged if they are dropped on a hard surface or become
wet. It is important to remove them when swimming or showering. Dogs enjoy
chewing on hearing aids, so the aids should always be kept in a secure
place when they are not being used. Aids' doors for batteries and access
to controls should open easily, so if you're having trouble, don't force
Keep your hearing aid clean. Moisture and wax can clog and damage components.
If you can, remove your hearing aid when doing 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.
Plan on taking your aid to the seller periodically for more thorough cleaning
and maintenance. Some aids will need these 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. There
are other steps that can be taken—including hearing and listening training
and counseling—to help integrate someone with hearing loss into the hearing
world by taking full advantage of the person's 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.
You may be able to get the needed services from your hearing specialist,
but there are other sources available. Community colleges and universities
often offer classes in hearing training or aural rehabilitation.
You may also want to consider joining a support group for hearing aid wearers.
In addition to providing moral support, the group can share ideas about
what does and does not work when wearing an aid. You can contact the Hearing
Loss Association of America (HLAA), a national organization with local
chapter networks, at 301-657-2248 for more 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).
There is only so much that hearing aids can do to improve your ability
to hear. The rest is up to you. There are a number of tactics you should
use to better your chances of hearing well in difficult listening environments.
They require considering the sort of situation you will be in and taking
the necessary steps to make it a more listening-friendly environment.
Lessen background noise. Make sure to create the best listening environment
wherever you go. Loud music and televisions can be turned down if they
are competing with someone for your attention. At restaurants, ask for
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 are trying to have a conversation.
Find a good spot. Position yourself in a room so that you minimize the
distance between yourself and the speaker. When in a group, seat yourself
in the center where you can see and hear everyone. In a large group listening
situation, show up early so you can choose a good position in the room.
Turn the lights on. To the extent that you can, make sure rooms where you
will be listening are well lit. In rooms with poor lighting, 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 some steps beforehand to make sure you won't be wasting
your time by showing up. You can always call ahead of time and talk to
someone who knows the environment in which you will be. Are there quiet
tables? Is there front row seating available? Will there be a light shining
on the speaker? In a large group listening situation (such as a place of
worship or a concert), call ahead to see if assistive listening devices
will be made available. These devices transmit sound to a special receiver
that you wear, reducing the loss of clarity that occurs when the sound
travels a distance 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 talk into the microphone. If unamplified
questions are being asked by audience members, ask that the questions be
repeated by the speaker before being answered. If you are in a restaurant
where the music is too loud, ask your waitperson if it is possible to turn
the volume down so that you can better hear your companion. If need be,
ask people to face you head-on when they speak to you. People will appreciate
your candor and your hearing will benefit tremendously.
If you answer "yes" to some of these questions, it might be time to get
your hearing checked.
Do I often ask people to repeat themselves? Does it often seem that people
Do I often feel tired or stressed during conversations?
Do I often misunderstand conversations? Do I miss the point of jokes because
I miss too much of the story?
Do I turn up the volume on televisions or radios so that others complain?
Do I have difficulty understanding speech in noisy places?
Do I find that when I look at people I can more easily understand what
they are saying?
Academy of Doctors of Audiology
Alexander Graham Bell Association for the Deaf and Hard of Hearing
American Academy of Audiology
American Academy of Otolaryngology
American Speech-Language-Hearing Association (ASHA)
Better Hearing Institute (BHI)
Hearing Industries Association (HIA)
Hearing Loss Association of America (HLAA)
International Hearing Society (IHS)
Lions Club Sight and Hearing Foundation