Most individuals who would benefit from hearing aids never get them. Many
who do are amazed at how much they improve their lives.
Dont get a hearing aid before first having a medical doctor determine
that a hearing aid will improve your hearingand that medical or surgical
treatment wont 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
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 youre not alone. About 10 percent of Americans have some
hearing loss, and the figure is more than 30 percent for persons over age
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 dont believe the benefits will justify
the trouble and cost.
It is true that hearing aids cant 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 cant 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 cant restore normal hearing, they have improved
the lives of millions of peopleenabling 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:
Its 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 someones conversation rather than parts.
Hearing aids have come a long way from the ear trumpets of the early 1800sand
even from the devices available just a few years ago. Todays 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.
The ear consists of three parts: outer ear, middle ear, and inner ear.
Figure 1Diagram of the 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 jingleseverything 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 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 ears 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 physiciansuch as an otolaryngologistwho 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 dont 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 patients 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 consumers 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
youd 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
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 patients 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 conductivethat the hearing
function is failing in the outer or middle ear, before it reaches the inner
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 patients 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 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
eardrums mobility and middle ear functions. This test helps rule out conductive
The examiner should also check a patients 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 results of a hearing test are recorded on an audiogram, a graph showing
the patients thresholds for hearing sensitivity. Several examples are
shown in Figure 2.
Figure 2Your Audiogram Shows, for Various Pitches, How Loud a Sound Must Be for You to Hear It
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:
015 dB Normal hearing
1625 dB Slight hearing loss
2640 dB Mild hearing loss
4155 dB Moderate hearing loss
5670 dB Moderately severe hearing loss
7190 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
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 cant 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
describeand treatthe problems patients have.
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 wearers ear. All these components are powered by a small
battery. 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 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.
As Figure 3 illustrates, a BTE hearing aid is so named because part of
the devicethe casing that holds microphone and circuitry componentssits
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 3Hearing Aid Types
An open-fit, or open-ear, BTE model is like a traditional BTE model,
with components that sit behind the wearers 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 aidsoften 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.
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
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 youre 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, youll probably buy a BTE style, since
ITE aids cant deliver the power youll 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 style because
of the shape of their ear openings or because their ears secrete excessive
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 priceswith
the most expensive models at $5,000 or more per hearing aidso think carefully
about whether or not the special features 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 wont
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
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 patientand highly motivatedto get used to a new way of
Additional featuresOther 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.
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. Theyll also make it easier for you
to understand speech in noisy environments and sort out which sounds are
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.
Most hearing-aid purchases go off without a hitch. But some dont. Its
not easy to get it right because each patients 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
Dispensing hearing aids is also tricky because most hearing aids are custom-molded,
so patients cant 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 youll
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 clients 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 dispensers 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 dispensers 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 dispensers 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 dont want to
lose your right to return an aid simply because youve spent weeks or months
trying to get it adjusted to meet your needs before concluding that it
just doesnt 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 manufacturers 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 arent worth their premiums.
With luck, and some effort, you wont need to buy new hearing aids that
often. One way to expand your hearing aids lifespan is to keep it clean.
The industry standard for a hearing aids lifespan is about four years,
but it is not uncommon for hearing aids to last much longersometimes 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.
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 states
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 AARPs 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 companys 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 dispensers 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 cant determine how much
youre 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 manufacturers 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.
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 dont cover hearing aids, youll 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 thats 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 companys 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
Table 1Low, Average, and High Prices Quoted by Sellers for Illustrative
|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
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 dont buy
a hearing aid from them. Find out if providers charge for the test if you
dont 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
arent in the business of providing full evaluative examinations.
After the hearing test, get the sellers 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 its 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.
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. Youll have to learn to integrate
background noisessuch as the hum of a refrigeratorinto 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 differentlymaybe with a different type of
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 dont 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
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
wetremove 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 youre having trouble, dont
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 sellers and manufacturers directions on how
to clean the aidand 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
stepsincluding hearing and listening training and counselingcan 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
ones 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
doesnt 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 HLAAs website (www.shhh.org).
If you answer yes to some of these questions, its time to get your hearing
Do I often ask people to repeat themselves? Do people often seem to be
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?
Academy of Doctors of Audiology
Alexander Graham Bell Association for the Deaf and Hard of Hearings Listening
and Spoken Language Knowledge Center
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
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
friends 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 wont 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. Dont 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.