How to Choose a Hearing Aid
Follow these suggestions before your next purchase
En español | Considering a hearing aid for yourself or a loved one? Forget everything you think you know about them. Traditional excuses for not wanting to wear a hearing aid — such as “they’re too ugly,” “they make me look old” or “they’re too complicated,” — simply don’t apply anymore. “Today’s hearing aids are smaller, supercool looking and connect seamlessly with all of our modern technology,” says Jessica Galatioto, director of audiology at Columbia University Irving Medical Center in New York City. Unfortunately, however, hearing aids aren’t cheap — typically ranging in price from $2,000 to $6,000 a pair — nor are they covered by Medicare or most insurance. But that doesn’t mean you have to sacrifice style or quality, if you know what to look for. Listen up as we explain the latest in technology, features and costs.
You’re going to need a hearing specialist
While your first conversation about hearing loss and an initial screening may be with your primary care physician, an audiologist is the expert trained to diagnose hearing loss and prescribe hearing aids. “If you’re experiencing gradual hearing loss without any medical issues like pain or discharge, you can schedule directly with an audiologist yourself, or ask your primary care doctor for a referral,” says Catherine Palmer, director of audiology and hearing aids at the University of Pittsburgh Medical Center. You can also ask for an audiologist recommendation from an ENT (ear, nose and throat) practice. Hearing instrument specialists are another type of provider licensed to fit and dispense hearing aids.
Customizing is critical
The key to successful hearing-aid use is the programming of these devices, which is what an audiologist or hearing instrument specialist does. “I can have five patients with the same diagnosis, but they all have different acoustic settings on their hearing aids,” Galatioto says. As a result, some tinkering is to be expected initially. “Your first prescription probably won’t be the same one you have at four months,” she adds. Over the course of a few visits, you can expect your provider to:
- Conduct a comprehensive hearing evaluation
- Have an in-depth discussion with you about your lifestyle, communication needs and difficulties, hobbies and interests
- Customize physical fit of the device, which is done by creating a mold of the size and shape of your ear canal for in-the-ear aids, or trying on different size domes and tubes for behind-the-ear aids
- Customize acoustic fit, which is achieved by programming the hearing aid for the best volume, frequencies, intensity levels, power output, noise-reduction settings and more to suit your specific hearing needs
Small size is a big deal
Since the best hearing aid is the one that someone will actually wear all the time, you can expect your provider to have a conversation about your individual style preferences.
“Hearing aids look much more modern now with sleeker designs and metallic and matte finishes that are very attractive,” Palmer says. “Many people can use the small, behind-the-ear hearing aids that mix in with a person’s hair and are hard to detect. In addition, the hearing aids that go completely in the canal are now so tiny they cannot be seen once placed in the ear.”
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Rechargeable models are revolutionary
Just as phone chargers freed us from cords, recharging technology is liberating hearing aid users from the endless job of changing tiny button batteries, which can be a real challenge for older people with vision or dexterity issues. “They’re about 10 percent more expensive than battery-operated models, but you’re going to be spending a dollar a week on batteries with traditional models, so you will recoup the extra cost,” says Brian Earl, associate professor of audiology and director of the Evoked Auditory Response Lab — EARLab — at the University of Cincinnati in Ohio.
Opt for an open-fit hearing aid, if possible
These devices have become increasingly popular for people with mild to moderate hearing loss for several reasons, including near invisibility. “These are high-end aids in very small packages that sit behind the ear and have a thin translucent tube with a speaker that extends into the ear canal near the eardrum,” says Ayasakanta Rout, director of the Hearing Aid Research Laboratory at James Madison University in Harrisonburg, Virginia. “They don’t require making a mold of your ear canal, so you can try one immediately at your first appointment rather than waiting a week or two for the custom models.” You can expect better sound and comfort, too. “Open fittings don’t block the ear canal, so natural sound enters your ear in addition to amplification. In the past, this caused feedback [squealing], but the newer technology reduces that,” Palmer says. “Having an open ear is much more comfortable for hearing-aid users, and their own voice sounds more natural.”
Consider smartphone capability
If you already use a smartphone, take advantage of that wireless technology, Galatioto says. Many hearing-aid designs are now equipped with Bluetooth, so with the push of a button you can stream phone calls, music, podcasts, or audio books from your phone, tablet, computer or TV directly into the hearing aid. The one caveat: Bluetooth is a notorious guzzler of power, so your charge or batteries will wear down much faster, Rout notes. Very soon all major hearing-aid manufacturers will include a new format known as Bluetooth Low Energy (BLE) — some already produce them — which should reduce this problem, he adds.
Think about telecoil technology if you’re frequently out and about
Do you enjoy going to the movies, the theater or concerts, or taking classes? Look for an aid with a telecoil (t-coil), which loops into public sound systems to extend the listening range, improve listening comprehension and eliminate unwanted background noise, Galatioto recommends. Thanks to the Americans with Disabilities Act, all public assembly areas with sound amplification (movie and live performance theaters, courthouses, public classrooms, meeting rooms) now have to be equipped with assistive listening systems. Hearing aids with this feature may be a little larger in size to accommodate the coil, but they won’t cost you any extra because the technology has been around for a while.
A remote microphone is a handy accessory for optimizing sound when someone is speaking in a noisy setting. These devices may be free-standing or can be worn on a lapel or a lanyard. You can then point them at, say, a minister speaking in church or a colleague giving a presentation, Earl says. They’re also great for dining out, family dinners or gatherings where many people may be speaking at once, or for having a one-on-one chat with a grandchild in a boisterous setting.
Monitor your health at the same time
Feeling guilty about that tech wearable or smartwatch sitting in your drawer? Some hearing aids can now take their place. Known as “healthables,” these hearing aids are equipped with sensors and artificial intelligence (AI) that can track your health and activity levels via an app, as well as detect when you fall and call 911 or a loved one for you. “Healthables provide greater quality of data than anything you wear on your wrist, because the ear is much closer to the brain,” Rout says.
You don’t need to splurge on the latest technology — unless you want to.
A lower price tag doesn’t mean lower quality. “There is not much difference in speech understanding, sound quality and listening-related effort between premium level technology and basic technology,” Rout says. “More advanced technology gives audiologists more options and flexibility to address patients’ issues, but most people do just fine with basic technology.”
Give it time
Getting and adjusting to a new hearing aid is a process that requires time and fittings by a specialist who will customize the sound for you. “A new hearing-aid user will typically not like them for the first week, because their brain is not used to all the low-level sounds,” Palmer says. “They may feel overwhelmed by sound, like things are too loud and noisy. Consistent, full-time use allows the brain to adapt, and over the first few weeks the annoying sounds will fade into the background as the brain realizes they are not interesting.”
Try a different model, if necessary
If you spend a month or so with hearing aids and still don’t like them, you’re not out of luck. Every state in the U.S. has a law that allows at least 30 days for you to test drive new hearing aids, Rout says. You’ll receive a full refund, with the exception of a small fee for your provider's time, which is also mandated by the state you live in.
Editor’s note: This article was originally published on May 19, 2021. It’s been updated to include information about hearing instrument specialists.