Updated on October 17, 2022.
Is the volume on your television steadily creeping upward? Do you find yourself asking others to repeat themselves during conversations?
These are classic signs of hearing loss, and if you’re experiencing them, you’re not alone: Fifteen percent of adults in the United States have some degree of hearing loss, according to the National Institute on Deafness and Other Communication Disorders (NIDCD).
More than 28 million Americans would benefit from wearing hearing aids, the NIDCD notes. And yet, most of them do not.
One barrier for many: cost. Hearing aids can be expensive, but in August 2022, the U.S. Food and Drug Administration (FDA) took action to improve access. The agency finalized an historic rule, establishing a new category of over-the-counter (OTC) hearing aids. As of October 17, these OTC hearing aids are available at retailers across the country. Adults with mild-to-moderate hearing loss can buy a pair a store or online at a lower cost without a prescription, medical exam, fitting by an audiologist fitting.
The move makes hearing aids easier to buy and more affordable for millions—something that could have a dramatic impact on their quality of life. The way in which the world and our society are arranged can pose many challenges for people with deafness or hearing loss, some obvious and others more subtle.
For example, the structure of schools or workplaces can make it difficult for people with deafness or hearing loss to communicate effectively with teachers, peers, and colleagues. This may cause one’s performance in these settings to suffer.
The general lack of use of American Sign Language (ASL) and other assistive technologies can also make it difficult for people with deafness or hearing loss to communicate with others and maintain relationships. Hearing aids cannot solve all these problems, but they may ease some difficulties.
Here’s what you should know about hearing aids, including who might benefit from them, which types are available, and how they work.
Who benefits from hearing aids?
“The majority of patients I see are elderly adults,” says Craig Hoekzema, MD, an ear, nose, and throat (ENT, or otolaryngology) specialist affiliated with Mercy Health in Michigan. But patients of all ages make their way to his practice.
Some people are born with hearing problems while others develop them. At every increased age bracket, the likelihood of hearing loss increases. For people 75 and over, for instance, there's a fifty-fifty chance of hearing loss.
Hearing aids benefit people with sensorineural hearing loss, caused by degeneration of the cochlea, or inner nerve of your ear, Dr. Hoekzema explains. This can happen due to wear and tear over time, he says. Diseases, injuries due to loud noises, and some medications are also factors, according to the NIDCD.
“Not all patients who are hearing aid candidates are created equal,” Hoekzema notes. If you start off without complete clarity, a hearing aid will help turn up the volume, but will not necessarily restore fully sharp or clear sounds.
How do hearing aids work?
Hearing aids have a microphone, a processor, and a speaker, which work together to amplify sound, Hoekzema says. But the technology, which has dramatically improved in recent decades, is more sophisticated than mere amplification.
“Hearing aids are complex,” Hoekzema says. “And not all frequencies are treated identically.” They are designed with the goal of increasing the volume of sounds you want to hear (like your spouse’s voice) without amplifying noises you don’t need to hear (like the background roar of conversation at a restaurant).
Making sense of hearing aid options
There are a few different types of hearing aids available:
Canal aids: These can be either completely-in-canal (CIC) or in-the-canal (ITC). If you choose a completely in the canal hearing aid, it will be well-concealed. “It’s nearly invisible to the casual observer,” Hoekzema says. Both options are quite small and fitted to your ear. They’re best for people with mild to moderate hearing loss.
In-the-ear hearing aids: Sitting in the outer ear, these devices are bigger than canal hearing aids, and used for people with mild to severe hearing loss.
Behind-the-ear: This may be what you picture when you imagine a hearing aid. There’s a small processor that sits behind your ear along with clear tubing, says Hoekzema. This hearing aid can help if you have mild to profound hearing loss.
Bone-anchored hearing aids: If you have conductive hearing loss (in which sound waves can’t reach the inner ear), your healthcare provider (HCP) may recommend a bone-anchored implant, Hoekzema says. This surgically implanted type of hearing aid transmits sound directly into the inner or middle ear.
How can you know which hearing aid is right for you?
Your ENT specialist or an audiologist (a licensed healthcare professional who is trained to diagnose and treat hearing and balance problems) can help you sort through the pros and cons. For instance, while you may like the discreet look of CIC or ITC models, they can lead you to hear your voice in your head when you speak, Hoekzama says. They are also associated with feedback, but fitting and programming can usually eliminate this whistling noise.
Batteries are another factor to consider. Some hearing aids have rechargeable batteries, while others use small disposable batteries. For people with limited dexterity, changing tiny batteries may be a challenge, which makes rechargeable models a better bet.
How to shop for hearing aids
The U.S. Food and Drug Administration (FDA) explains that the process usually begins by visiting an ENT or an audiologist for an exam. During your visit, you can discuss the hearing aid options that may be right for you.
Those with mild to moderate hearing loss, however, can purchase hearing aids online or directly from stores without a medical exam, prescription, or an adjustment by an audiologist. The FDA cleared the sale of over-the-counter hearing aids to reduce costs and make it easier for people who would benefit from these devices to get them.
Patients may need to try a few options before determining which one makes the most sense, says Hoekzema. Your ear shape, level of hearing loss, and personal preferences must all be taken into account.
You’ll also likely need time to adjust. It can take a month or more to get comfortable with a new hearing aid, Hoekzema says. Many states require a 30- to 60-day trial period for hearing aids, and most sellers will provide some trial regardless of the state. Always check to see if a trial period is available before buying.
Hearing aids can be a big purchase. If over-the-counter options are not right for you, the cost of one prescription hearing aid could range from $1,000 to $4,000, on average, and high-end products can be even more expensive. Unfortunately, they’re often not covered by insurance. Medicare, for instance, only covers bone-anchored hearing aids because they are classified as a prosthetic. Medicaid covers hearing aids for children, but coverage varies by state for adults.
In some cases, the U.S. Department of Veterans Affairs (VA) will cover the cost of hearing aids for veterans. For instance, if you are a veteran with significant hearing loss linked to your military service or a medical condition treated at a VA hospital, you may be eligible to receive hearing aids through the VA. Federal employees and their families may also be entitled to basic hearing aids through some insurance plans. Some nonprofit organizations may also help cover the cost of hearing aids for those with limited incomes.
You may also be able to receive discounted or free hearing aids or other assistive devices to help you better manage your job through a Vocational Rehabilitation (VR) program. Search for VR programs in your city or state to see if you may be eligible.
Keep in mind, if you have a medical flexible spending account (FSA) or a health savings account (HSA), these funds could be used to purchase hearing aids and batteries.
Life with hearing aids
The goal when using a hearing aid is to allow you to hear as well as you possibly can, but it’s important to recognize that the overall benefit may be limited.
“The tone and quality with hearing aids is a little bit different,” says Hoekzema. “Nothing is quite as good as the hearing you were born with.”
It can also take patients several months to adjust. When you first start wearing your hearing aids, you may hear overly loud background sounds or experience occlusion (the sound of your voice echoing in your head).
Be sure to mention any issues to your HCP or audiologist; sometimes adjustments can help. That's particularly true for feedback, which is a fixable problem. If the tweaks do not help, you may decide that you prefer another type of hearing aid.
Hearing aids typically have a five- to six-year lifespan, Hoekzema says. How long they last will depend on which type you choose. “We typically see patients one or two times a year to clean their hearing aids, maybe do a quick hearing test and make any required adjustments,” he adds.
Don’t delay
“Patients often wait too long to start wearing hearing aids,” Hoekzema cautions. “If you’re 95 years old, and you’ve had hearing loss for 30 years, and you’re just now starting to wear hearing aids, changes have happened in your brain in those hearing pathways that aren’t going to come back,” he says. In fact, even relatively mild levels of hearing loss can lead to changes in perception, comprehension, and memory.
Your response to hearing aids will not be the same as someone who began wearing them closer to the onset of their hearing loss, Hoekzema points out.
“I’ve become a bit more aggressive about suggesting hearing aids,” he adds, given the latest research on the association between hearing loss and dementia.
If you’re on the fence about hearing aids, go for an appointment and explore the available options. Then work with your HCP to determine if a hearing aid is right for you.
