Hearing Aids 101: Here’s What You Should Know

Hearing Aids 101: Here’s What You Should Know

Not all hearing aids are alike. Find out what types are available and which option might be right for you.

Is the volume on your television steadily creeping upward? Do you find yourself saying “Would you repeat that?” frequently during conversations? These are classic signs of hearing loss, and if you’re experiencing them, you’re not alone: 15 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—yes, million—Americans would benefit from wearing hearing aids, notes the NIDCD. And yet, most of them do not.

“With hearing aids, we can correct someone to very good hearing,” says Craig Hoekzema, MD, an ear, nose and throat, or ENT (otolaryngology) specialist, affiliated with Mercy Health in Michigan.

While it’s true that hearing aids aren’t a perfect solution—they can be pricey and don’t restore hearing back to “normal”—they can help dramatically.

Hearing loss affects your ability to communicate with the world around you. You might have trouble maintaining relationships. Your job or school performance may suffer. Hearing aids could not only help you get back to your daily routine, but also reduce your risk for hearing loss-related health issues, such as depression and anxiety.

Here’s what you should know about hearing aids, including who could 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 Dr. Hoekzema. But patients of all different ages make their way to the practice, he adds. Some people are born with hearing problems; others develop them. At every 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, Hoekzema explains. This can happen due to wear and tear over time, he adds. 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 turn up the volume, but will not necessarily restore fully sharp or clear sounds.

How do they 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 over the past two decades, is far more sophisticated than mere amplification.

“Hearing aids are intricate and complex,” Hoekzema points out. That’s because their goal is to increase the volume on sounds you want to hear (like your spouse’s questions) without amplifying noises you don’t need to hear (like the background roar of conversation at a restaurant).

“When you wear a hearing aid, not all frequencies are treated identically,” Hoekzema says.

There are a few different types of hearing aids available:

  • Canal aids: These can either be completely-in-canal (CIC) or in-the-canal (ITC). Opt for a completely in the canal hearing aid, and it’ll be very hidden. “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, according to the NIDCD.
  • Bone-anchored hearing aids: If you have conductive hearing loss (sound waves can’t reach the inner ear), your doctor may recommend a bone-anchored implant, Hoekzema says. This surgically implanted type of hearing aid transmits sound directly into the inner or middle ear.

It's good to have options, but how can you know which hearing aid is right for you?

Your ENT doctor or an audiologist, a licensed health care professional who can help diagnose and treat hearing and balance problems, can help you sort through the pros and cons. For instance, while you may like the discretion of CIC or ITC models, they can lead to hearing 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 other use small disposable batteries. For people with limited dexterity, changing tiny batteries may be a challenge, making rechargeable options a safer bet.

The process of getting hearing aids
Typically, notes the U.S. Food and Drug Administration, the process 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.

“A hearing aid is not something you can buy off the shelf,” notes Hoekzema, who says sometimes patients need to try a few options before determining which one makes the most sense. He points out that your ear shape, 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 required a 30- to 60-day trial period for hearing aids, notes the Federal Trade Commission, 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 are a big purchase—the National Institutes of Health estimates that the average cost is $1,500, but notes that some devices can cost up to $5,000. And, 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 for adults, coverage varies by state.

In some cases, the U.S. Department of Veterans Affairs 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 non-profit organizations may also help cover the cost of hearing aids for those with limited incomes.

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
Let’s get the bad news out of the way first: “Nothing is as good as the hearing you were born with,” Hoekzema says. With hearing aids, the goal is to allow you to hear as well as you possibly can, he says.

“The tone and the quality [with hearing aids] is a little bit different,” says Hoekzema, who adds that it can take patients several months to adjust. When you first start wearing your hearing aids, you may also hear overly loud background sounds or experience occlusion (the sound of your voice echoing within your head). Be sure to mention any issues to your doctor or audiologist; sometimes adjustments can help. That's particularly true for feedback, which is a fixable problem. If the adjustments 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 however, 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,” Hoekzema adds.

Don’t delay
“Patients often wait too long to start wearing hearing aids,” Hoekzema cautions.

“If you’re 95, 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 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.

So, if you’re feeling on the fence about hearing aids, go in for an appointment and explore the options that are available to you. It could not only dramatically improve your quality of life but also protect your long-term health.

Medically reviewed in March 2019.

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