The audiologist’s guide to choosing a hearing aid

What you need to know

Modern hearing aids aren’t one-size-fits-all — and not just because ear sizes vary. You’ll want to keep these important factors in mind when navigating the market to find the device that will most benefit you.

• There are over-the-counter or prescription aids —  People with mild to moderate hearing loss can get a hearing aid without stepping foot in a clinic, but OTC hearing aids might not include the same support and customization as prescription hearing aids.
• Consider the type — Hearing aids fall into two categories: Behind-the-ear (BTE) and In-the-ear (ITE). But you have several designs within these categories.
• Look at special features  — Modern hearing aids can come with popular features like noise reduction and Bluetooth capabilities.
• What is your budget? — The average cost of a hearing aid is $2,500 for one ear, but there’s variation based on important factors like technology level, features, type, and whether you’re looking for an OTC or prescription device.

How does a hearing aid work?

Hearing aids are small electronic devices worn on, within, behind, or around the ear of a person with hearing loss. The circuitry of the hearing aid (or aids) uses three parts — small microphones, amplifiers, and speakers — to transmit a louder volume of sounds into the user’s ears.

Aids amplify the sounds of the environment through the use of either analog or digital electronics, leading to improved hearing, even in crowded places like large social gatherings.

Are all hearing aids built the same way?

There are two different ways that hearing aids are built: analog and digital. Analog systems are limited by their technology, while digital hearing aids are more advanced.

Analog hearing aids

Analog or programmable hearing aids are often the less-expensive type of hearing aid, as the technology is not as advanced. This type of hearing aid uses electrical signals to amplify sound waves, creating a louder, crisper sound.

Digital hearing aids

Digital hearing aids use numerical codes rather than electrical signals to amplify sound to the user’s ear. These hearing aids use code similar to the binary code in a computer. The digital code allows audiologists more control over how they adjust and tweak each hearing aid to meet the user’s specific needs.

Different types of hearing aids

Hearing aid styles are often divided into two main categories: Behind-the-ear (BTE) and In-the-ear (ITE). However, there are many different distinctions between these two categories. Learn more about the six different types of hearing aids to help determine which hearing aid style could be a good choice for you.

Behind-the-ear (BTE)

This style of hearing aid tends to be larger than others, as it includes three parts. The hearing case sits behind the user’s ear, which gives the device its name.

BTE hearing aids work for any degree of hearing loss, regardless of the severity, from mild to profound. It is a good choice for someone shopping for a standard hearing aid. These may require a custom ear mold and tube to fit properly.

Mini behind-the-ear

As the name suggests, this style is exactly like the BTE hearing aid but on a smaller scale. The piece that sits behind the user’s ear is smaller, making it more discrete.

This option could be a good choice for someone wanting a more basic, affordable hearing aid that still provides a lot of power. It might not be a good choice for someone with dexterity issues, as the design is very small.

Receiver-in-the-canal (RIC)

Another style similar to the BTE hearing aid, this version uses a tiny wire receiver that extends into the user’s ear. The main body of this hearing aid is worn behind the ear.

RIC hearing aids can be worn by people of all degrees of hearing loss, but the smaller pieces require the user to have manual dexterity. Some users prefer the RIC design as it allows natural sounds and air to flow in and out of the ear, making it less likely to feel ‘plugged up.’

In-the-ear (ITE)

Otherwise known as full or half-shell, ITE hearing aids fill up either a portion of or the user’s entire ear. This type of hearing aid is an option for patients with any degree of loss but is often recommended for moderate to severe hearing loss.

It can be a great choice for older patients who may have trouble handling smaller devices since this type is larger and custom fits to their ear.

In-the-canal (ITC)

In-the-canals are compact hearing aids that fit inside the user’s ear canal. These smaller aids are so tiny that they can be hard to handle. However, they can block out background noise quite effectively.

Audiologists recommend people with mild to moderate levels of hearing loss as candidates for this style. ITC options might not work for people with a lot of wax build-up, as that can affect how the device fits and functions.

Completely-in-the-canal (CIC)

The most discrete option, CICs fit entirely inside the user’s ear canal. This makes them an ideal pick for someone leading an active lifestyle. However, because CICs are smaller than some other options, they are often less powerful and may have fewer features.

Since these devices are so small, they also have a much shorter battery life than those that use larger or rechargeable batteries. These hearing aids are not recommended for children or people with severe hearing loss.

What hearing aid features should you consider?

Hearing aids can be as unique as the people who wear them, each with different styles, preferences, and needs. Below are just a few of the advanced features and options you can shop around for when comparing devices on the market in search of one that meets your individual needs.

Battery life

A traditional hearing aid battery can last three days to around three weeks. Rechargeable battery options nixed the need to change batteries. Now, you can use a port, charge the battery, and you’re likely good to go for about 24 hours of use for select devices.

These batteries typically last between four to five years. Though hearing aids with rechargeable batteries cost more on the front end by around 10%, people can save approximately $1 weekly, or around $52 across a period of 12 months, if they do not have to replace batteries constantly.

Rechargeable battery-powered hearing aid devices may or may not be an option. RIC and BTE hearing aid styles often come with rechargeable batteries. However, CIC and ITE styles are usually designed with disposable batteries. Size is the differentiator between these common hearing aid styles — ITE and CDC hearing aids are usually much smaller than RIC and BTE options.

Bluetooth capabilities

Avid smartphone users will likely want a hearing aid with Bluetooth capabilities. This allows your hearing aid to sync with your device to stream music, answer phone calls, and hook up to smartphone apps for easy adjustment.

Customizable programs

Some hearing aids allow users to switch quickly to preset programs based on changes in their listening environment.

This gives the user more control and the ability to adapt quickly to environmental sounds like wind, traffic, and music. It’s best to have these custom programs set up by your audiologist, who can adjust the settings to fit your unique needs.

Directionality

This feature is important for people who enjoy environments known for loud noises, like concerts or large gatherings.

Rather than boosting all the sounds in an environment, directionality allows the hearing aid to tune into one primary sound. This feature helps cut background noise so the user can be focused on the sounds they want to hear.

Water-resistance

No hearing aid is completely waterproof. However, some devices are water-resistant. This feature makes them less prone to being ruined should you get caught in the rain. Some allow wearers to continue to use their devices in the pool or when performing sweat-inducing exercises.

Where can you buy hearing aids?

While certain types of hearing aids can only be purchased with a prescription and the help of an audiologist, the Food and Drug Administration (the FDA) approved a new category of hearing aids, over-the-counter, in August 2022 in an effort to make them more affordable and accessible.

The approval made hearing aids more accessible — perhaps even stylish. However, you’ll want to remember important factors when deciding between OTC and prescription devices, as each has its share of benefits and drawbacks.

The pros of OTC hearing aids

• Most are much more affordable than prescription hearing aids. Retailers such as Walmart, CVS, and Best Buy offer hearing aids for as inexpensive as $100 per device.
• You can get them without a prescription or clinic visit. Access to over-the-counter options allows customers to purchase a pair of hearing aids at pharmacies and retail stores. Skipping the audiologist visit or hearing test can save you time and money.
• Some are Bluetooth-enabled, allowing for self-adjustment. OTC brands like Jabra Enhance are keeping up with technology, allowing users to connect their hearing aids to their smartphones via Bluetooth. Some OTC devices even allow you to stream music and make calls.

The cons of OTC hearing aids

• Most only work for those with mild to moderate hearing loss. OTC hearing aids are not designed for people with severe or profound hearing loss. These individuals need a more powerful hearing aid to suit their needs.
• Quality and professional support are not guaranteed. Without the help of an audiologist, patients are left to self-diagnose their own hearing problems and choose a hearing aid themselves. This allows freedom and flexibility but removes the insight and advice a professional can offer.
• You usually can’t customize them to a diagnostic hearing test. Prescription hearing aids are fitted and programmed for each individual, while OTC options are not. This means they won’t necessarily fit your specific hearing needs.

The pros of prescription hearing aids

• Customizable to your diagnostic hearing test. Audiologists perform hearing tests that assess your degree and specific type of hearing loss. After this, they can recommend the hearing aids that will best meet your needs.
• Many have rechargeable batteries and Bluetooth capabilities. Many newer prescription hearing aids can be charged overnight, similar to a cell phone. They can also connect to smartphones and other forms of technology for easy listening. Talk to your audiologist about what you’re looking for in a hearing aid so they can find the type that works for you.
• Quality is all but guaranteed with every brand. Standards for hearing aids are regulated by the FDA through the American National Standards Institute (ANSI). This provides consumers with quality devices and sets the industry standard. Additionally, audiologists in clinics often only sell certain brands of hearing aids that they are trained on and familiar with, giving patients the best first-hand knowledge.

The cons of prescription hearing aids

• Cost. Hearing aids are expensive, averaging between $2,000 and $3,000 for each device. The cost of hearing aids often includes the fitting by an audiologist and maintenance during the device’s warranty period. However, this isn’t always the case, so be sure to check with your audiologist to know what’s included in your purchase.
• Insurance reimbursement. Public and private insurance policies are different and can be challenging to navigate. Even if all or part of the device is covered by insurance companies, a person may need to submit additional paperwork and wait for reimbursement.
• Time. “Time is money,” the old cliche goes. Whether or not you agree, using a prescription hearing aid will require a trip to see a professional for a hearing test. This test and commute to an office may be cumbersome for individuals who qualify for OTC devices. However, you may save time with a correct fit in the long run.

Cost expectations, insurance, and warranties

It’s challenging to give a hard-and-fast answer to the question, “How much are hearing aids?” Generally, a hearing aid costs between $1,000 to $3,000 per ear — an important consideration for wearers. So many factors come into play, like features, insurance coverage, and the warranty you choose.

Payment plans and leasing

Typically, a hearing aid provider will have financing options to make a device more affordable and accessible. A payment plan is the most common. This process usually involves someone opening a credit card or line and incrementally repaying the overall cost.

Alternatively, you may be able to lease a hearing aid. It’s not much different than how people lease cars. After a specific time, the audiology center will let a wearer trade in their hearing aid for an upgraded model, such as one with more advanced technology.

Some non-profit organizations, like the Help America Hear program, may also help those most in need of financial assistance to afford a hearing aid.

Insurance

Every insurance plan is different, and while some plans provide coverage for hearing tests and hearing aids, others do not. Always check with your health insurance provider first to know what will be covered.

For example, Medicare does not cover the costs of hearing aids but will cover hearing tests if medically necessary, and private insurance companies will have different policies.

Warranties and after-sale services

The warranty level will vary. For instance, some brands offer repairs but not replacements. Others include replacements under specific conditions. That said, OTC and prescription devices can both come with one.

Some states require a trial period by law that allows a hearing aid to be returned for any reason. These trial periods typically range between 30 and 60 days. Check your state’s laws before purchasing your device.

All manufacturers’ devices have what’s known as a “standard limited warranty.” These warranties will cover repairs needed for component failures, fixable external damage, and remakes needed for improper fits. Factory warranties usually run for one to four years and cover a device’s loss, damage, and repair.

However, these warranties only apply to devices purchased from authorized dealers. Your audiologist can walk you through different warranty options before purchasing a hearing aid.

How to choose the best hearing aid for you

Audiologists are trained to test a patient’s hearing and recommend hearing aids for each situation. Your audiologist will consider factors such as your lifestyle and activities, your degree of hearing loss, and even the size and shape of your ear canal before recommending the right choice for you.

You can also “test drive” different models by trying them on during your selection process. Here are a few considerations to keep in mind when choosing a hearing aid.

Consider your degree of hearing loss

The degree of hearing can help determine which type of hearing aid best suits your needs. For instance, people with mild to moderate hearing loss will likely be able to find an OTC device that meets their needs. However, individuals who experience severe and profound hearing loss will want to invest in a prescription aid.

The FDA approval for OTC hearing aids only includes ones for people with mild or moderate loss.

Assess the lifestyle you lead

Your lifestyle may affect your decision or your care team’s recommendation. People with active lifestyles may do best with invisible-in-canal devices. These devices stay in place more easily during favorite daily activities like power walks, hikes, and cycles because they are designed to fit deep within an ear canal. Additionally, people who sweat or swim regularly or live in a rainy climate may wish to opt for a water-resistant device.

Individuals with motor skill challenges that make it difficult for them to change batteries may prefer a rechargeable device. Those looking to stream music and take calls can purchase in-the-canal, in-the-ear half-shell, or in-the-ear full-shell styles.

Hearing aid styles and comfort

Comfort and style are subjective, but the good news is that a great deal of today’s hearing aid styles allow wearers of all preferences to look and feel their best.

For instance, some people want a hearing aid in a small size. In-the-canal devices are more discreet, which some people prefer if they want to keep their condition more private. These devices are also well-equipped to stay put during workouts, a perk for people with active lifestyles. However, they are so small that they can be challenging to handle if a person has dexterity issues and usually require disposable batteries.

RIC devices can also be discreet and comfortable, partly because the design leaves users feeling less “plugged up.” BTE devices are generally larger but accessible to people with any degree of hearing loss.

Proper hearing aid maintenance and care

Taking good care of your hearing aid can extend its lifespan (and save you time and money in the process). The best care will depend on your hearing aid type, but you’ll want to wash your aid after each use.

For most devices, you’ll gently wash the earmold of the device using warm and soapy water. Give it a gentle shake to eliminate excess water before letting the device completely air dry overnight so it’s ready to go the next day. You can also use wipes. If you’re looking for device-specific cleaning instructions, check your hearing aid’s care kit.

Adjusting to your new hearing aid

Hearing aids can take a while to get used to. You’re experiencing different, more amplified sounds and new sensations in and around the ear courtesy of your small electronic device. Typically, it will take several months to fully adjust to your new hearing aid.

Common hearing aid problems

Hearing aids can be beneficial, but hurdles can prevent people from getting the most out of them and may even deter a person from wearing one. These common problems generally have solutions:

• Discomfort. Feeling plugged up, also known as occlusion, is a common issue. Earwax, moisture, and poor ventilation or fit can leave users feeling like their ears are blocked.
• Poor fit. If your hearing aid constantly falls out or feels loose, it may not fit correctly. A standard limited warranty will cover replacements for improper fit.
• Feedback. Hearing aids amplify sound. If these amplified signals bounce from the ear canal to the microphone, it can cause feedback.
• Distorted sounds. Sound doesn’t always come through the way it should. Sometimes, this sound quality issue is because the batteries are low or there’s wax build-up on the ear mold.

Your best bet is to contact your audiologist or the manufacturer if you have consistent hearing aid issues.

The impact of choosing the right hearing aid

Today’s hearing aids come in many styles with distinct features and at various price points. Finding the right one for you can enhance your quality of life if you’re having trouble hearing, helping you feel more connected with the world around you.

The best hearing aid for you (or your family member) will depend on your budget, degree of hearing loss, and desire for specific features like higher levels of technology. As positive as it is to have so many options, it can be overwhelming. An audiologist can help you find your best fit — literally and figuratively.