Hearing Aids

Hearing aids are wearable electronic devices that make selected sounds louder and more accessible to people with hearing loss. A typical hearing aid contains microphones that pick up sound, digital processing that modifies the signal, and a receiver that delivers the processed sound to the ear. Modern devices can analyze incoming sound and adjust amplification according to frequency, volume, direction, and listening environment. Hearing aids are primarily used to manage sensorineural hearing loss, although amplification may also be appropriate for certain patients with conductive or mixed hearing loss. The appropriate device depends on the underlying cause and degree of hearing loss.

Hearing aids may benefit adults and children with hearing loss when amplification can improve access to speech and other important sounds. They are commonly recommended for sensorineural hearing loss associated with aging, noise exposure, genetic factors, certain medications, or other conditions affecting the inner ear.

Common signs that it may be time to consider hearing aids include:

• Frequently asking people to repeat themselves
• Turning up the television or phone volume
• Having difficulty understanding speech in restaurants or groups
• Struggling to follow conversations when there is background noise
• Feeling that people are mumbling
• Avoiding social situations because hearing has become difficult
• Relying heavily on lip reading or visual cues
• Feeling fatigued after conversations because of the effort required to listen

A hearing evaluation is the best way to determine whether hearing loss is present, what type of hearing loss you have, and whether hearing aids are appropriate.

A hearing aid uses microphones to capture sound and digital processing to modify that sound according to the wearer’s hearing needs. The processed signal is then delivered through a receiver into the ear. Modern digital hearing aids can provide different levels of amplification at different frequencies, allowing the device to be programmed to match an individual’s hearing profile.

Advanced hearing aids may also use directional microphones, noise-management algorithms, feedback reduction, environmental classification, automatic program changes, and wireless connectivity. These technologies are intended to make hearing easier in a variety of environments, but they cannot completely separate speech from all background noise or reproduce normal hearing.

Hearing aids come in several styles, and each has advantages depending on the degree of hearing loss, ear anatomy, cosmetic preferences, dexterity, and desired features. Common styles include:

Receiver-in-canal (RIC) hearing aids: A small device sits behind the ear while the receiver is positioned in the ear canal. RIC hearing aids are widely used because they can be discreet while accommodating a broad range of features.

Behind-the-ear (BTE) hearing aids: Most of the electronics sit behind the ear and connect to an earmold or ear tip. BTE devices can provide substantial amplification and are available for a wide range of hearing losses.

In-the-ear (ITE) hearing aids: The electronics are contained in a custom shell that sits within the outer ear. These devices can offer a balance of accessibility, power, and customization.

In-the-canal (ITC) and completely-in-canal (CIC) hearing aids: These smaller devices sit partly or almost entirely within the ear canal. Their small size can be appealing cosmetically, although size limitations may affect available power and features.

The best hearing aid style is determined by your hearing loss and individual needs rather than appearance alone.

Choosing hearing aids starts with understanding your hearing loss and the situations in which hearing is most difficult. An audiologist can use your hearing test results and communication goals to determine appropriate levels of amplification and then compare devices based on features, physical design, connectivity, battery options, and ease of use.

Your hearing aid selection may depend on:

• The type and degree of hearing loss
• Hearing in one ear versus both ears
• Speech understanding
• Ear anatomy and medical history
• Your work and social environments
• How often you communicate in noisy settings
• Smartphone and Bluetooth needs
• Rechargeable versus disposable batteries
• Cosmetic preferences
• Dexterity and ability to handle small devices
• Tinnitus or other hearing-related concerns
• Budget and available warranty or service options

More expensive technology is not necessarily better for every patient. The most appropriate hearing aid is the one that provides suitable amplification and features while fitting your hearing needs and daily life.

Adults age 18 and older with perceived mild to moderate hearing loss can purchase FDA-regulated over-the-counter (OTC) hearing aids without a prescription. Prescription hearing aids remain available through hearing healthcare professionals and may be appropriate for people with a broader range of hearing losses or more complex hearing needs.

OTC hearing aids can be a reasonable option for some adults, but an audiologic evaluation can provide important information about the type and degree of hearing loss before selecting amplification. Medical evaluation may also be appropriate when hearing loss is sudden, asymmetric, associated with other concerning symptoms, or potentially caused by an underlying ear condition. Prescription hearing aids also provide the benefit of professional selection, fitting, programming, verification, and follow-up. These services can be particularly important when hearing loss is more significant or when a patient has difficulty achieving adequate speech understanding with amplification.

Today’s hearing aids can include technologies designed to make listening easier and more convenient. Depending on the device, available features may include:

• Bluetooth connectivity for compatible smartphones and other devices
• Direct audio streaming
• Rechargeable batteries
• Directional microphones
• Background-noise management
• Feedback reduction
• Automatic environmental adjustments
• Smartphone apps for volume and program control
• Remote adjustments in supported systems
• Telecoil connectivity for compatible assistive listening systems
• Tinnitus-management features
• Compatibility with accessories for television or other audio sources

Not every feature is necessary for every patient. The most useful technology is the technology that addresses your actual listening needs.

Bluetooth hearing aids can connect compatible hearing aids directly to smartphones and other devices, allowing users to stream phone calls, music, podcasts, videos, and other audio. Depending on the hearing aid and connected device, Bluetooth functionality can also allow the smartphone to act as a remote control for volume or listening programs.

Bluetooth compatibility varies among hearing aids, smartphones, operating systems, and manufacturers. During a hearing aid evaluation, it is useful to bring the devices you use most often so your audiologist can consider connectivity requirements when recommending hearing technology. For patients specifically interested in Bluetooth hearing aids, The New York Hearing Center also provides more specialized information about wireless hearing technology and streaming options.

A hearing aid evaluation goes beyond simply choosing a device. Your audiologist reviews your hearing test, discusses where you have difficulty hearing, considers your lifestyle and communication goals, and identifies the features that are most likely to benefit you.

The process may include:

1. Reviewing your medical and hearing history
2. Performing or reviewing a comprehensive hearing evaluation
3. Discussing your communication difficulties and listening environments
4. Determining whether hearing aids are medically and audiologically appropriate
5. Comparing appropriate hearing aid styles and technology levels
6. Selecting devices based on your hearing loss and preferences
7. Fitting and programming the hearing aids
8. Verifying and fine-tuning the amplification
9. Providing instructions for use and care
10. Scheduling follow-up visits for adjustments and support

Professional hearing aid fitting is important because amplification needs to be matched to the individual’s hearing loss and then adjusted based on real-world experience.

Hearing aids can sound different when you first begin wearing them. Sounds that have been difficult to hear may become more noticeable, and your own voice may initially sound different. Your brain may also need time to adapt to amplified environmental sounds. Regular use and gradual exposure to different listening environments can help with the adjustment process. If sounds are uncomfortable, speech remains difficult to understand, or the hearing aids do not feel physically comfortable, your audiologist can make programming or fitting adjustments. Follow-up care is an important part of successful hearing aid use. A hearing aid should not simply be purchased and forgotten. Ongoing adjustments, maintenance, and counseling can help you get the most from the technology.

Hearing aids require regular care to maintain performance. Earwax, moisture, debris, and physical damage can interfere with the microphones, receiver, or other components.

Basic hearing aid care includes:

• Cleaning the devices as instructed
• Keeping hearing aids away from excessive moisture and heat
• Following manufacturer instructions for charging or battery replacement
• Keeping microphones and receivers clear of debris
• Using recommended wax filters or domes when applicable
• Removing hearing aids when instructed for activities that could damage them
• Scheduling professional cleaning or repairs when needed

If a hearing aid suddenly becomes weak, distorted, intermittent, or unusually noisy, professional inspection may be necessary.

Hearing aids are an important treatment for many forms of hearing loss, but they are not the right solution for every hearing condition. Some conductive hearing losses may be better treated medically or surgically. Patients with severe to profound sensorineural hearing loss who receive limited benefit from appropriately fitted hearing aids may require evaluation for other technologies, including cochlear implants. Other specialized hearing devices may also be appropriate depending on the type of hearing loss. Bone-anchored hearing systems can be considered for certain conductive, mixed, or single-sided hearing losses, while specialized technologies such as Earlens may be appropriate for selected patients. The goal is not simply to provide a hearing aid. The goal is to identify the hearing solution that best addresses the underlying condition and the patient’s communication needs.