Preface and Disclaimer

It is outside the scope of our agency's mission to report in depth on the most recent technological advances in the field of hearing aid research, development and production. Our goal in this document is to provide some basic, useful information to consumers who are "new" to hearing loss and who are bewildered by the profusion of hearing aids and the claims and counterclaims made for and against them.

It goes without saying that hearing aids themselves as electronic devices do not exist in a vacuum. They are worn by people, and people will disagree as vehemently with one another on the benefits and drawbacks of particular hearing aid technologies or models as they will on most other subjects. There is no such thing as the "perfect" hearing aid, and it needs to be said at the outset that NO hearing aid is capable of matching the healthy human ear in the reproduction of sound. A hearing aid is exactly that: an "aid" to hearing, not a magical restoration of lost auditory capability. It is a mechanical device, and will not reproduce sound as the unaided, "normal" human ear does. To expect things from hearing aids that they are not capable of delivering is almost certain to lead to premature and ill-advised discontinuation of their use.

Hearing aids are but one tool in the arsenal of technology. Please look at our Assistive Listening Devices page to see what some of the other technologies are than can complement an appropriately fitted hearing aid or even supplant it in some situations.

Diagnosis and Assessment

If you suspect you have a hearing loss, your doctor can refer you to an Otorhinolaryngologist, more commonly referred to as Ear, Nose and Throat specialists or ENT's. This physician will examine your ears to see if there is any underlying disease, abnormality or possible undiagnosed condition that is causing your hearing loss and needs to be treated. For example, ear wax accumulation can in some cases completely block the passage of sound through the ear canal, causing a de facto conductive hearing loss which can be easily reversed by simply removing the ear wax - if the correct diagnosis is made.

MCDHH strongly encourages all consumers who notice a change or deterioration in their hearing acuity to undergo a thorough examination by a qualified medical specialist to determine the origins of this change. While it is possible to sign a waiver allowing the dispensation of a hearing aid without such a medical examination, MCDHH does not believe that this is in the consumer's best interests as hearing loss has been in some cases been known to be one of the side effect of serious illnesses that will go untreated if not diagnosed.

If there is no apparent physiological damage or treatable condition which is causing your hearing to deteriorate, it is possible that you may have developed a sensorineural hearing loss. This, unlike a conductive hearing loss, is not characterized by the breakdown of sound conduction from the outer to the inner ear; rather, it is a malfunction of the delicate auditory nerve complex inside the inner ear. This in turn affects the quantity and quality of the signals sent to the brain for "decoding" into what we then understand as speech or as sounds. With incomplete information to work with, the brain's auditory center cannot construct a full picture of what one is hearing, leaving people to complain that " I hear but don't understand". This type of hearing loss is the most common one; it has many causes ranging from simple "wear and tear" to damage by trauma, disease or other factors. While it is true that seniors are disproportionately affected by this, it is a misconception to think that only older people develop hearing loss. Hearing loss is one of the great "equalizers" in that it affects people of all different ages, cultures, and socioeconomic levels.

If the physician thinks you may have a sensorineural hearing loss, he or she will refer you to an Audiologist, another medically trained professional who will evaluate your hearing by giving you a hearing test. In this test, several things will be assessed: the degree or severity of your loss, the sound frequencies in which it is most apparent, and your speech discrimination (the ability to understand rather than simply hear words, both with and without amplification). Based on the results of this test, your Audiologist may make a recommendation for a hearing aid which he/she believes would be most effective given your individual needs, and refer you to a hearing aid instrument specialist. If he/she is also a dispensing Audiologist, he/she may provide you with the hearing aid directly.

If you are looking for an audiologist near you, the Massachusetts Division of Professional Licensure has a listing of licensed professionals.

The Hearing Aid

Hearing aids today come in several different configurations. They are available as Behind The Ear (BTE) models, ITE ( In The Ear ) models, ITC ( In The Canal ) models and CIC ( Completely in the Canal ) models. Body worn hearing aids still exist but are rarely used. They all essentially work the same: they pick up sound by means of a microphone, amplify that sound, adjust it based on the hearing aid's settings, and feed it into the wearer's ear directly (ITE,ITC, CIC models) or via a small plastic tube ( in the case of a body aid, a wire ) leading to an ear mold.

Several years ago, the first "digital" hearing aids made their appearance. Rather than being true digital hearing aids, the first models were traditional analog hearing aids with digital or "hybrid" controls. From there, it did not take long until the first "true" digital models made their appearance. In theory, these hearing aids provide far better sound than traditional (analog) aids because they are able to receive the incoming sound and then separate it into individual frequencies for selective processing according to the individual's hearing loss, rather than simply amplifying everything indiscriminately. Furthermore, several manufacturers of digital hearing aids touted their products' supposed ability to reduce background noise - a claim that resulted in action taken against these companies by the FDA, which at the time called these assertions misleading because there was no conclusive data to support the claim.

Whether digital hearing aids are worth the several hundred or even thousand dollars more that they cost when compared to traditional analog hearing aids is still a subject of heated debate. For every user who swears by their digital hearing aid, there is another who went back to his or her "old" analog hearing aids. It is, largely, a personal preference, and guided in no small part by the consumer's financial resources. Whichever hearing aid you decide to buy, make sure you obtain, in writing, a receipt on which your right to return the hearing aid(s) for a full refund within thirty days of purchase is clearly stated. Preferably, this should also include a statement guaranteeing the extension of the initial trial period if any adjustments were made to the hearing aid within the first thirty days. While such a return will not include the cost of the ear mold(s) and/or the fitting, it will allow you to recoup the money you spent on the hearing aid(s) rather than wasting thousands of dollars on (a) hearing aid(s) that will spend more time in your desk drawer than behind your ears if you do not like them.

In reality, thirty days is hardly sufficient to become comfortable with a hearing aid, especially if it has been some time since the user has been able to hear. We recommended adhering to the acclimatization schedule your Audiologist or hearing instrument specialist will develop for you, during which hearing aid usage is increased incrementally from one day to the next, preferably in ideal listening environments. Regrettably, many first-time users do not follow these schedules, wearing the hearing aids full-time immediately and using them in the worst possible listening environments. Under these circumstances, dissatisfaction is almost a given, and the blame in this case falls squarely on the user.

Finally, one often overlooked but vitally important characteristic of a hearing aid is its "handling". Even larger hearing aids are in reality quite small , and this can present significant problems for people with vision impairment, Parkinson's, advanced arthritis, and a host of other medical conditions affecting eye-hand coordination and fine motor control. While most manufacturers offer remotes for some of their models, these add significantly to the cost of the aid(s) and are useless in terms of changing the battery or inserting and removing the hearing aid, which are two of the most common problem areas for hearing aid wearers. Thankfully, hearing aid battery manufacturers have recently introduced a slew of more intelligent packaging designed to dispense the batteries from the package directly into the hearing aid; but this still leaves the daunting task of handling a piece of sensitive electronic equipment that could fit inside half a peanut shell. The bottom line: if during the selection process you have even one iota of doubt about your ability to handle the hearing aid, don't consider it.

Shop Smart

It is amazing that most "smart shoppers" who would not dream of purchasing an expensive item without first doing background research, comparing prices among different vendors and even checking up on a particular vendor's track record do nothing of the kind before they put down hundreds if not thousands of dollars on hearing aids. Here are some tips to avoid being sold something you don't need and/or can't afford. Keep in mind again that these are, unavoidably, generalizations and do not apply to every vendor or every situation.

  • If any person tells you that their hearing aid will restore your hearing - leave immediately. They are lying to you and that is not a promising start. In fact, you should report anyone who uses this approach with you to the Board of Registration of Hearing Aid Instrument Specialists .
  • If you express discomfort with the price of the hearing aid , and the vendor becomes insistent that only this hearing aid and no other will do - again, leave. With the profusion of hearing aids on the market today, there is no such thing as one hearing aid that will do something that no other aid will at least approximate . It is true that different hearing aids use proprietary technologies, but it is for you and not the vendor to determine whether this is worth the extra cost.
  • Be aware that dispensing Audiologists and hearing instrument specialists may have exclusive agreements with particular hearing aid manufacturers. This is especially true of franchise businesses, which sell only those hearing aids manufactured by the franchise owner. If you do not find a hearing aid you are completely and totally comfortable with at one particular location then by all means do some comparison shopping elsewhere. Do not "choose the lesser of two evils". A hearing aid is too expensive and too important for you to accept one you know you will not be comfortable with. Remember that for all their knowledge, training and expertise, no medical professional or instrument specialist can get inside your head and hear sound the way you do. You are the best judge of whether a hearing aid's sound quality is insufferable or not. Since subjective experience of sound quality does vary tremendously between hearing aids, you would be well advised to look for an hearing aid you feel very comfortable with.
  • Hearing aid instrument specialists are highly trained professionals and the overwhelming majority or them are very dedicated and very good at what they do. As in every other profession, there are the proverbial "bad apples", and the best way to avoid these is to ask other hearing aid users for recommendations on who to seek out and/or avoid. You can also call the Attorney General's Office of Consumer Protection to find out how many complaints have been logged against a particular vendor in the past. In addition, the Board of Registration of Hearing Aid Instrument Specialists may be a useful resource to you should you find yourself having fallen prey to predatory or misleading sales tactics. Unfortunately, however, after the 30-day trial period has passed, there is little anyone can do for you if the vendor chooses at that point not to accept a return.
  • The word "digital" has a magical ring to it - that of the cash register. As stated in the text above, it is wrong to assume that a digital hearing aid is inherently superior to a cheaper analog model. Insist on a comparison between digital and analog models to see if you would not be just as happy with an analog hearing aid costing hundreds if not thousands less. If you suspect you are being given the proverbial apple and orange to compare, ask for the manufacturer's technical specification sheets on both models, and pay particular attention to the maximum amplification, which is expressed in decibel levels or dB. They will differ but should not do so dramatically.
  • On the flip side, if it sounds too good to be true, it generally is. There have been a number of scams in recent years that involved "hearing assistance devices," usually by mail, for under $50. These are not hearing aids, so if an ad refers to a product that looks like a hearing aid but does not call it one, that should be a BIG warning sign that this is most likely a scam. Hearing aids are sophisticated medical devices and are not inexpensive. Expect to pay at least $ 400 to $ 500 for an analog BTE hearing aid.
  • Find out what, if anything, your health insurance provider covers per calendar year, and what restrictions are placed on that coverage. Again, the best way to keep costs down is not to be lured into buying something you don't need in the first place. If you are able to keep the cost of the aid within reason, then even a relatively small insurance co-payment of $ 500 could, for example, cover three quarters of the expense of an analog BTE, while going for a high-end digital model would still leave you with an out of pocket cost probably in excess of $ 1500 or more.
  • Log onto the Internet and see if you can find reputable online hearing aid vendors. While we do not recommend purchasing anything but an outright replacement without a physician's examination, this will give you some idea of what the baseline cost of the hearing aid may be. If you see a reputable online vendor selling the exact same new hearing aid for $ 500 that your vendor is asking $ 2,500 for, something is wrong, even when the cost of overhead, time spent fitting the aid and everything else is added into the equation. A 500% markup is not justifiable by any standards.
  • Last but not least, do check out the manufacturer's home page and see if they have information on the specific model you are considering. While most of the information is intended for professionals in the industry or medical service providers, it never hurts to have some information to go on and to educate yourself so you are an empowered consumer.

Afterword

The focus of this page has been heavily weighted toward helping consumers realize they are not without options if they - like most consumers who have come to MCDHH over the years - do not happen to have several thousand dollars available and are not covered by any insurance plan that will pay for part of the total cost of hearing aids. We believe that ultimately the only way to increase the percentage of hearing aid use in the population is to adhere to a low-pressure, maximum - benefit for minimum - cost , highly consumer and service - oriented approach, and we applaud the many dedicated Audiologists and hearing aid instrument specialists who share this vision and help us all to hear better.


This information is provided by the Massachusetts Commission for the Deaf and Hard of Hearing.