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How to Choose a Hearing Aid

Learn about the different types of hearing aids and how to choose the right one for your needs.

Brad Ingrao Dr. Brad Ingrao Audiologist

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If you're new to the world of hearing aids, you may be full of questions and feel overwhelmed with the myriad choices. As with any new endeavor, learning more about the topic will help put your mind at ease and give you the confidence to make the right choice.

I began practicing audiology in 1992. Over the years, I've seen thousands of patients and have been actively involved in consumer groups for hearing loss. I wrote this guide to equip those experiencing hearing loss with the knowledge they need to find the hearing aid.

In this guide, I'll explain the different types of hearing aids that are available, so you can decide which will work for you or your loved one. I'll also go into detail about the types of hearing loss that can occur — and the early warning signs you should know.

Improve Your Hearing With a Pair of Hearing Aids

Are you looking for an affordable pair of hearing aids that fits your budget? Or do you want top-of-the-line hearing aids that can provide the absolute best sound quality and features? Maybe something in between? Regardless of your specific needs, we are here to help on your hearing journey with up-to-date information, hands-on reviews, and general guidance. Be sure to check out some of our favorite hearing aid brands below to learn more.

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Best Hearing Aids for Every Need

We’ve researched and reviewed the industry’s top providers to help you find the best hearing aid for your needs.


Hands-On Hearing Aid Reviews

Our detailed, hands-on reviews of the industry’s most popular hearing aids will give you an inside look at our experience with the company’s products and our key takeaways.


Getting the Best Deal on Popular Hearing Aids

Want a closer look at pricing and value? Visit our pricing pages for these popular providers to learn more and learn how to get the best deal on your hearing aids.


Comparing the Top Hearing Aid Providers

MDHearing Volt packaging

With so many hearing aids on the market, comparing providers side by side is a helpful way to determine which device is best for you. If you’re struggling to pick between two providers, take a look at our comparison pages.


Additional Hearing Aid Resources

Whether you’re looking for step-by-step how-to guides or resources on Medicare coverage for hearing aids, we’ve got you covered with a wide range of additional hearing aid resources.


I began practicing audiology in 1992. Over the years, I’ve seen thousands of patients and been actively involved in consumer groups for hearing loss. I wrote this guide to accomplish a few things.

First, I’d like more people to seek help for hearing loss. Millions of Americans (mostly seniors) have hearing loss. A discouraging fact has rung true for almost a century: just 20 percent of people who would benefit from a hearing aid wear one.1 In my experience, a big reason for that is a lack of knowledge. This guide aims to address this.In my experience, a big reason for this is a lack of knowledge. This guide aims to address this.

Second, I wanted to open the curtain on the seemingly endless options for hearing aids. Just like buying a car, there are hundreds of makes and models to choose from. But if you zoom out a bit, all of them have four wheels, a frame, a motor, and a body. Beyond that, most models just differ based on convenience and style. Hearing aids are much the same.

Finally, I wanted to arm you with some not-so-common tools to weed out the good, the bad, and the ugly in terms of who actually dispenses these devices. Returning to the car analogy, you want a mechanic who won’t quit “wrenching” until your ride is purring like a kitten. With a smidge of knowledge and healthy skepticism, you can push your “hearing mechanic” to help you hear the best you can.

Check out this interesting hearing aids study!

What is a Hearing Aid?

Hearing aids are electronic devices that can be worn in or behind the ear. Hearing aids improve the lives of those who have mild to significant hearing impairments. But, as I counsel my patients, they aren't  a cure for hearing loss. Rather, they improve the quality and level of sound around you. This increases your ability to comprehend human speech and enjoy the sounds of life while they're being worn. Once you pop them out, your hearing will revert back to its natural state.

The moral of the story? You have to wear hearing aids to reap their benefits. That's why buying the right type is so important. Hearing aids that don't work tend not to be worn.

How Do Hearing Aids Work?

Hearing aid technology is constantly changing and improving. But in general, most hearing aids work in a similar way. When you wear a hearing aid, sound vibrations enter the ear and travel into the ear canal. These vibrations continue to travel through the eardrum and the small bones of the middle ear, and into the inner ear; this is where the sound is processed and sent to the brain.

Hearing aids contain one or more microphones that pick up sound, a digital amplifier that makes sounds louder, and a receiver that sends sound into the ear canal. These components work together to amplify and crystalize the sounds around you. Many hearing aids are even engineered to prioritize important sounds, like voices.

Need Help Finding the Right Hearing Aid?

Answer a few easy questions to find the hearing aid that’s right for you.

What Types of Hearing Aids Are There?

Now that you have some general knowledge about the hearing aid types from the previous section. Take a moment to check out this video on the Types of Hearing Aids from the Senior Living YouTube Channel. In this video, we cover all of the major hearing aid types, how they work, and some of their functionalities. Hear all of this information directly from our resident audiologist Brad Ingrao, Au.D.

Hearing Anatomy 101

Hearing aids fall into two major categories — in-the-ear (ITE) and behind-the-ear (BTE) — and a few subcategories in terms of style or shape. In general, the internal electronics are the same across styles of a given model, but some features may not be available in certain styles due to size. The currently available styles are as follows:

Types of hearing aids

As you can see, there are a lot of options when it comes to the size and shape of hearing aids. As an audiologist, I've noticed that most of my patients prefer not to advertise their hearing loss. The exception is typically younger folks who opt for bright and obvious BTE versions. People who prefer very discreet hearing aids should see if the invisible-in-the-canal (IIC) or extended wear (EW) options are appropriate for their hearing loss level and needs.

Unless you're completely bald, the receiver-in-canal (RIC) style, when color-matched to the hair, is nearly invisible in most cases. Hearing aids that look good (or at least acceptable) are very desirable; however, it’s essential to realize that going that small means you may have to compromise on some features.

Take a moment to check out our video on types of hearing aids below. In this video, we cover all of the major hearing aid types, how they work, and some of their functionalities.

Learn about the different types of hearing aids.

Hearing Anatomy 101

Now that we know what types of hearing aids there are, let's talk about hearing anatomy; it will help you better understand what causes hearing loss and how to address it. The human hearing system has four parts:

  • The outer ear collects, directs, and amplifies incoming sound. This part of the ear includes the Pinna (where you hang your glasses), the ear canal, and the outer surface of the eardrum (tympanic membrane).
  • The middle ear is a mechanical amplifier. Behind the eardrum, the three smallest bones in the body: the hammer, anvil, and stirrup (or malleus, incus, and stapes for you Latin aficionados) amplify the sound energy in the ear canal; they also deliver those enhanced vibrations to the inner ear. Collectively, these bones are known as ossicles. An often-neglected part of the middle ear is the Eustachian tube. This structure connects the middle ear to the back of the nose and allows your ears to “pop” on an airplane or when scuba diving.
  • The inner ear includes the cochlea and vestibular, or balance system. The cochlea contains roughly 30,000 tiny receptors called hair cells; these receptors convert the vibrations in the cochlear fluid into nerve impulses. The inner ear’s balance components convert movement into nerve impulses.
  • The central auditory system is the “computer” of hearing. It includes a sophisticated group of structures in the auditory nerve, brain stem, and several areas of the brain — these brain areas decode the nerve impulses from the inner ear into perceptions of pitch, loudness, and duration. This system combines with memory to allow us to hear and understand speech and other sounds.

How to Know If You Have Hearing Loss: Tests and Evaluations

Now that we know a little about what might cause hearing to decline, let’s talk about how to find out if your hearing isn’t up to snuff.

People with hearing loss tend to exhibit or notice one or more of these behaviors:

  • Asking people to repeat themselves, particularly in settings with background noise (restaurants, stores, offices, etc.)
  • Listening to television or other media at a louder volume than family or friends
  • Avoiding social situations that require listening (meetings, houses of worship, parties, etc.)
  • Missing the punch lines of jokes
  • A decreasing level of confidence that you understand what people say
  • Monopolizing conversations to avoid having to hear and understand other people
  • You've started to notice tinnitus sounds, like humming, ringing, or buzzing, in one or both ears

In the video below, I further discuss how to spot the early signs of hearing loss with SeniorLiving.org's Editor-in-Chief Jeff Hoyt.

Learn from AuD, Brad Ingrao, about the early signs of hearing loss.

If you do any of these things more often than you change the oil in your car, you should have your hearing evaluated. There are two basic forms of checking out your hearing: a screening and an evaluation.

Hearing Screenings and How They Work

A hearing screening is used to determine if hearing loss likely exists. It's not a diagnostic test, and it won't identify the specific type of hearing loss you may have or its likely cause.

These types of tests generally only address the sensitivity part of hearing. They're quick and typically free. Like other types of health screenings, a hearing screening lets you know if further investigation is needed. Hearing tests are available in many apps and on websites where hearing aids are sold. You can also use SeniorLiving.org's online screening test as a first step.

Quick Tip:

Quick Tip: Are you looking to take a hearing test for the first time but don’t know where to start? Visit our guide on how to take a free online hearing test.

A hearing care professional may also recommend a type of test called a pure-tone audiometric screening. These are identical to the hearing test you had in the nurse’s office back in elementary school. Like the smartphone apps, they provide a hint into your hearing abilities and indicate if further testing is warranted.

They may also recommend a speech discrimination test. This type of test analyzes your ability to clearly hear and discern speech. Presbycusis — age-related hearing loss — often begins with reduced higher-frequency hearing ability. This test helps sleuth that out.

Hearing Evaluation

If your hearing screening suggests that you may have hearing loss, it’s best to have a complete hearing evaluation. This can be performed by either an audiologist or a licensed hearing instrument specialist.

Your hearing evaluation will include a number of tests, including:

  • Visual inspection of the inner and outer ear
  • Evaluation of middle-ear function
  • Pure-tone testing to identify the softest sounds you hear at each pitch
  • Bone-conduction testing to look for wax or fluid buildup
  • Speech testing
  • Auditory brainstem response to analyze the efficacy of the communication pathways between the inner ear and brain
  • Otoacoustic emissions test to check inner ear function
  • Tympanometry to analyze eardrum movements
Audiologist Dr. Ruth Reisman demonstrates taking a hearing evaluation

Audiologist Dr. Ruth Reisman demonstrates taking a hearing evaluation

What to Expect During Your First Audiologist Visit Video

Making an appointment to visit the doctor can be stressful, but going to your first audiologist visit doesn't have to be! Audiologists are trained professionals who specialize in hearing and the ear, and they can provide you a thorough assessment of your hearing loss. By the end, in terms of your hearing and your knowledge of your ears, things will be crystal clear. Check out the video below to learn what to expect during your first audiologist visit.

Never visited an audiologist before? Brad Ingrao explains what to expect when you first visit an audiologist

If I Have Hearing Loss, Do I Need a Prescription for Hearing Aids?

That depends on the level of hearing loss you have. In October 2022, new legislation was passed that allows hearing aids to be sold over the counter. These over-the-counter (OTC) hearing aids are designed for adults with mild to moderate hearing loss and can be purchased online or from a drug store. Check out our guide to OTC hearing aids to learn more.

There are not currently any OTC solutions available for severe to profound hearing loss; those with higher levels of hearing loss need a prescription for hearing aids suitable to their needs. Prescription hearing aids require an in-person visit to a hearing care professional to assess your hearing needs and help you find the best solution for your hearing loss.

Where to Buy Hearing Aids

There are several places to buy hearing aids, including audiology clinics, retail chains, VA medical centers, and online. Below is a full list of where you can buy hearing aids:

  • Private-practice audiology clinics
  • Otolaryngology offices
  • Manufacturer-owned retail chains such as Miracle-Ear, Beltone, Audibel, Connect Hearing, and Hearing Life
  • VA medical centers
  • OTC retailers such as Walgreens, CVS, Walmart, Best Buy, and Hy-Vee

Hearing Aid Features to Consider

Hearing aids are miniature computers that process sound digitally in real time. They offer many features that can be confusing, and there is no standard lingo for them. Instead, each manufacturer has its own catchy name. Below are the most common hearing aid features described in as generic terms as possible.

Power

Hearing aids, like all electronics, need power to operate. This function was traditionally accomplished with a small, disposable battery. Current versions of these use a “zinc-air” technology; this provides between three and 22 days of use, depending on the size and power requirements of the hearing aid.

In the last few years, rechargeable options have become widely available. Most rechargeable hearing aids fully charge in an hour or two and provide a full 24 hours of use time.

Charging Jabra Enhance Select 300 hearing aids

Charging Jabra Enhance Select 300 hearing aids

Directional Microphones

Everyone, even those with perfect hearing, has more difficulty understanding speech in background noise. Directional microphones lessen that difficulty. The degree to which directional microphones allow you to hear successfully in noise depends on the amount of difficulty you have and the level of noise in the environment. The difference between the loudness of speech and noise is called signal-to-noise ratio (SNR) and is measured in decibels (dB).

Wireless Accessories

In almost 30 years of fitting hearing aids, I rarely encounter patients who hear their best in the real world of noise with just their hearing aids. Fortunately, there are tools to help.

Nearly all ITE, RIC, BTE, and some CIC hearing aids can connect wirelessly to external devices — collectively called accessories. The idea is to overcome the challenges of distance, reverberation, and background noise by capturing the desired signal (speech, music, TV, etc.) in an ideal condition; then, it's beamed to the hearing aids across distances ranging from 30 to 80 feet, depending on the wireless technology. Wireless hearing aid accessories fall into a few categories:

Remote Microphones

These small devices clip onto the clothing of the person who is speaking, or the person wearing hearing aids. There are also remote microphones available that you place on a table, such as in a restaurant or conference room, so you can hear everyone speaking more clearly.

Media (TV) Streamers

Hearing the television well depends on a number of things: the size and shape of the room, whether you’ve updated the shag carpet you installed in the ‘70s, the quality of the speakers, and the recording quality of the program.

A media streamer neutralizes all these variables by taking a direct, hard-wired audio signal from the TV or cable box (RCA or digital TOSLINK) and beaming that signal to the hearing aids; this is akin to the remote microphone. Most are easy to set up; once they are set up, they either automatically connect or you just tap a button on the hearing aid or use a smartphone app to activate streaming.

Remote Control

Even the largest hearing aids have small buttons. Those with wireless capability offer the option to control volume, programs for different listening situations, and streaming using either a smartphone app or a dedicated remote control. The stand-alone remote controls are usually the size of a key fob, and they either use a long-life watch-type battery or are rechargeable.

Smartphone Apps

Almost all wireless hearing aids offer a smartphone app. These apps are generally available on both Apple (iOS) and Android; they're provided free from the manufacturer.

Eargo App Bass and Treble

Eargo App Bass and Treble

In addition to basic hearing aid controls like volume and program selection, some apps offer added services like geotagging. This functionality serves two purposes: First, it allows you to fine-tune the hearing aids and accessories in specific settings, like your favorite bistro; then it has them automatically go to those settings every time you walk in the door. Secondly, geotagging allows the app to “find” a misplaced hearing aid.

Hearing aid apps may also provide you with audiological support, remote programming capabilities, and tinnitus-masking sound libraries.

Check out my interview with SeniorLiving.org Editor-in-Chief Jeff Hoyt for more information on hearing aid accessories.

Audiologist Brad Ingrao explains how you may be better off spending less money on hearing aids and more on certain accessories, such as media streamers, remote microphones, and special smoke alarms.

Telecoil (Tcoil)

This technology is quite old — making its first appearance in hearing aids in the 1930s. Tcoils are electromagnetic receivers that pick up sound transmitted from hearing-aid-compatible telephones and special public address systems called “hearing loops.”

Hearing loops are becoming more popular around the U.S. in places like airports and convention centers. Using them provides the same benefit as a remote microphone — without having to clip anything onto clothing.

Tcoils are recommended in all hearing aids by the Hearing Loss Association of America.8 They are so effective that several states require a signature indicating that a discussion of them occurred during your hearing aid consultation.

Bluetooth Streaming (Wireless Audio)

If a hearing aid can use wireless accessories, it can probably also stream directly from devices like your iPhone, iPad, or Android phone. For instance, if your phone rings, you can answer it and hear the conversation directly through your hearing aids.

Direct streaming uses Bluetooth LE technology or the newer Bluetooth Auracast broadcast audio technology. Streaming enhances your ability to hear telephone conversations clearly and to better hear media such as YouTube, Netflix, and podcasts.

Auracast also lets you share your audio with others. This improved technology is poised to become the next generation of assistive listening technologies.

Moisture Resistance

Modern hearing aids, particularly Lithium-Ion rechargeable models, have all been designed to resist moisture and dust. These water-resistant hearing aids are not technically waterproof, but they can hold their own in the gym, rain, or humid climates. Some hearing aids, like Phonak's Audéo Life, are waterproof. These can be worn while showering or even swimming.

Programming Features

Hearing aids often have programming capabilities that mimic the way your ears naturally adapt to changes in the sound environment. These vary by brand and style. You may be able to change your program through an app or on the hearing aids themselves. Some of these hearing environments are:

  • Quiet conversations
  • Noisy places, like restaurants
  • Outdoors in nature
  • Wind reduction
  • Listening to music

Your hearing aids may also come with programs that log hours of use, social time, and battery life. Some provide health-tracking data, like the number of daily steps and automatic fall detection.

Making adjustments using the Jabra Enhance mobile app

Making adjustments using the Jabra Enhance mobile app

Things to Consider When Making the Purchase

Whether you buy them OTC or get them by prescription, hearing aids can be a heavy financial burden. Keep these things in mind, before you buy:

  • Only buy hearing aids that come with a risk-free trial period and free return option.
  • Look for long-term warranties that cover repairs, loss, and damage claims.
  • Don't buy hearing aids secondhand or from unknown manufacturers.
  • Prices may vary between providers; if possible, shop around.
  • Original Medicare doesn't cover hearing aids, but more and more insurance providers are getting on board with coverage. Keep your hearing needs in mind when comparing insurers, including Medicare Advantage (Part C) plans.
  • To reduce their cost, consider purchasing your hearing aids from a community clinic at an audiology training program.
Pro Tip:

Pro Tip: If you’re worried about the price of hearing aids, there are a few ways to reduce the cost. Head to our guide on how to get free hearing aids for more details.

Adjusting Hearing Aids After Purchase

Prescription Hearing Aids

After purchasing prescription hearing aids, you need your devices fitted and programmed to your specific hearing needs in person. If you work with an audiologist, the hearing aids you select will be ordered; then you will return for a fitting anywhere between two days and a few weeks. The audiologist will adjust your hearing aids to fit your ears and set your sound levels for optimum listening throughout multiple environments. They'll explain how to use all the programming features, such as using Bluetooth, while you drive. Of course, they'll also answer any questions you may have.

If properly fitted, hearing aids shouldn’t need many adjustments. However, it’s important to specify exactly how many adjustment appointments come in the price and how much additional service might cost. This varies between providers, and it can represent significant ongoing costs.

Dr. Ruth Reisman testing and customizing a pair of hearing aids

Dr. Ruth Reisman testing and customizing a pair of hearing aids

OTC Hearing Aids

If you purchase OTC hearing aids, the devices will be shipped right to your door — you won't need to visit a hearing care professional for fittings or adjustments. OTC providers typically offer remote help, so you can get all set up from the comfort of your home; however, these hearing aids aren't usually as customizable as prescription hearing aids. Some OTC hearing aids may even be preprogrammed with little to no room for adjustments.

Keep in mind that wearing hearing aids has a learning curve. Give yourself time to adjust. In the long run, this will provide you with enhanced hearing ability and, hopefully, more enjoyment out of life!

Wrapping Up

As you can see, getting hearing aids is not as simple as grabbing a pair of readers off the rack at the drugstore. Nor is it an insurmountable task!

Hearing is one of our primary senses because it connects us with the thoughts and emotions of those in our lives. As such, it's worth doing your research, asking hard questions, and being patient to find a solution and provider that matches your needs and personality.

After the devices hit your ears, a process or neural rewiring begins that can take up to three months, so be patient. Seek the advice of others who have walked in these new and louder shoes. On the lighter side, remember that the volume control on your new hearing aids gives you the superpower of reducing the rhetoric and amplifying the awesome!


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    Written By:
    Dr. Brad Ingrao
    Audiologist
    Read About Our Panel of Experts
    As a practicing audiologist since the 1990’s, Brad Ingrao, AuD has fitted thousands of hearing aids to seniors and people of all ages. Brad is the Official Audiologist for the International Committee on Sports for the Deaf and a well-known… Learn More About Dr. Brad Ingrao