Best Hearing Aids in 2020

How We Rated Hearing Aids

Based on nearly 30 years of clinical experience fitting hearing aids from all manufacturers, and hands-on testing of the latest product lines, I rated each provider based on total user experience taking into account fit, affordability, effectiveness, and technology.

The features listed are an aggregate of features available in a given manufacturer’s current line of products, but may not be present at all price points. For a detailed description of each feature, click here.

A Comparison of the Best Hearing Aid Companies

How I Recommend Hearing Aids to Patients

I get asked all the time, “what’s the best hearing aid?” As I used to say to my university students, it depends.  When meeting with patients in the clinic, I try to get an idea about their areas of greatest need and then attempt to match features with those needs. Manufacturers print out “Lifestyle Guides” which are in reality sales tools to steer folks into the highest technology level they can afford. There’s nothing inherently wrong with this, but it’s not at all scientific.

In addition to traditional hearing evaluation, I also perform two additional measures for those considering hearing aids. The Abbreviated Profile of Hearing Aid Benefit (APHAB 2) was developed by Cox and Alexander at the University of Memphis in 1995. This 24 item questionnaire helps me identify the amount of difficulty in four types of listening: Quiet settings (Ease or Listening or EC), Reverberation (RV), Background Noise (BN), and Aversiveness to loud sounds (AV).  These scores can then be compared to a normative database of others with and without hearing loss. The APHAB is available as a PDF download and is also included in the Noah hearing aid software system that nearly all brick and mortar dispensing locations use.

When I look at these scores, I draw lines to specific hearing aid features as follows:

• The higher the EC scores, the more difficulty the person has hearing in the nest case scenario of a quiet room. This deficit is easily addressed by any hearing aid that has sufficient power. The only products in this review that would screen out at this stage would be those specifically designed for hearing loss less severe than “severe.”
• The RV and BN scores are very much related, and I typically consider them together. In my experience, if these scores are higher than 50%, I strongly advise remote microphones and TV streamers.
• AV scores relate to the reality that all people with sensorineural hearing loss experience abnormally rapid growth of loudness perception called recruitment.  Those with AV scores over 50% need some meticulous attention when fitting their hearing aids. For these folks, I make sure that I measure the loudest sounds they can tolerate (called UCL) at all test frequencies. Then I make sure that the hearing aids we consider have adjustment channels very hear the frequencies where their UCL’s are closest to their thresholds.

About three weeks after the initial fitting, I repeat the APHAB, and ideally, all the high scores are lower. If not, then I got some of the feature-matching incorrect.

After the APHAB, I also perform a Quick Speech in Noise (Quick SIN) test 3. This recorded test presents short sentences with increasing amounts of background noise, similar to what you’d hear at a pre-COVID cocktail party.  This test is available as a stand-alone CD and is also built into several popular audiometers. The scoring recommends features that match up with the “Signal to Noise Ratio Loss (SNR Loss).  Like the APHAB, I repeat the Quick SIN once the hearing aids have been fitted.

Another big part of my evaluation is to look at dexterity and how tech-savvy the client is. The first guides discussion about device size, shape, and power (zinc-air vs. rechargeable).  The second opens the door to the discussion of smartphone apps.

Finally, I look at how much tinnitus the patient has and how troublesome it is. I use the Tinnitus Handicap Inventory to measure this before and after addressing it. The American Tinnitus Association has a great online version 4. This score maps to tinnitus sound generators and smartphone apps.

Looking at these factors, I tend to group potential hearing aid users into four categories:

Group 1:

• Hearing thresholds in mild to moderate range
• APHAB RV and BN less than 20%
• Quick SIN SNR Loss less than 5 dB
• Tinnitus Handicap Inventory in Normal range
• Able to handle all size Zinc-Air Batteries
• Uses smartphone and tablets daily

Group 2:

• Hearing thresholds in mild to moderate
• APHAB RV and BN between 20% and 50%
• Quick SIN SNR Loss between 5 and 10 dB
• Tinnitus Handicap Inventory in the mild range
• Able to handle size 312, 13 and 675 Zinc-Air Batteries
• Uses smartphone for calls and tables a few times a week

Group 3:

• Hearing thresholds in moderate to severe range
• APHAB RV and BN 50%
• Quick SIN SNR Loss between 10 and 15 dB
• Tinnitus Handicap Inventory in moderate range
• Able to handle size 13 and 675 Zinc-Air Batteries
• Uses smartphone occasionally

Group 4:

• Hearing thresholds in severe to profound range
• APHAB RV and BN greater than 50%
• Quick SIN SNR Loss greater than 15 dB
• Tinnitus Handicap Inventory in Severe range
• Able to handle  only 675 Zinc-Air Batteries
• Does not use smartphones or tablets

So Doc, How Should I Narrow Down My Choices?

If you’ve gotten this far, you know that level of hearing loss is an important consideration.

• Group 1 Patients – Eargo
• Group 2 Patients –  Tie between Audicus, Beltone, and Miracle-Ear
• Group 3 Patients – Tie between Oticon, Signia, and Starkey
• Group 4 Patients – Tie between GN ReSound and Phonak

Within each category, there are financial considerations. While I don’t think very many people actively look for ways to spend the most they can for technology, yes, there are folks for whom typical prices are not a real issue. I know of no research that correlates financial resources with the above categories of patient need, so I’ll just leave the pricing and financing information in each summary for your review.

Feature Descriptions and Considerations

Warranty

All hearing aids provide at least a “parts and labor” type of standard warranty.  In traditional hearing aids, this has almost universally been one year from the date of fitting. With new companies getting into the game via internet sales, we’re starting to see shorter standard warranties.

In addition to “if it’s broke, please fix it” coverage, most companies also offer a one-time replacement for loss or damage beyond repair (e.g., dog eats it, Hearing aid vs. lawnmower, etc.) historically called “Loss and Damage: or “L&D.” This typically mirrors the length of the repair warranty. It is not uncommon for there to be a deductible for filing an L&D claim of a few hundred dollars per instrument. If a claim for loss is fulfilled and then the original device is found, it should be surrendered to the manufacturer. If you send that device in for service, it will often be confiscated.

Most traditional companies allow you to purchase additional years of both repair and L&D coverage.

Return Option

Sometimes referred to as a trial period, this ability to cancel the sale and obtain a refund is included in all US state hearing aid sales statutes. Internet-based sales also offer this return option. In a traditional sales model, it is typical for the dispenser to retain a portion of the sale price to cover the time spent between the sale and the return under the assumption that they tried to “get it right” before you cancel the transaction. The maximum ammonium retained is dictated by stature and detailed on the original sale agreement.

iOS Streaming

Also called “made for iPhone,” this feature allows the hearing aid to stream telephone and audio directly from an Apple iPhone, iPad, iPod, or Mac to the hearing aid using the Bluetooth LE protocol without the need for an intermediary device.

Android Streaming

Also called “made for iPhone” this feature allows the hearing aid to stream telephone and audio directly from Android-based smartphones and tablets to the hearing aid using the Bluetooth LE protocol without the need for an external device. At this point, only Phonak can stream to their devices using the “Bluetooth Classic” protocol. Looking at the full range of small, inexpensive Bluetooth LE earbuds on the consumer electronics market, I expect more companies to crack this nut soon.

Rechargeable

The products listed above as rechargeable use Lithium-Ion batteries and plug-in chargers to power the hearing aids.

Zinc-Air

Zinc Air is the traditional power cell used in hearing aids. They are available from dispensers at retail stores and on the Internet, usually at a cost of less than one dollar per cell. Depending on the size, expect them to last between 3 and 14 days.

LiON Charge Time

This is the manufacturer’s reported time to deliver a full charge to the hearing aids.

LiON LifeStream

This number is the manufacturer’s reported use time when using the hearing aids to listen through their onboard microphones as well as stream audio wirelessly. This was generally reported based on 50% of the time streaming, but was often a very vague “it depends.”

LiON Life Mic

This number is the reported use time without streaming. Note that some consumer literature will indicate this as “all-day,” but dispensers have access to a more precise number if needed.

Stock CIC

This indicates if the manufacturer offers a Completely In Canal device that uses a stock sleeve, allowing you to buy it and walk away the same day. Those without this designation will require an ear impression and at least a few days to make and ship a custom CIC.

Self Test

If the manufacturer offers a self-test, either online or within a smartphone app, they will have this box ticked.

Internet Sale

Traditional hearing aids are sold through brick-and-mortar offices. Those with this indicator also, or in some cases, exclusively sell their products online.

Remote Support

All hearing aid companies have websites and toll-free numbers, but this indicates the ability for a dispenser to adjust your hearing aids remotely either via the internet or by sending changes to your hearing aids through a secure connection to your smartphone app.

Remote Control

This indicates that the manufacturer offers a physical remote control for at least some of their hearing aids.

TV Streamer

This indicates that a device is available to connect to your TV that streams the audio signal wirelessly to your hearing aids.

Remote Mic

This indicates the availability of a remote microphone to capture voices and stream them to your hearing aids.

T-Coil

This indicates that at least one device in the manufacturer’s current line up offers a telecoil, which is a universal receiver for hearing loops and other electromagnetic inductance audio systems. These need to be activated and adjusted by the dispenser at the fitting to work correctly.

iOS App

The availability of one or more applications for iPhone, iPad, or iPods. These apps provide a variety of functions, including remote control, education, rehabilitation, and tinnitus management.

Android App

The availability of one or more applications for Android-based smartphones and tablets. These apps provide a variety of functions, including remote control, education, rehabilitation, and tinnitus management.

Financing

Information about the availability of payment plans and other financial assistance for the purchase of hearing aids.