Looking into hearing aid options? You’re not alone. 30 million people in the United States have hearing loss, and the majority of those people have never tried hearing aids. If you are investigating hearing aids for the first time, you may be overwhelmed by all the options out there. This article will walk you through the important things to know about finding the best hearing aid for you.
How do hearing aids work?
First of all, you may have read that the best hearing aids are digital. In truth, these days it’s hard to find a hearing aid that isn’t digital. What was once cutting-edge technology has become standard, and digital hearing aids have dominated the hearing aid market for twenty years. All digital hearing aids consist of three primary components: a microphone (or, usually, a pair of microphones) that takes in sound, a computer chip that processes the sound and amplifies some parts of it, and a speaker which puts out the processed sound. The speaker is, confusingly, called the receiver in hearing aid terminology.
The quality of hearing aids depends primarily on what that computer chip is able to do. The most basic hearing aids, including the cheap drugstore devices known as Personal Sound Amplifier Products, or PSAPs, essentially just amplify everything equally with minimal processing. High-quality hearing aids are able to amplify just the frequencies where your hearing is impaired, filter background noise, focus their microphones toward speech, and generally provide a more natural sound quality compared to the cheaper devices.
Many hearing aids offer features such as Bluetooth connectivity (which allows you to pair your hearing aids to your phone, control them via an app, take phone calls through them, and stream audio) and rechargeable batteries. These features are also becoming standard, and generally aren’t what determines the price of the hearing aids; the sophistication of the sound processor is the primary driver of price.
Types of hearing aids
Hearing aid styles can be broken down into two primary categories: behind-the-ear and in-the-ear. Behind the ear hearing aids have the microphones and sound processor encased in a module that sits behind your ear, and the sound is piped into your ear via either a tube (as in true BTE hearing aids, which are mostly used for profound hearing losses and for children) or a thin wire where the speaker is actually inside the ear canal (as in receiver-in-the-ear or RIC hearing aids – remember the speaker is called a receiver here). RIC hearing aids are by far the most popular hearing aids these days, owing to their small size, natural sound quality, ease of maintenance, and the fact that new technological innovations are almost always available in RIC aids first.
In-the-ear hearing aids are typically custom-fitted and require that an impression be taken of the inside of your ear, although there are a few non-custom options available such as Signia’s Silk product. They range in size from the Completely-In-Canal, or CIC aid, which is very small and fits entirely inside the ear canal, up through the In-The-Canal (ITC) and the In-The-Ear (ITE), which are increasingly large but offer additional features and longer battery life the larger they become.
When people first begin researching hearing aids, they frequently gravitate to CIC style hearing aids because they like the idea of invisibility. This is indeed a benefit, and can certainly be appropriate for some individuals. It’s important to know the drawbacks as well: CIC aids are not rechargeable and run on the smallest batteries on the market, meaning you have to change batteries every three to four days. They do not have Bluetooth, and the smallest ones aren’t even wireless, because the size of the device doesn’t allow the antenna to fit inside it. And if you have hearing loss only in the high frequencies – as many people do – plugging up your ears with any type of in-the-ear hearing aid will cause your own voice to sound loud and hollow to you, while actually blocking out the natural sound that you would have been able to hear perfectly well with your own ears.
Receiver-in-the-canal (RIC) aids allow for a more open fitting, meaning that the speaker only takes up a portion of your ear canal, allowing natural sound to also come in. For folks with good low-frequency hearing, this allows the hearing aid to enhance your hearing rather than taking it over. For folks who do have moderate or severe hearing loss in the low frequencies, RICs are versatile enough to accommodate their needs with a simple change of the silicone tip that covers the receiver. Additionally, they are surprisingly invisible! The main portion of the hearing aid, the module that sits behind the ear and contains most of the electronics, is largely hidden by your ear itself, and if you have long hair it’s completely hidden. The wire that comes over the top of the ear to pipe the sound into your ear canal is so thin as to be nearly invisible to anyone who isn’t specifically looking for it.
Now, with over-the-counter hearing aids on the near horizon, there may be other types of hearing aids available soon. Some of these devices may look more like sports earbuds than typical hearing aids. There is plenty of room for innovation in this space, and it will be interesting to see what companies come up with!
Which hearing aid is the best for you?
With so many options available to choose from, it can be hard to know where to start. Your best bet is to discuss your budget, lifestyle, and hearing requirements with your audiologist or hearing care professional. The primary considerations are as follows:
- Your level of hearing loss. If you have profound hearing loss, a more powerful BTE hearing aid with a tube and custom earmold will likely be the best hearing aid for you. If you have mild to moderate hearing loss, you will probably do best with a RIC aid which will enhance your existing hearing and selectively amplify only the frequencies where you have trouble. Whether you are missing only high frequencies or have hearing loss across all frequencies also matters.
- Your lifestyle and listening environments. If you are retired and not socially active, preferring to spend quiet time alone at home, you may not need high-end hearing aids. If you work a job that puts you in noisy or reverberant environments, frequent meetings or high-stakes situations where mishearing things could affect your performance (courtroom attorneys are my favorite example here), you would absolutely benefit from the more sophisticated noise reduction and speech enhancement offered by advanced hearing aid technology.
- Specific features you may need or want. If you know you need a telecoil-equipped hearing aid in order to use the “loop” system at your church or another public place, you’ll need to look for this in particular, as many hearing aids don’t have telecoils. If you want Bluetooth audio streaming, some hearing aids are better for iPhones and some are better for Android phones, and not all phone models are supported. Most folks these days prefer rechargeable hearing aids, but if you have specific reasons for preferring batteries – frequent off-grid travel, for example – you’ll want to look for this in particular. Other features to look into include accessories such as TV streamers and remote microphones.
- Hearing aid brands/manufacturers. The hearing aid industry is dominated by six major players. All six are large international corporations, and all six make equally high-quality hearing aids in every style listed above. Hearing aid technology changes rapidly, and companies are in very close competition with one another. This is good for the consumer because it means hearing aid pricing, features, and quality stay competitive. The Big Six, in no particular order, are as follows:
- Signia (previously known as Siemens)
Of course, there are many other hearing aid manufacturers out there. Some of them are smaller companies that offer equally high quality as the big companies do, but some of them are cheap knock-offs that will only make things loud and unclear. If you choose to purchase a lesser-known brand of hearing aid, do your research. If it seems too good to be true, it probably is! Our position is that the most reliable way to ensure you’re purchasing a quality hearing aid is to stick with the Big Six.
This guide has largely skipped over the new category of over-the-counter (OTC) hearing aids because at the time of writing, they aren’t yet available. We would suggest that if you are looking into these options, you’ll still want to start with a hearing test, as these devices are only appropriate for mild to moderate hearing loss. For a more comprehensive discussion of OTC hearing aids, see our previous article on the topic Here