Hearing aids: How to choose the right one

Perhaps you've thought about getting a hearing aid, but you're worried about how it will look or whether it will really help. It may help ease your concerns to know more about:

• The hearing aid options available to you
• What to look for when buying a hearing aid
• How to get used to a hearing aid

Hearing aids can't restore normal hearing. They can improve your hearing by amplifying sounds that you've had trouble hearing.

All hearing aids use the same basic parts to carry sounds from the environment into your ear and make them louder. Most hearing aids are digital, and all are powered with a traditional hearing aid battery or a rechargeable battery.

Small microphones collect sounds from the environment. A computer chip with an amplifier converts the incoming sound into digital code. It analyzes and adjusts the sound based on your hearing loss, listening needs and the level of the sounds around you. The amplified signals are then converted back into sound waves and delivered to your ears through speakers, sometimes called receivers.

Hearing aids vary a great deal in price, size, special features and the way they're placed in your ear.

The following are common hearing aid styles, beginning with the smallest, least visible in the ear. Hearing aid designers keep making smaller hearing aids to meet the demand for a hearing aid that is not very noticeable. But the smaller aids may not have the power to give you the improved hearing you may expect.

Completely in the canal (CIC) or mini CIC

A completely-in-the-canal hearing aid is molded to fit inside your ear canal. It improves mild to moderate hearing loss in adults.

A completely-in-the-canal hearing aid:

• Is the smallest and least visible type
• Is less likely to pick up wind noise
• Uses very small batteries, which have shorter life and can be difficult to handle
• Often doesn't include extra features, such as volume control or a directional microphone
• Is susceptible to earwax clogging the speaker

In the canal

An in-the-canal (ITC) hearing aid is custom molded and fits partly in the ear canal. This style can improve mild to moderate hearing loss in adults.

An in-the-canal hearing aid:

• Is less visible in the ear than larger styles
• Includes features that won't fit on completely-in-the-canal aids, but may be difficult to adjust due to its small size
• Is susceptible to earwax clogging the speaker

In the ear

An in-the-ear (ITE) hearing aid is custom made in two styles — one that fills most of the bowl-shaped area of your outer ear (full shell) and one that fills only the lower part (half shell). Both are helpful for people with mild to severe hearing loss and are available with directional microphones (two microphones for better hearing in noise).

An in-the-ear hearing aid:

• Includes features that don't fit on smaller style hearing aids, such as a volume control
• May be easier to handle
• Uses a larger battery for longer battery life, with several options for rechargeable batteries
• Is susceptible to earwax clogging the speaker
• May pick up more wind noise than do smaller devices
• Is more visible in the ear than smaller devices

Behind the ear

A behind-the-ear (BTE) hearing aid hooks over the top of your ear and rests behind the ear. A tube connects the hearing aid to a custom earpiece called an ear mold that fits in your ear canal. This type is appropriate for people of all ages and those with almost any type of hearing loss.

A behind-the-ear hearing aid:

• Traditionally has been the largest type of hearing aid, though some newer mini designs are streamlined and barely visible
• Has directional microphones
• Is capable of more amplification than are other styles
• May pick up more wind noise than do other styles
• May be available with a rechargeable battery

Receiver in canal or receiver in the ear

The receiver-in-canal (RIC) and receiver-in-the-ear (RITE) styles are similar to a behind-the-ear hearing aid with the speaker or receiver that sits in the ear canal. A tiny wire, rather than tubing, connects the piece behind the ear to the speaker or receiver.

A receiver-in-canal hearing aid:

• Typically has a less visible behind-the-ear portion
• Has directional microphones
• Has manual control options
• May be available with rechargeable battery
• Is susceptible to earwax clogging the speaker

Open fit

An open-fit hearing aid is a variation of the behind-the-ear hearing aid with a thin tube or the receiver-in-the-canal or receiver-in-the-ear hearing aid with an open dome in the ear. This style keeps the ear canal very open, allowing for low-frequency sounds to enter the ear naturally and for high-frequency sounds to be amplified through the hearing aid. This makes the style a good choice for people with better low-frequency hearing and mild to moderate high-frequency hearing loss.

An open-fit hearing aid:

• Is often visible
• Doesn't plug the ear like the in-the-ear hearing aid styles, often making your own voice sound better to you
• May be more difficult to insert into the ear due to the noncustom dome

Some optional features of hearing aids improve your ability to hear in specific situations:

• Noise reduction. All hearing aids have some amount of noise reduction available. The amount of noise reduction varies. Some also offer wind noise reduction.
• Directional microphones. These are aligned on the hearing aid to provide for improved pickup of sounds coming from in front of you with some reduction of sounds coming from behind or beside you. Some hearing aids are capable of focusing in one direction. Directional microphones can improve your ability to hear when you're in an environment with a lot of background noise.
• Rechargeable batteries. Some hearing aids have rechargeable batteries. This can make maintenance easier for you by eliminating the need to regularly change the battery.
• Telecoils. Telecoils make it easier to hear when talking on a telecoil-compatible telephone. The telecoil reduces the sounds from your environment and picks up the sounds from the hearing-aid-compatible telephone. Telecoils also pick up signals from public induction loop systems that can be found in some churches and theaters, allowing you to hear a speaker, play or movie better.
• Wireless connectivity. Increasingly, hearing aids can wirelessly interface with certain Bluetooth-compatible devices, such as cellphones, music players, computers and televisions. You may need to use an intermediary device to pick up the phone or other signal and send it to the hearing aid.
• Remote controls. Some hearing aids come with a remote control, so you can adjust features without touching the hearing aid. Some hearing aids connect wirelessly to a cellphone and have a cellphone application that allows use of the cellphone as a remote control.
• Direct audio input. This feature allows you to plug in to audio from a television, a computer or a music device with a cord.
• Variable programming. Some hearing aids can store several preprogrammed settings for various listening needs and environments.
• Synchronization. For an individual with two hearing aids, the aids can be programmed to function together so that adjustments made to a hearing aid on one ear (volume control or program changes) will also be made on the other aid, allowing for simpler control.

When looking for a hearing aid, explore your options to understand what type of hearing aid will work best for you. Also:

• Get a checkup. See your doctor to rule out correctable causes of hearing loss, such as earwax or an infection. And have your hearing tested by a hearing specialist (audiologist).
• Seek a referral to a reputable audiologist. If you don't know a good audiologist, ask your doctor for a referral. An audiologist will assess your hearing, help you choose the most appropriate hearing aid and adjust the device to meet your needs. If you have hearing loss in both ears, you will get best results with two hearing aids.
• Ask about a trial period. You can usually get a hearing aid with a trial period. It may take you a while to get used to the device and decide if it's right for you. Have the dispenser put in writing the cost of a trial, whether this amount is credited toward the final cost of the hearing aid and how much is refundable if you return the hearing aid during the trial period.
• Think about future needs. Ask whether the hearing aid you've chosen is capable of increased power so that it will still be useful if your hearing loss gets worse. Hearing aids do not function indefinitely, but they should last about five years.
• Check for a warranty. Make sure the hearing aid includes a warranty that covers parts and labor for a specified period. Some dispensers may include office visits or professional services in the warranty.
• Beware of misleading claims. Hearing aids can't restore normal hearing or eliminate all background noise. Beware of advertisements or dispensers who claim otherwise.

• Plan for the expense. The cost of hearing aids varies widely — from about $1,500 to more than a few thousand dollars each. Professional fees, remote controls, hearing aid accessories and other hearing aid options may cost extra. Talk to your audiologist about your needs and expectations.

  Some private insurance policies cover part or all of the cost of hearing aids — check your policy to be sure. Medicare doesn't cover the cost of hearing aids for adults. In many states, private insurers are required to pay for hearing aids for children. Medical assistance covers hearing aids in most states. If you're a veteran, you may be able to get your hearing aid at no cost through the U.S. Department of Veterans Affairs (VA).

Getting used to a hearing aid takes time. You'll likely notice that your listening skills improve gradually as you become accustomed to amplification. Even your own voice sounds different when you wear a hearing aid.

When first using a hearing aid, keep these points in mind:

• Hearing aids won't return your hearing to normal. Hearing aids can't restore normal hearing. They can improve your hearing by amplifying soft sounds.
• Allow time to get used to the hearing aid. It takes time to get used to your new hearing aid. But the more you use it, the more quickly you'll adjust to amplified sounds.
• Practice using the hearing aid in different environments. Your amplified hearing will sound different in different places.
• Seek support and try to stay positive. A willingness to practice and the support of family and friends help determine your success with your new hearing aid. You may also consider joining a support group for people who have hearing loss or are new to hearing aids.
• Go back for a follow-up. Specialists may include the cost of one or more follow-up visits in their fees. It's a good idea to take advantage of this for any adjustments and to ensure that your new hearing aid is working for you as well as it can.

Your success with hearing aids will be helped by wearing them regularly and taking good care of them. In addition, an audiologist can tell you about new hearing aids and devices that become available. He or she can also help you make changes to meet your needs. The goal is that, in time, you find a hearing aid you're comfortable with and that enhances your ability to hear and communicate.