What is a hearing aid?

A hearing aid is a small electronic device that you wear in or behind your ear.  It makes some sounds louder so that a person with hearing loss can listen, communicate, and participate more fully in daily activities.  A hearing aid can help people hear more in both quiet and noisy situations. However, only about one out of five people who would benefit from a hearing aid actually uses one.

A hearing aid has three basic parts: a microphone, amplifier, and speaker.  The hearing aid receives sound through a microphone, which converts the sound waves to electrical signals and sends them to an amplifier.  The amplifier increases the power of the signals and then sends them to the ear through a speaker.

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How can I find out if I need a hearing aid?

If you think you might have a hearing loss and could benefit from a hearing aid, visit your physician, who may refer you to an otolaryngologist or audiologist.  An otolaryngologist is a physician who specializes in ear, nose, and throat disorders and will investigate the cause of the hearing loss.  An audiologist is a hearing health professional who identifies and measures hearing loss and will perform a hearing test to assess the type and degree of loss.  Audiologists also recommend hearing aids.

If you are experiencing difficulty hearing or having increased stress or strain in your daily life because of hearing loss, you may be noticing the following: asking people to repeat, trouble hearing in noisy environments, struggling to hear women and children's voices, feeling that othera seem to be mumbling, and reduced clarity on TV.   Amplification may help you not only with hearing better, but also relieve the strain of trying to hear and the often resulting fatigue.

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Are there different styles of hearing aids?

There are three basic styles of hearing aids.  The styles differ by size, their placement on or inside the ear, and the degree to which they amplify sound.

  • Behind-the-ear (BTE) hearing aids consist of a hard plastic case worn behind the ear and connected to a plastic, custom-made earmold that fits inside the outer ear.  The electronic parts are held in the case behind the ear.  Sound travels from the hearing aid through the earmold and into the ear.  BTE aids are used by people of all ages with mild to profound hearing loss.

    A new kind of BTE aid is an open-fit hearing aid. Small, open-fit aids fit behind the ear completely with only a narrow tube inserted into the ear canal, enabling the canal to remain open. For this reason, open-fit hearing aids may be a good choice for people who experience a buildup of earwax since this type of aid is less likely to be damaged by such substances. In addition, some people may prefer the open-fit hearing aid because their perception of their voice does not sound "plugged up."

  • In-the-ear (ITE) hearing aids fit completely inside the outer ear and are used for mild to severe hearing loss.  The case holding the electronic components is made of hard plastic, custom molded to your ear.  Some ITE aids may have certain added features installed, such as a telecoil, a small magnetic coil that makes it easier to hear conversations over the telephone.  ITE aids usually are not worn by young children because the casings need to be replaced often as the ear grows.

  • In-the-canal (ITC) aids fit into the ear canal and are available in two styles.  The ITC hearing aid is made to fit the size and shape of a person’s ear canal.  A completely-in-canal (CIC) hearing aid is nearly hidden in the ear canal.  Both types are used for mild to moderately severe hearing loss.

  • Because they are small, canal aids may be difficult for a person to adjust and remove.  In addition, canal aids have less space available for batteries and additional devices, such as a telecoil.  They usually are not recommended for young children or for people with severe to profound hearing loss because their reduced size limits their power and volume.

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What determines the style of hearing aid I should wear?

While many people choose the style of the hearing aid based on vanity, decisions regarding which style of hearing aids are most appropriate for you may need to be based on a variety of factors.

Physical factors include:

1.  The shape of your outer ear: irregular outer ears may not allow for BTE styles.

2.  The depth of the depression near the ear canal (technically called the concha): if your ears are very shallow there may not be adequate space for retaining ITE model aids.

3.  The ear canal and shape: certain ear canals may be too narrow or shaped in a manner such that ITC or CIC styles will either not go in easily, or may fall out too easily.

4.  Manual dexterity: not only is the removal and insertion of canal style hearing aids difficult for some people, but some invididuals are unable to insert the battery or manipulate the volume control.

5.  Wax in the ear: some people build up large amounts of earwax, or may have extremely moist ear canals that require adequate ventilation.  For these people, ITC or even certain ITE aids may not be appropriate.

6.  Draining ears, or ears otherwise having medical problems, may not be able to safely utilize hearing aids that completely block the ear canal.   For these ears, it is vital to allow ventilation.  Hearing aids that do not fully block the ears may be required.  Sometimes, BTEs that are connected to earmolds that have large vents (openings to let air pass through) are useful.

Hearing related factors include:

1.  The shape of the audiogram; individuals who have hearing loss for certain pitches (frequencies) but not others (for example, those who hear the low frequencies fine, but have a high frequency hearing loss), may be better served by systems that do not fully block the ear canal.

2.  Degree of loss; currently, severe and profound hearing losses are best served by BTE style aids.  This style may also minimize the likelihood of feedback (whistling).

3.  The need for special features such as directional or multiple microphones and/or the use of a telecoil (a small magnetic loop contained within the hearing aid that allows for better use with telephones or assistive listening devices), may dictate the preferred style.

4.  Acoustic feedback (whistling) occurs when the microphone is close to the loudspeaker.  BTE aids have a clear advantage over the smaller ITE or ITC aids because feedback is less likely to occur.  While you may feel that you will only wear an inconspicuous device, check the appearance of a small or mini-BTE aid coupled with an open earmold.  These types of aid are often less noticable than most ITE and many ITC aids.  Most importantly, discuss the pros and cons of different styles with your audiologist.

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What questions should I ask before buying a hearing aid?

Before you buy a hearing aid, ask your audiologist these important questions:

  • What features would be most useful to me?
  • What is the total cost of the hearing aid?  Do the benefits of newer technologies outweigh the higher costs?
  • Is there a trial period to test the hearing aids?  What fees are nonrefundable if the aids are returned during the trial period?
  • How long is the warranty?  Can it be extended?  Does the warranty cover future maintenance and repairs?
  • Can the audiologist make adjustments and provide service and minor repairs?  Will loaner aids be provided when repairs are needed?
  • What instruction does the audiologist provide?

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How can I adjust to my hearing aid?

Hearing aids take time and patience to use successfully.  Wearing your aids regularly will help you adjust to them.

Become familiar with your hearing aid features.  With your audiologist present, practice putting in and taking out the aid, cleaning it, identifying right and left aids, and replacing the batteries.  Ask how to test it in listening environments where you have problems with hearing.  Learn to adjust the aids volume and to adjust it for sounds that are too loud or too soft.  Work with your audiologist until you are comfortable and satisfied.

You may experience some of the following problems as you adjust to wearing your new aid.

  • My hearing aid feels uncomfortable.  Some individuals may find a hearing aid to be slightly uncomfortable at first. Ask your audiologist how long you should wear your hearing aid while you are adjusting to it.


  • My voice sounds too loud.  The "plugged-up" sensation that causes a hearing aid user's voice to sound louder inside the head is called the occlusion effect, and it is very common for new hearing aid users.  Check with your audiologist to see if a correction is possible. Most individuals get used to this effect over time.


  • I get feedback from my hearing aid.  A whistling sound can be caused by a hearing aid that does not fit or work well, or your ear is clogged by earwax or fluid.  See your audiologist for adjustments.


  • I hear background noise.  A hearing aid does not completely separate the sounds you want to hear from the ones you do not want to hear.  Sometimes, however, the hearing aid may need to be adjusted.  Talk with your audiologist.


  • I hear a buzzing sound when I use my cell phone.  Some people who wear hearing aids or have implanted hearing devices experience problems with the radio frequency interference caused by digital cell phones.  Both hearing aids and cell phones are improving, so these problems are occurring less often. When you are being fitted for a new hearing aid, take your cell phone with you to see if it will work well with the aid.

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Why do hearing aids amplify so much noise and make sounds too loud, but speech still isn't clear enough?

Among the most frequent complaints voiced by hearing aid users are that noise is amplified too much and that certain sounds become too loud for the user to bear.  Some modern hearing aids contain sensors that allow the hearing aid to detect sounds exceeding a certain loudness level, and then self-adjust to reduce the amplification (gain) for those sounds.  Unfortunately, because noise is comprised of many of the same frequencies as speech, it is virtually impossible to "shut out" the unwanted speech babble noise without also adversely affecting the quality of the speech you want to hear.  The good news is that audiologists can measure and control the maximum sound intensity reaching your ear.  If sounds (speech or noise) exceed either the saturation level (maximum level the hearing aid can amplify without distortion) or your personal loudness discomfort level, distortion or discomfort will be the result.  Modern hearing aids utilize technology that allows for adequate gain for soft sounds while minimally (or not at all) amplifying loud input signals.  Concerning background noise, new techniques using multiple microphones within the same hearing aid are improving the listener's ability to function in noisy environments.  With regard to clarity, even the most sophisticated hearing aids' ability to clarify speech is limited by the degree of inner ear and/or central auditory nervous system distortion.  The most recent research studies confirm the fact that our auditory system slows down and becomes less efficient with age, reducing our ability to undertand rapid speech or speech presented in noisy environments. 

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What should new users of hearing aids realistically expect?

When wearing hearing aids:

1.  Your hearing in quiet environments (one to one communication, watching TV, etc.) should be improved.

2.  Your hearing in moderate background noise should be improved.

3.  Your hearing in background noise is NOT going to be as good as your hearing in quiet.

4.  Your hearing in loud background noise should be NO WORSE than without hearing aids.

5.  Soft speech should be audible, average speech should be comfortable, and loud speech should be loud, but never uncomfortable.

6.  Your earmolds should be comfortable.

7. Your own voice should be "acceptable" to you but will sound different.

8.  There should be no feedback (whistling) when the hearing aids are properly seated in your ears.

9.  You may hear sounds you have not heard for a while (i.e. footsteps or the refrigerator humming).  This is not abnormal.

Be patient.  It requires time to adjust to hearing aids.  Your listening skills should improve gradually as you become accustomed to amplification.

Hearing aids WILL NOT restore your hearing capabilities to "normal".

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How can I care for my hearing aid?

Proper maintenance and care will extend the life of your hearing aid. Make it a habit to:

  • Keep hearing aids away from heat and moisture.
  • Clean hearing aids as instructed.  Earwax and ear drainage can damage a hearing aid.
  • Avoid using hairspray or other hair care products while wearing hearing aids.
  • Turn off hearing aids when they are not in use.
  • Replace dead batteries immediately.
  • Keep replacement batteries and small aids away from children and pets.

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Why do hearing aids cost so much?

There are multiple factors affecting hearing aid cost:

1.They are sold in relatively low volume (i.e. approximately 1.7 million hearing aids for some 30 million hearing impaired are sold per year).

2.  The amount of time and money spent by manufacturers on research and development is considerable. 

3.  The amount of time spent by an audiologist with a patient is significant.  Data indicate that an average of five direct contact hours is spent in the first year a patient receives hearing aids.  This time is critical for new users, particularly to assist during the acclimatization process.  Mail-order or budget clubs can afford to sell hearing aids at lower prices because the electronic components often are inexpensive and the hearing aids themselves are often placed on the user with minimal or no instruction or fine-tuning adjustments.  Furthermore, the patient may be charged for every return visit, including minor changes and adjustments.  In the long run, the patient is likely to pay as much or even more.  Additionally, the minimum amount of training required for a dispensing audiologist is a master's degree, while mail-order or discount centers are often staffed by sales people having limited technical training.  Audiologists, like consumers, are concerned about keeping the cost of hearing aids affordable.  The reality is that communication is one of mankind's most important skills.  If wearing hearing aids allows you to resume normal activities and communicate with loved ones, the cost becomes immensely more justifiable.

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Can I obtain financial assistance for a hearing aid?

Hearing aids are generally not covered by health insurance companies, although some do.  For eligible children and young adults ages 21 and under, Medicaid will pay for the diagnosis and treatment of hearing loss, including hearing aids under the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) service.  Also, children may be covered by their states early intervention program or State Childrens Health Insurance Program (SCHIP).

Medicare does not cover hearing aids for adults; however, diagnostic evaluations are covered if they are ordered by a physician for the purpose of assisting the physician in developing a treatment plan.  Since Medicare has declared the BAHA a prosthetic device and not a hearing aid, Medicare will cover the BAHA if other coverage policies are met.

Some nonprofit organizations provide financial assistance for hearing aids, while others may help provide used or refurbished aids.  Contact Minnesota Hearing Aid Professionals, Inc. with questions about organizations that offer financial assistance for hearing aids.

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Is it really necessary to wear two hearing aids, or can I get by with just one?

There are four main reasons why binaural (two eared) listening is superior to monaural (one eared) listening. 

1.  Better Hearing In Noise:  An individual's hearing in noise can be improved if the signal reaching the ear arrives at a slightly different moment in time.  This is technically referred to as "phase".  When the brain receives slightly different, yet still audible signals, at the two ears, it has the ability to process the primary signal (usually speech) better than if the signal is received monaurally.

2.  Improved Signal Versus Noise Level From Optimizing Position:  Sound loses intensity (loudness) when it travels across the head.  High frequency consonants (/s/, /th/, /f/, /sh/) are the most affected, but are also the most important for speech understanding.  If you have a hearing aid on only one ear, and the person you wish to hear speaking to you is on the other side, the consonants may be decreased by nearly 20 decibels in the time it gets to your aided ear.  Unfortunately, noise in the room may occur from any or all directions.  While the noise level is not decreased, the speech level is.  Wearing two hearing aids ensures that the speech sound will not be diminished any more than necessary because of your position in the room.

3.  Improved Localization Ability:  We determine where a sound is coming from on the basis of 1) the relative time in which the sound arrives at each ear, 2) the relative difference in loudness at the two ears, and 3) the relative difference in pitch of the sound at the two ears.  When there is a large difference in hearing between two ears (as might occur when a person with similar hearing in both ears only wears one hearing aid) the brain cannot make use of these subtle relative differences and their ability to locate sound may suffer.

4.  Possible Deterioration of the Unaided Ear:  We hear in our brain, not in our ears.  The ultimate goal of hearing aids is to not just send sound to the ear, but to retrain the central auditory system in the brain.  While it is uncertain whether hearing sensitivity (ability to hear soft sounds) will decrease if your ear is not stimulated adequately, research shows that there can be changes in the way in which your brain processes sound when it is "starved".  Providing stimulation may be important in preserving your auditory potential.

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Where can I find more information?

For more information, additional addresses and phone numbers, or a printed list of organizations, contact:

Minnesota Hearing Aid Professionals, Inc.
2211 Park Avenue South
Minneapolis, MN 55404

Phone: 612-871-2445
E-mail: info@mhapi.com

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