Hearing Aids Basics

Updated: Nov 23, 2022
Medically Reviewed by:

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Do you often find yourself asking people to repeat themselves, or have family members complain that you turn the TV volume up too much? You may have age-related hearing loss, and you’re certainly not alone.

According to the National Institute on Aging (NIA), about one-third to one-half of older adults experience hearing loss. Hearing loss not only makes it more difficult for you to understand people, but it also affects your relationships. It makes interacting with other people more exhausting, can cause you to socially withdraw, and, as a result, may increase your risk of dementia if left untreated. Untreated hearing loss is also thought to be linked to dementia by changing how the brain functions. When the brain’s hearing centers are no longer stimulated, they lose their intended purpose. This loss of function is thought to reorganize the brain and lead to cognitive decline.

Our AgingInPlace.org team held a Hearing Aid Summit at our headquarters and testing laboratory in Raleigh, North Carolina, where we interviewed hearing aid users and expert audiologists, including Brad Ingrao, Au.D., with the Department of Veterans Affairs and Sheri Mello, Au.D., with Raleigh Hearing and Tinnitus Center. One thing we learned when speaking to these audiologists is the importance of treating hearing loss early. Delaying treatment and depriving the brain of sounds for too long can affect how well hearing aids work for you.

hearing aid fitted on a person

If you’re new to hearing aids and hearing loss research, the amount of information can be overwhelming and even discouraging. Trust us, it’s taken AgingInPlace.org more than 4,000 hours to research what we know about hearing aids. Following our specific methodology, we research and test hearing aids to produce digestible resources that make your shopping experience easier. To gather first-hand data, our team surveyed 1,000 hearing aid users and purchased and tested 15 FDA-cleared hearing aid models across different criteria, like price, features, durability, user friendliness, customer service, and brand reputation. Our insights also come from our medical reviewers, audiologists Rachel Magann Faivre, Brad Ingrao, and Hadassah Kupfer, who review our content to ensure its accuracy in educating our readers.

How Hearing Aids Help With Hearing Loss

Hearing loss occurs when parts of the ear are damaged and no longer function as they should. Types of hearing loss vary according to which part of the ear is damaged and range in severity from mild to moderate to severe. When hearing loss is considered profound, it is referred to as deafness. The most common causes of hearing loss are age and exposure to loud noises, but other causes include genetics, taking medications that damage the ear, and medical conditions like diabetes, heart disease, and, more rarely, tumors of the auditory nerve. 

Age-related hearing loss is a type of sensorineural hearing loss that affects the inner ear. Sensorineural hearing loss occurs when there’s damage to the inner ear or the auditory nerve that transmits sound from the ear to the brain. The inner ear is responsible for detecting the different pitches in each sound and converting these sounds into electrical signals that the brain can understand. Hearing aids are medical electronic devices that treat age-related hearing loss by compensating for the damaged inner ear. The inner ear is also responsible for the vestibular system, which is used for balance.

How Hearing Aids Work

Age-related hearing loss is treated with air conduction hearing aids, or your typical modern hearing aids. Air conduction hearing aids use air to transmit sound waves into the ear to improve hearing. Another type of hearing aid called a bone conduction hearing aid exists but is used to treat a different type of hearing loss that affects the outer or middle ear rather than the inner ear. Bone conduction hearing aids use vibrations against the skull to transmit sound to the inner ear and brain.

Today’s modern hearing aids work by using digital technology that both amplifies and analyzes sounds, as opposed to more primitive hearing aids that used analog technology to simply amplify sounds. Digital hearing aids have multiple components that compensate for hearing loss: a microphone, a processing chip, an amplifier, and a speaker or receiver. The microphone (sometimes more than one) detects sounds from the environment. A computer-based chip processes and differentiates sounds by their frequencies, including wind, music, speech, and background noises, in order to make speech sounds clearer. The digital signal from the chip then gets converted back to sound waves that are increased, or amplified, in volume by an amplifier before they’re delivered into the ear by a speaker, also called a receiver. Hearing aids also contain a rechargeable or disposable battery that powers their function.

Hearing Aids vs Hearing Amplifiers

In August 2022, the Food and Drug Administration (FDA) released its official and specific definition of over-the-counter (OTC) hearing aids and described how they differ from hearing amplifiers. In the U.S., hearing aids are considered medical devices and are regulated by the FDA. Other products called personal sound amplification products (PSAPs) amplify sounds but are not intended to treat hearing loss. Instead, they’re meant for people with normal hearing who want to amplify sounds for specific activities, such as hunting or birdwatching. Because they’re considered electronics rather than medical devices, PSAPs are not regulated by the FDA, so their manufacturers don’t have to follow regulations to ensure these products won’t damage your hearing and pass sound quality inspections.

Types of Hearing Aids / Hearing Aid Styles

Comparison of different types of hearing aids

There are two broad categories of modern hearing aids, behind the ear (BTE) and in the ear (ITE). Each category includes more specific styles. BTE hearing aids have a hard shell that houses the hearing aid technology and sits behind the upper part of the ear with a tube or wire that loops around to the front of the ear. Specific BTE styles are traditional BTE hearing aids and receiver-in-canal (RIC) hearing aids.

Traditional BTE hearing aids are the largest hearing aids. They contain the microphone, amplifier, and receiver in the hard shell and have a plastic tube that connects to an ear mold at the bowl of the ear (outer part of the ear at the opening of the ear canal). RIC hearing aids, also known as mini BTE (mBTE) hearing aids, are the most popular hearing aid style according to Ingrao. They have a slimmer, hard shell that contains the microphone and amplifier but not the receiver. Instead, the receiver sits at the entry of the ear canal and is connected to the hearing aid’s hard shell by a wire that’s more discreet than the plastic tubing of traditional BTE hearing aids.

ITE hearing aids contain all of the technology in a hard shell that sits in the bowl of the ear or inside of the canal depending on the exact style. Styles worn in the bowl of the ear include the ITE that fills up the whole bowl, the ITE half shell that fills up half the bowl, and the in the canal (ITC) that fills up less than half of the bowl. Styles worn inside of the ear canal include the completely in the canal (CIC) that’s barely visible when worn and the invisible in the canal (IIC) that rests deeply in the ear canal, can’t be seen when worn, and is the smallest hearing aid available. In general, the smaller the hearing aid, the more limited is its technology and battery life because of space limitations. This makes smaller hearing aids appropriate for mild to moderate rather than severe hearing loss.

Rechargeable Hearing Aids

Eargo rechargeable hearing aid in charging case

Hearing aids come with either disposable or rechargeable batteries; some brands offer the same hearing aid model in each version. However, rechargeable hearing aids are becoming more common than disposable ones, with many models offering only rechargeable versions. Rechargeable hearing aids can be more convenient since disposable hearing aids require a new battery nearly weekly if not more often, which can cost anywhere from an extra $60-$200 a year. They also help people with hand dexterity issues avoid having to change out small batteries. Rechargeable hearing aids primarily use a lithium-ion battery, fully charge in around four hours, and can stay charged anywhere from 15-30-plus hours depending on the brand. On average, rechargeable hearing aids last about five years before you need to purchase a new pair.

Bluetooth Connectivity

Jabra Enhance Select Bluetooth Hearing Aid

Bluetooth hearing aids are considered higher-tech hearing aids. All Bluetooth hearing aids connect to Bluetooth-enabled smartphones and tablets but vary in what capabilities they have once they’re paired with these devices. Each hearing aid brand that has a line of Bluetooth hearing aids has its own app that allows you to control your hearing aid volume and settings with your phone. Basic Bluetooth connectivity hearing aids are able to be adjusted remotely by an audiologist in the form of telehealth visits so you don’t have to go in-person to a hearing aid clinic. Bluetooth streaming hearing aids have these same capabilities and more. Bluetooth streaming hearing aids can be used as wireless headphones for hearing audio from your phone or tablet directly in your hearing aids. Many allow you to take phone calls hands free. Although iPhones were the first smartphones to be compatible with Bluetooth hearing aids, most of these hearing aids can now pair with Androids that have newer operating systems. Bluetooth streaming hearing aids can also directly stream audio from your TV or a person you’re having a conversation with to improve general sound quality. To do so, you have to purchase streamers from the same brand as your hearing aids. These are known as TV streamers and partner mic streamers.

Hearing Aid Brands

Audicus: An OTC brand that sells invisible and BTE hearing aids with disposable battery, rechargeable, and Bluetooth streaming options; known for the Audicus Plus Plan that lets members rent hearing aids

Audien: One of the least expensive online OTC brands that sells rechargeable, non-custom, ITE hearing aids

Eargo: An OTC brand that sells Bluetooth-enabled (except for the Eargo Max), rechargeable invisible hearing aids. However, none of the hearing aid models by Eargo can stream music or movies using Bluetooth.

MDHearing: An OTC brand that sells BTE hearing aids with disposable battery, rechargeable, and Bluetooth connectivity options

Jabra Enhance (formerly Lively): An online prescription hearing aid brand that sells Bluetooth-streaming RIC hearing aids with disposable battery and rechargeable options

Phonak: A prescription hearing aid brand that must be purchased at a hearing clinic; offers custom-fit hearing aids in all styles with disposable battery, rechargeable, and Bluetooth streaming options; known for its RogerDirect technology that has more advanced streaming technology than Bluetooth, and for its disposable invisible hearing aid model (Phonak Lyric)

ReSound: A prescription hearing aid brand that must be purchased at a hearing clinic; offers custom-fit hearing aids in all styles with disposable battery, rechargeable, and Bluetooth streaming options; known for its advanced tinnitus management technology

Signia: A prescription hearing aid brand that must be purchased at a hearing clinic; offers custom-fit hearing aids; offers all hearing aid styles with disposable battery, rechargeable, and Bluetooth streaming options

Starkey: A prescription hearing aid brand that must be purchased at a hearing clinic; offers custom-fit hearing aids in all styles with disposable battery, rechargeable, and Bluetooth streaming options; known for its caregiver apps and hearing aids with fall detection

Widex: A prescription hearing aid brand that must be purchased at a hearing clinic; offers custom-fit hearing aids in all styles with disposable battery, rechargeable, and Bluetooth streaming options; known for its tinnitus programs

Hearing Aid Prices

Hearing aids can vary widely in price, from around $99–$8,000 a pair, and high cost is the most commonly reported reason that people hesitate to buy hearing aids, according to our AgingInPlace.org hearing aid survey respondents

“Technology and service components determine the cost of a hearing aid,” Mello stated. 

Whether a hearing aid is OTC or prescription affects the cost. Prescription hearing aids are more expensive because they have more sophisticated technology capable of treating more severe types of hearing loss. They also require a comprehensive hearing test and examination by an audiologist before purchase. Once purchased, costs for ongoing services with an audiologist are often bundled into the overall price.

By contrast, a pair of OTC hearing aids cost between $99–$2,000 a pair, do not require a hearing examination, and can be purchased online to avoid or reduce audiologist service costs.

Where To Buy Hearing Aids

Hearing aids can be purchased online, at hearing clinics through an audiologist, through discount retailers like ZipHearing, and through big-box retailers like Walmart and Costco. The purchasing process depends on the severity of your hearing loss, which determines whether you need prescription or OTC hearing aids. Prescription, or medical-grade hearing aids, can be purchased after an audiology consult in person at an audiologist’s office, through retailers like Costco that provide audiology consults, or online after a remote audiology consult.

ZipHearing, an online prescription hearing aid retailer, sells popular brands at a discount after you visit one of its partner hearing aid clinics for testing and hearing aid selection. Prescription hearing aids, as opposed to OTC hearing aids, are the only option for people with severe hearing loss or for children younger than age 18 who need hearing aids. If you have mild to moderate hearing loss, you can purchase OTC hearing aids online directly from their manufacturers, in pharmacies, and in retail shops or hearing aid clinics that sell them.

Over-the-Counter (OTC) Hearing Aids

To make hearing aids more affordable and accessible, the FDA finalized its rules in August 2022 for allowing OTC hearing aids to be sold in stores. Before October 2022, hearing aids could only be sold in stores after a hearing exam was conducted by an audiologist or other hearing care specialist. OTC hearing aids, now available for adults age 18 and older with perceived mild to moderate hearing loss, can be purchased without a hearing exam or prescription. OTC hearing aids are still considered medical devices, and their manufacturers have to follow FDA regulations, although these regulations are less strict than those for prescription hearing aids. OTC hearing aid manufacturers provide ongoing services through their hearing care professionals. With Bluetooth hearing aids, adjustments and software updates can be done remotely. For hearing aids that don’t have Bluetooth, you can mail them to the manufacturer to receive adjustments and updates.

From our hearing aid survey, in-person audiology visits appear to still be a popular way to buy hearing aids, with nearly 50% of respondents reporting they got their hearing aids by going to an audiologist compared to going online or to a retailer.

Prescription Hearing Aids

Prescription hearing aids are usually purchased in person at a hearing clinic and require a hearing test and consultation with an audiologist before purchase. They are capable of treating more severe hearing loss than OTC hearing aids. Prescription hearing aids are more expensive than OTC hearing aids because they have more sophisticated technology that requires more extensive programming from an audiologist. People with prescription hearing aids typically have regular visits with an audiologist either remotely (in the case of Bluetooth hearing aids) or in person for adjustments and updates as hearing changes or problems arise.

Features To Consider

Battery: Hearing aids are powered by either rechargeable or disposable batteries. Disposable batteries usually last between 3-10 days, while rechargeable hearing aids stay charged from 15-35 hours after a single charge depending on the brand and model. Battery life varies based on use and drains more quickly with Bluetooth hearing aids because the Bluetooth feature requires more power to operate. Also, the severity of hearing loss affects battery life. For more severe hearing loss, more power is required for sound amplification. This is why more powerful hearing aids use larger, disposable batteries. In one of our hearing aid focus groups, some hearing aid users reported feeling wasteful and frustrated by having to change disposable hearing aid batteries so often.

Channels: Hearing aid processing channels filter and analyze sounds by the pitch range the sounds fall into. The more processing channels a hearing aid has, the better the sound quality because the hearing aid can more precisely differentiate speech from noise to amplify speech sounds and reduce noise.

Directional Microphones: Directional microphones allow hearing aids to detect sounds coming from various directions and enhance speech sounds while reducing levels of background noise. This improves your ability to hear a person speaking in front of you in a noisy environment.

Noise Reduction: This feature allows hearing aids to reduce the volume of wind and background noise, making speech sounds in loud environments clearer. Hearing aids differ by how well they reduce background noise. 

Remote Controls: Many hearing aid models come with the option to purchase a remote control as an add-on. Hearing aid remote controls pair with non-Bluetooth and Bluetooth hearing aids, for people who prefer to not use a smartphone to control their Bluetooth hearing aid. Remote controls are useful for changing hearing aid volume and switching to different listening programs, especially when hearing aids don’t have push buttons directly on them to change these settings.

Water Resistance: Hearing aids are typically water resistant, which means they can handle exposure to sweat and light rain but should not be submerged in water. This means you should not wear hearing aids while swimming, bathing, showering, or in heavy rain.

Tinnitus Masking: Tinnitus is defined as a ringing in the ears or similar sound you hear when no such sound is being produced in the environment. It’s a common symptom of hearing loss. Tinnitus can become less noticeable when you introduce other sounds into the ear that compete for your brain’s attention. Hearing aids that have a tinnitus-masking feature play white noise or soothing sounds, like the sound of a stream, in moments when you’re experiencing bothersome tinnitus so that you notice it less.

Insurance Coverage of Hearing Aids

Medicare Part A does not pay for hearing aids, exams, or fittings. Medicare Part B pays for hearing exams if you have a referral from your primary care physician but does not cover hearing aids. Medicare Advantage, known as Medicare Part C, may offer coverage for hearing aids, but this will depend on your individual plan. 

For private insurance plans, Mello stated, “Other insurance companies follow suit with Medicare, so some insurance companies may not cover the cost of hearing aids.” Both Ingrao and Mello recommend calling the number on the back of your insurance card and asking about your hearing aid benefits to see if your insurance pays a portion of hearing aid costs. 

Ingrao shared more tips on purchasing hearing aids at a more affordable price: “Ways to save some money might be to work with a university clinic or a not for profit, and if you’re a veteran of the military, almost all veterans who are eligible for general VA health care can get free premium hearing aids through the VA. If you’re still working, most states have an office of vocational rehabilitation, which can often, even for a short period of time, help you out with hearing aids.”

There are also options for financing hearing aids. If you want to finance your hearing aids, audiologists typically offer financing plans through CareCredit or Wells Fargo. Both institutions offer no interest plans for at least 12–18 months. If you don’t pay off balance by the time the no interest promotion ends, you’ll be responsible for the interest.

Other ways to save on hearing aids, especially prescription hearing aids, include asking your audiologist if you can unbundle a service plan so you’re not paying upfront for more audiology visits than you need. You can also reach out to organizations with resources for people who can’t easily afford hearing aids. These groups can include local chapters that may donate hearing aids and the national organization known as The Hearing Loss Association of America, which can connect you with other organizations that help cover the cost of hearing aids. Searching your state’s website for financial assistance for hearing aids may also provide more resources and options.

Do I Need Hearing Aids?

Age-related hearing loss may cause signs and symptoms such as:

  • Trouble understanding speech
  • Tinnitus, or ringing in the ears
  • Asking others to repeat themselves or speak more slowly
  • Increased difficulty understanding others when background noise is present
  • Turning up the TV volume more than usual
  • Having more difficulty understanding women, children, or anyone who has a higher-pitched voice
  • Difficulty hearing chirping birds or beeping devices

As a start, many online hearing aids manufacturers offer free online hearing tests to see if you have hearing loss. Although the FDA now allows hearing aids to be purchased without a hearing exam and based on your own perception of your hearing loss, the only way to know for sure what type of hearing loss you have is through testing and examination by a licensed audiologist. An audiologist is a specialist who diagnoses and treats hearing loss and balance disorders and determines if hearing aids are appropriate for your hearing loss.

Hearing aid manufacturers and hearing clinics may also hire hearing instrument specialists. Hearing instrument specialists have less formal education than audiologists and can’t diagnose your type of hearing loss. However, they can interpret hearing tests, make ear molds for custom-fit hearing aids, and program your hearing aids. An ear, nose, and throat doctor, or ENT, can also treat your hearing loss if it is caused by a condition that requires surgery or medications for management.  

Audiologists diagnose the type and severity of hearing loss most often through a hearing test, and the results are then charted on an audiogram. Audiograms look at how well you hear different pitches at different volumes in each ear and trace your hearing loss to damage in a particular part of the ear.  

Mello gave some helpful advice at our Hearing Aid Summit for new hearing aid users: Give yourself time to adjust to them. The brains of people with hearing loss take a little time to get used to interpreting sound through hearing aids. Audiologists can help explain this process and readjust or upgrade your hearing aids as your hearing loss changes.

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MEDICALLY REVIEWED BY

Dr. Magann Faivre is an audiologist with a passion for being active in audiology organizations, particularly concerning advocacy, patients’ rights issues, and teaching student leadership. She intimately grew up around hearing loss and empathizes with patients when discussing their hearing journey. She is dedicated to creating a positive and integrative hearing healthcare experience so patients leave informed and confident. Dr. Magann Faivre currently serves on The Audiology Project’s Board of Directors and on Northern Illinois University’s Advisory Board. She is a longstanding fellow of the American Academy of Audiology and Academy of Doctors of Audiology.

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