How to Buy a Hearing Aid: Understanding Hearing Loss


When shopping for hearing aids, the single most important thing you can do is to become as educated as possible. You will benefit from increasing your knowledge in 5 key areas. First,  learn about hearing loss in general, and about your hearing loss in particular. Second, become aware of the potential consequences of not getting hearing aids, or “waiting until later”. Third, become as knowledgeable as possible about current hearing aid technology. Finally, hearing aids are sold by many sources: Familiarize yourself with the different levels of service and products available in your area.

The following information is intended to help you become a more informed consumer. The more you know, the more likely you are make decisions that will optimize your hearing and satisfaction.

General Information about Hearing Loss

Hearing loss is a growing health problem in the U.S. According to the National Institute on Deafness and other Communication Disorders (NIDCD) and The Better Hearing Institute (BHI), the number of Americans with hearing loss has more than doubled in less than 30 years, growing from 14.2 million 1n 1977 to over 31 million in 2005.

Baby boomers have the dubious distinction of having 26% more hearing loss than previous generations. The consequences are reduced job performance, disruptions in family life, and difficulty hearing television and cell phones. A 2005 BHI study found that untreated hearing loss reduced annual income by an average of $12,000, leading to reduced savings and retirement income. Hearing aid use lessened this impact by 50%.

Aging is directly related to hearing loss, affecting about 30% of those 65 years and older, and about 50% of those over 75. Hearing loss in older persons reduces communication enjoyment, increases frustration and depression, makes it difficult to understand and follow a physician’s advice, and may make it difficult to hear warning sounds and alarms. Thus, hearing loss can

not only be annoying and embarrassing, but possibly downright dangerous. Because the number of adults 65 years and older is growing faster than the rest of the population, untreated hearing loss is increasing.

The Impact of Untreated Hearing Loss

Unfortunately, to many of us, having hearing loss has a host of negative connotations.

The good news is that we can do something about hearing loss. Organizations such as the American Academy of Audiology have launched campaigns to educate everyone, especially children and teens, about protecting their hearing. For baby boomers and older adults, modern hearing aid technology is incredibly better than was available even 3 or 4 years ago. These hi-tech aids are smaller and more comfortable, and offer advanced features such as Bluetooth connectivity to cellphones, music devices and television. According to the National Council on Aging, benefits of hearing aid use include: reduced anxiety, improved self-esteem and communication, and yes, even an improved sex life. Simply put, hearing loss distances you from people, hearing aids bring you closer.

An audiologist (the healthcare professional who diagnoses, treats and manages individuals with hearing loss) will work with you and your physician to find the solution that is best for you. Audiologists will also help you protect the hearing you have. Find an audiologist online, via phone book, or by contacting the American Academy of Audiology.

Types of Hearing Loss

Hearing loss can be described by the part of the hearing system that is not working properly.

Conductive Hearing Loss occurs when sound cannot pass normally through the external or middle ears (see Figure 1).


Conductive hearing loss can be caused by an earwax blockage of the external canal, by an external ear canal infection, by a perforated eardrum, by poor Eustachian tube function (see figure 1), by damage to the small bones in the middle ear, by benign tumors, by malformations of the external or middle ear, and by fluid build-up in the middle ear due to ear infection, colds or allergies. This type of hearing loss tends to make speech and other sounds difficult to hear at normal loudness levels. However, these sounds are typically heard clearly when they are amplified. Conductive hearing loss can often be corrected medically or surgically.

Sensorineural Hearing Loss occurs when there is damage to the inner ear (cochlea) or to the nerve pathways to the brain. Sensorineural loss can be caused by the aging process, genetic factors, illness, toxic medications, head trauma, tumors, and noise exposure. Sensorineural loss is permanent, and may get worse over time. This type of hearing loss not only makes speech and other sounds too soft, but it can also make them sound distorted. The most effective treatment for most sensorineural hearing loss is to use hearing aids.

Mixed Hearing Loss occurs when there is both a conductive loss and a sensorineural loss. While the conductive part of the hearing loss might improve with medical treatment, the sensorineural component will be permanent. Effective treatment includes referral to an otolaryngologist or ENT (physician who specializes in disorders of the ear) and possibly hearing aid use.

Most hearing loss affects both ears, and is referred to as a Bilateral Hearing Loss. When hearing loss affects only one ear, it is referred to as a Unilateral Hearing Loss. If both ears have hearing loss, but the degree of loss is different in each ear, the loss is referred to as an asymmetric hearing loss. An asymmetric hearing loss is somewhat unusual, and referral to an ENT is indicated.

Degree of Hearing Loss

Degree of hearing loss cannot be described accurately in terms of percentage because too many unpredictable variables are involved, including: loudness of the target signal, pitch composition of the target signal, distance from speaker or sound source, background noise, attention and concentration, context, visual cues, reverberation, and other factors.

Hearing loss is classified using a sound intensity measure called the decibel (dB). During your hearing test, we measure the softest dB level at which you can just barely hear tones and speech. The softest dB level that you can hear is called you “threshold”. Based on this threshold measure, degree of hearing loss is classified as shown in Table I.

Hearing Threshold

In decibels (dB)

Degree of Hearing Loss

0 –  15 dB


16 – 25 dB


26 – 40 dB


41 – 55 dB


56 – 70 dB

Moderately Severe

71 – 90 dB


91 + dB


Table I

Dr. Littman will explain what your hearing test results mean, and how they affect your ability to hear and understand speech, in quiet and in noisy situations.

Speech Understanding Ability: One of the most common complaints we hear from our patients is that they can hear people talking, but they can’t understand them. We will measure how loud speech must be for you to just hear it (threshold) and your ability to understand speech in quiet and in noisy conditions. This information helps Dr. Littman fully diagnose your hearing problem and help you find the best way to hear better.

The Consequences of Untreated Hearing Loss

We are often reluctant to admit we have a hearing problem, for a number of possible reasons:

a) We recognize that we have a hearing problem but we believe “I get by…It’s no big deal” or  b)We don’t want to acknowledge  that time has taken a toll on us;  or c)We don’t want to “give in” to a perceived defect or infirmity; or d)We don’t want to buy hearing aids because they will just end up in a drawer “like uncle Ed’s did”. Let’s look at these “reasons” one at a time.

“I get by just fine……..”

Baby boomers have the dubious distinction of having 26% more hearing loss than previous generations. The consequences are reduced job performance, disruptions in family life, and difficulty hearing television and cell phones. A 2005 BHI study found that untreated hearing loss reduced annual income by an average of $12,000, leading to reduced savings and retirement income. Hearing aid use lessened this impact by 50%.

How to Buy Hearing Aids

Have a thorough hearing evaluation by an audiologist. According to State law and for your own good, this test should be within 6 months of getting your hearing aids. Your audiologist should talk with you about your general medical history and what types of hearing problems you are having. This test should be done in a sound-treated booth, using properly calibrated equipment. It should never be done in your home or in any place that is noisy. Be sure the audiologist explains the results to you and discusses your treatment options. It helps to have a friend or family member present. It also helps to get a copy of your test results and follow-up recommendations.

Recommendations for follow-up will be made, depending on your test results, medical history and communication needs. Make sure you fully understand these recommendations. Request educational materials, written and/or electronic, so you can absorb additional information at your own pace. This may help you collect your thoughts and determine questions you want to ask at your next appointment. Write the questions down and bring them to your next appointment, to be sure they are addressed.

A Hearing Aid Evaluation should be completed, if the audiologist feels you could benefit from trying hearing aids. Part of this evaluation might have been done during your hearing evaluation(when you were asked to determine when speech was comfortably loud and when it was too loud). Your audiologist should explain what styles and types of hearing aid technology are available, their prices, the advantages and limitations of each of them, and what would be best for you. If your audiologist doesn’t make it clear to you why he/she is recommending a particular hearing aid, be sure to ask.

Work with an audiologist you trust and can communicate with.

Make sure the audiologist will spend the necessary time with you.

Make sure you can be seen by your audiologist as often as you need to, at no charge, during the trial period and during the warranty period. After the warranty is expired, you may be charged for any follow-up. Be sure to ask about that at the time of purchase.