A hearing aid is a small electronic device that you wear in or behind your ear. It makes some sounds louder. A hearing aid can help people hear more in both quiet and noisy situations.

Hearing aids help people who have hearing loss from damage to the small sensory cells in the inner ear. The damage can occur as a result of disease, aging, or injury from noise or certain medicines. Only about one out of five people who would benefit from a hearing aid actually uses one. If you think a hearing aid could help you, visit your doctor.

There are different kinds of hearing aids. They differ by size, their placement on or inside the ear, and how much they amplify sound. The hearing aid that will work best for you depends on what kind of hearing loss you have, and how severe it is.

Many people slowly lose their hearing as they get older. Not being able to hear well can make it hard to communicate. That can affect your relationships, emotional well-being, and work performance.

For those who need them, hearing aids can help. These electronic devices are worn in or behind the ears. They make sounds louder. Close to 29 million adults could benefit from hearing aids, yet only 1 in 4 of them has ever used one.

An exam of your ears, nose, and throat might detect a physical reason why you’re not hearing as well. You may want to start by talking with your primary care provider or an ear, nose, and throat doctor, also known as an ENT or otolaryngologist.

A doctor can look for ear wax, an infection, injury, or other reason for hearing loss. A hearing test can show the type and amount of hearing loss. For a hearing test, your doctor may refer you to an audiologist.

If ear wax or an ear infection is the cause, the hearing loss may be temporary. Other causes, such as nerve damage, may lead to more permanent hearing loss. Nerve damage can be caused by loud noises, as a side effect of certain medicines, or for other reasons. Hearing aids may help in these cases.

Some people don’t want to try hearing aids because of how they think it might look to others. “Hearing loss is far more obvious than a hearing aid,” says Dr. Kelly King, an NIH hearing health expert. “The hard work people do to compensate for their hearing loss, and the mistakes they sometimes make when communicating, make the loss more noticeable to those around them than a hearing aid.”

And now, advances in technology are making hearing aids less visible. “One of the biggest changes that has taken place in the last 15 years is a major reduction in the size of these devices,” King says. Some can be hidden inside the ear canal. Others are worn over the ear.

Choosing the best device for you will depend on factors like cost, features, and your amount of hearing loss. Today’s hearing aids offer different features. For example, some can connect to your mobile phone, TV, and other devices using Bluetooth technology. That means you can talk on your phone and stream music directly to the speakers within the hearing aids without wires.

It’s important to understand that hearing aids can’t restore your hearing the way that reading glasses correct vision. Instead, a hearing aid can help you make the most of your remaining hearing by making sounds louder. If it’s been a while since you’ve heard the soft sounds of speech, your brain may need time to re-learn and translate those sounds for you.

Do You Need Your Hearing Tested?

If you answer yes to several of these questions, you may want to get a hearing test:

• Is it hard to hear or understand others?
• Do you get frustrated trying to hear things?
• Do people get frustrated because they need to repeat what they say to you?
• Do you turn up the TV or radio louder than those around you would like?
• Do you have trouble hearing what people are saying in restaurants or at the movies?
• Is your social life, school, or job limited by your problem with hearing?

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.

If you or an adult family member have questions or concerns about hearing loss, you have options. Over-the-counter (OTC) hearing aids are a new category of hearing aids that people can buy directly, without visiting a hearing health professional for an examination. These hearing aids are intended to help adults with perceived mild to moderate hearing loss. Prescription hearing aids are available from a hearing health professional who will program them for your degree of hearing loss. Prescription hearing aids or other devices may be necessary for more significant or complicated hearing loss.

Hearing aids are primarily useful in improving the hearing and speech comprehension of people who have hearing loss that results from damage to the small sensory cells in the inner ear, called hair cells. This type of hearing loss is called sensorineural hearing loss. The damage can occur as a result of disease, aging, or injury from noise or certain medicines.

A hearing aid magnifies sound vibrations entering the ear. Surviving hair cells detect the larger vibrations and convert them into neural signals that are passed along to the brain. The greater the damage to a person’s hair cells, the more severe the hearing loss, and the greater the hearing aid amplification needed to make up the difference. However, there are practical limits to the amount of amplification a hearing aid can provide. In addition, if the inner ear is too damaged, even large vibrations will not be converted into neural signals. In this situation, a hearing aid would be ineffective.

• Behind-the-ear (BTE) hearing aids consist of a hard plastic case worn behind the ear and connected to a plastic 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 for 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. Some ITE aids may have certain added features installed, such as a telecoil. A telecoil is a small magnetic coil that allows users to receive sound through the circuitry of the hearing aid, rather than through its microphone. This makes it easier to hear conversations over the telephone. A telecoil also helps people hear in public facilities that have installed special sound systems, called induction loop systems. Induction loop systems can be found in many churches, schools, airports, and auditoriums. ITE aids usually are not worn by young children because the casings need to be replaced often as the ear grows.

• Canal aids fit into the ear canal and are available in two styles. The in-the-canal (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.

Hearing aids work differently depending on the electronics used. The two main types of electronics are analog and digital.

Analog aids convert sound waves into electrical signals, which are amplified. Analog/adjustable hearing aids are custom built to meet the needs of each user. The aid is programmed by the manufacturer according to the specifications recommended by your audiologist. Analog/programmable hearing aids have more than one program or setting. An audiologist can program the aid using a computer, and you can change the program for different listening environments—from a small, quiet room to a crowded restaurant to large, open areas, such as a theater or stadium. Analog/programmable circuitry can be used in all types of hearing aids. Analog aids usually are less expensive than digital aids.

Digital aids convert sound waves into numerical codes, similar to the binary code of a computer, before amplifying them. Because the code also includes information about a sound’s pitch or loudness, the aid can be specially programmed to amplify some frequencies more than others. Digital circuitry gives an audiologist more flexibility in adjusting the aid to a user’s needs and to certain listening environments. These aids also can be programmed to focus on sounds coming from a specific direction. Digital circuitry can be used in all types of hearing aids.

The hearing aid that will work best for you depends on the kind and severity of your hearing loss. If you have a hearing loss in both of your ears, two hearing aids are generally recommended because two aids provide a more natural signal to the brain. Hearing in both ears also will help you understand speech and locate where the sound is coming from.

You and your audiologist should select a hearing aid that best suits your needs and lifestyle. Price is also a key consideration because hearing aids range from hundreds to several thousand dollars. Similar to other equipment purchases, style and features affect cost. However, don’t use price alone to determine the best hearing aid for you. Just because one hearing aid is more expensive than another does not necessarily mean that it will better suit your needs.

A hearing aid will not restore your normal hearing. With practice, however, a hearing aid will increase your awareness of sounds and their sources. You will want to wear your hearing aid regularly, so select one that is convenient and easy for you to use. Other features to consider include parts or services covered by the warranty, estimated schedule and costs for maintenance and repair, options and upgrade opportunities, and the hearing aid company’s reputation for quality and customer service.

Having trouble hearing? Close to 30 million adults in the United States have some degree of hearing loss. Hearing loss can have a negative effect on communication, relationships, school or work performance, and emotional well-being. However, hearing loss doesn't have to restrict your daily activities. Properly fitted hearing aids and aural rehabilitation can help in many listening situations. Aural rehabilitation is the use of techniques to identify and diagnose hearing loss and implement therapies for patients who are hard of hearing, which often involves the use of hearing aids. Aural rehabilitation helps a person focus on adjusting to their hearing loss and the use of their hearing aids. It also explores assistive devices to help improve communication. Most people who are hearing-impaired will need two hearing aids because both ears are often affected by hearing loss, though some people may only need one 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? (Most manufacturers allow a 30- to 60-day trial period during which aids can be returned for a refund.) What fees are nonrefundable if the aids are returned after 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 servicing and minor repairs? Will loaner aids be provided when repairs are needed?
• What instruction does the audiologist provide?

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’s 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 aid’s volume and to program 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 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, however, 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.

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.

Although they work differently than the hearing aids described above, implantable hearing aids are designed to help increase the transmission of sound vibrations entering the inner ear. A middle ear implant (MEI) is a small device attached to one of the bones of the middle ear. Rather than amplifying the sound traveling to the eardrum, an MEI moves these bones directly. Both techniques have the net result of strengthening sound vibrations entering the inner ear so that they can be detected by individuals with sensorineural hearing loss.

A bone-anchored hearing aid (BAHA) is a small device that attaches to the bone behind the ear. The device transmits sound vibrations directly to the inner ear through the skull, bypassing the middle ear. BAHAs are generally used by individuals with middle ear problems or deafness in one ear. Because surgery is required to implant either of these devices, many hearing specialists feel that the benefits may not outweigh the risks.

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 state’s early intervention program or State Children’s Health Insurance Program.

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 the National Institute on Deafness and Other Communication Disorders (NIDCD) Information Clearinghouse with questions about organizations that offer financial assistance for hearing aids.

Researchers are looking at ways to apply new signal processing strategies to the design of hearing aids. Signal processing is the method used to modify normal sound waves into amplified sound that is the best possible match to the remaining hearing for a hearing aid user. NIDCD-funded researchers also are studying how hearing aids can enhance speech signals to improve understanding.

In addition, researchers are investigating the use of computer-aided technology to design and manufacture better hearing aids. Researchers also are seeking ways to improve sound transmission and to reduce noise interference, feedback, and the occlusion effect. Additional studies focus on the best ways to select and fit hearing aids in children and other groups whose hearing ability is hard to test.

Another promising research focus is to use lessons learned from animal models to design better microphones for hearing aids. NIDCD-supported scientists are studying the tiny fly Ormia ochracea because its ear structure allows the fly to determine the source of a sound easily. Scientists are using the fly’s ear structure as a model for designing miniature directional microphones for hearing aids. These microphones amplify the sound coming from a particular direction (usually the direction a person is facing), but not the sounds that arrive from other directions. Directional microphones hold great promise for making it easier for people to hear a single conversation, even when surrounded by other noises and voices.

What is that buzzing noise in my cell phone?

People who wear hearing aids or have implanted hearing devices may experience some difficulties when trying to use cell phones. That buzzing noise you hear is interference due to radiofrequency (RF) emissions from your phone. RF interference does not occur for all combinations of digital wireless telephones and hearing aids. However, when interference does occur, the buzzing sound can make understanding speech difficult, communication over cell phones annoying, and, in the worst case, render the cell phone unusable for the hearing aid user.

Fortunately, the compatibility of cell phones and hearing aids is improving. Some cell phones have lower radiofrequency emissions or use different technologies that can reduce the unwanted effects on hearing aids.

What should I look for in a cell phone?

Rules set by the Federal Communications Commission (FCC) make it easier for you to choose a cell phone right for you. The FCC requires cell phone manufacturers to test and rate their wireless handsets' hearing aid compatibility using the American National Standards Institute (ANSI) C63.19 standard. These ratings give an indication of the likelihood that a cell phone may interfere with hearing aids; the higher the rating, the less likely the cell phone-hearing aid combination will experience undesired interference.

Labeling on the outside packaging of cell phones will tell you if they are hearing aid compatible (HAC). Hearing aid users should read and understand these ratings when choosing a cell phone.

What do these ratings mean?

Cell phones that are rated "good" or "excellent" for use with hearing aids set in microphone (M) mode will have a rating of M3 or M4. The higher the "M" rating, the less likely you will experience interference when the hearing aid is set in the microphone mode while using the cell phone.

Cell phones are also rated with hearing aids or cochlear implants that have a T-coil. (See Types of Hearing Aids, What are some features for hearing aids?) Those rated "good" or "excellent" for use with hearing aids set in T-coil mode will have a rating of T3 or T4. The higher the "T" rating, the less likely you will experience interference when the hearing aid is set in the T-coil mode while using the cell phone.

Hearing aid manufacturers also use a rating system from the same ANSI standard. The hearing aid ratings and the cell phone ratings should be combined to help identify combinations that will provide you with a positive experience. So, a hearing aid rated M2 and a wireless device rated M3 with a combined rating of 5 and would likely provide "normal" use. A ratings combination of 6 would likely provide "excellent performance". Every individual's hearing aid technology and settings are unique; therefore, these ratings do not guarantee performance.

Because these HAC ratings do not guarantee performance, you should "try before you buy" any wireless device if possible. You should try different brands and models to see which phone works best for you. Also, be sure to closely examine the return policy for the device and the service provider's policy on early termination of contracts before signing up for service.

Assistive Listening Devices

Assistive listening devices (ALDs) or assistive listening systems include a large variety of devices designed to help you hear sounds in everyday activities. ALDs are available in some public places such as auditoriums, movie theaters, houses of worship, and meeting rooms. They may be used by both normal hearing and hearing-impaired people to improve listening in these settings.

ALDs can be used to overcome the negative effects of distance, poor room acoustics, and background noise. To achieve this purpose, many ALDs consist of a microphone near the source of the sound and a receiver near the listener. The listener can usually adjust the volume of the receiver as needed. Careful microphone placement allows the level of the speaker's voice to stay constant regardless of the distance between the speaker and the audience. The speaker's voice is also heard clearly over room noises such as chairs moving, fan motors running, and people talking.

ALDs can be used with or without hearing aids.

Cochlear Implants

A cochlear implant is an implanted electronic medical device that can produce useful hearing sensation by electrically stimulating nerves inside the inner ear. Cochlear implants currently consist of two main components:

• External, comprised of an externally worn microphone, sound processor and transmitter system
• Internal, comprised of an implanted receiver and electrode system, which contains the electronic circuits that receive signals from the external system and send electrical signals to the inner ear

Cochlear implants are different from hearing aids in some aspects:

Implantable Middle Ear Hearing Devices

Implantable Middle Ear Hearing Devices (IMEHD) help increase the transmission of sound to the inner ear. IMEHDs are small implantable devices that are typically attached to one of the tiny bones in the middle ear. When they receive sound waves, IMEHDs vibrate and directly move the middle ear bones. This creates sound vibrations in the inner ear, which helps you to detect the sound. This device is generally used for people with sensorineural hearing loss.

Bone-Anchored Hearing Aids

A bone-anchored hearing aid (BAHA), like a cochlear implant, has both implanted and external components. The implanted component is a small post that is surgically attached to the skull bone behind your ear. The external component is a speech processor which converts sound into vibrations; it connects to the implanted post and transmits sound vibrations directly to the inner ear through the skull, bypassing the middle ear. BAHAs are for people with middle ear problems (usually a mixed hearing loss) or who have no hearing in one ear.

Personal Sound Amplification Products

Personal Sound Amplification Products (PSAPs), or sound amplifiers, increase sounds in certain environments for non-hearing-impaired consumers. Examples of situations when these products would be used include hunting (listening for prey), bird watching, listening to a lecture with a distant speaker, and listening to soft sounds that would be difficult for normal hearing individuals to hear (for example, distant conversations, performances). Unlike hearing aids, PSAPs are not intended to aid with or compensate for hearing impairment. These products are not medical devices and are not subject to FDA’s medical device requirements.

Are you or a loved one having a hard time hearing? Perhaps you considered getting a hearing aid in the past?

Hearing aid technology keeps evolving, which means there’s a growing variety of styles and features to consider.

“People who already use a hearing aid know that selecting one is not a simple decision,” says Eric Mann, M.D., Ph.D., Senior Advisor in the U.S. Food and Drug Administration office responsible for hearing aids. “Hearing loss affects people in different ways. So, it’s important to choose a hearing aid that’s appropriate for your condition and fits your lifestyle.”

The FDA regulates hearing aids to make sure they provide reasonable assurance of safety and effectiveness. If you’re considering hearing aids, this article highlights some common technologies and terms you may encounter, including information about the FDA’s requirements for hearing aids sold over-the-counter (OTC), which are intended for people 18 years of age and older who have perceived mild to moderate hearing loss.

Hearing Aids and How They Work

People may be born with hearing loss. Or they may develop it later in life — often because the inner ear can wear out as we age or be damaged by years of exposure to loud sounds.

In some cases, hearing loss is temporary and can be restored with medical help. In other cases, it’s permanent but can be improved with hearing aids.

Hearing aids are medical devices worn behind or in the ear. They can improve hearing by making sounds louder. However, hearing aids usually won’t restore your hearing to normal levels or quality in the way that eyeglasses can often restore vision to 20/20.

Air-conduction vs. bone-conduction hearing aids

Most hearing aids work through air conduction. They bring amplified sound into the ear canal. Sound then moves through the eardrum and three tiny bones in the middle ear to reach the inner ear, where it’s processed and sent to the brain.

For people who have problems with their outer or middle ear, those areas can be bypassed with bone-conduction hearing aids. They send sound through the skull to reach the inner ear.

Styles of Hearing Aids

Behind-the-ear (BTE) aids: BTE hearing aids are generally the largest hearing aid style. A plastic case containing most of the electronics sits behind the ear and is connected to an earmold that fits in the ear canal. BTE hearing aids can be used by people of all ages. The style is often chosen for young children because it can be adapted as they grow.

Receiver-in-the-canal (RIC) aids: RIC (or mini receiver-in-the-ear; mini RITE) hearing aids sit behind the ear but are typically smaller than a BTE. The RIC hearing aid is attached to a tube housing a small wire with a dome-shaped tip at the end that rests in the ear canal (in some cases, earmolds are used). The RIC design allows more of the ear canal to remain open and is less visible than the BTE style.

In-the-ear (ITE) aids: This hearing aid sits completely in the outer ear (the “bowl” of the ear). All the hearing aid electronics are housed in a custom-fit shell.

In-the-canal (ITC) aids and completely-in-the-canal (CIC) aids: These are the smallest hearing aids currently available. The electronics are contained in a small custom-fit shell that fits partly or completely into the ear canal. Some people may like them because they are less noticeable while other people may find them harder to handle.

Hearing Aid Features

Today’s hearing aids come with a variety of features. Here are some of the more common ones.

Directional microphones focus on sound from a specific direction. They could help you hear someone in a face-to-face conversation over the noise around you, for example.

Telecoils enable the hearing aid to pick up sound directly from compatible phones or compatible sound systems in public places, such as theaters and houses of worship.

Wireless connectivity such as Bluetooth allows hearing aids to interact with televisions, cellphones, computers or tablets, for example.

Getting Hearing Aids

Medical evaluation for children (younger than 18 years of age)

While hearing loss in adults is often caused by aging or noise exposure, the reasons for hearing loss in children are more varied and may be associated with other medical conditions that should be medically evaluated prior to prescribing hearing aids. OTC hearing aids are not intended for and must not be sold to people younger than 18 years of age. Hearing aids intended for people younger than 18 years of age are prescription hearing aids.

Prescription hearing aids are sold by audiologists; ear, nose, and throat doctors; or sellers licensed to dispense hearing aids, such as instrument specialists.

Over-the-counter (OTC) hearing aids

To broaden access to hearing aids, the FDA established a new category of OTC hearing aids so you will be able to buy one in the store or online without seeing a physician for an exam or an audiologist for help with fitting. The new FDA regulation, which implements a law from Congress, also aims to stimulate competition, providing consumers with improved access to devices that meet their needs and are less expensive than current options.

The OTC final rule applies to certain air-conduction hearing aids intended for people 18 years of age and older who have perceived mild to moderate hearing loss. A person with mild hearing loss may have difficulty hearing some speech sounds but not others. A person with moderate hearing loss may have increased difficulty hearing some speech sounds, even in a quiet room with someone talking at a normal level.

“We want hearing aids to be more readily available and accessible, especially as our population ages,” Mann explains. “It’s also important for people to recognize that hearing loss could be a sign of an easily treatable problem like built-up earwax or a more serious problem like a benign tumor on the hearing nerve. See a doctor when things don’t feel right, when your hearing loss is progressing, or if you are having associated symptoms like dizziness, ear pain, or drainage from the ear canal.”

Hearing aids vs. personal sound amplification products

You may have seen products in stores or online that are known as personal sound amplification products (PSAPs). These are not alternatives to hearing aids.

While hearing aids and PSAPs both amplify sound for the user, the products have different intended uses. Hearing aids are intended to make up for impaired hearing. PSAPs, in contrast, are intended for people with normal hearing to amplify sounds in certain situations, such as recreational activities like birdwatching or hunting.

Because such PSAPs are regulated as consumer electronics and not medical devices, they may be more variable in terms of product quality compared to hearing aids.