If I suspect I have a hearing loss, what should I do?

If you suspect that you have a hearing loss, consult with a Doctor of Audiology. A Doctor of Audiology is trained to identify whether a hearing loss requires medical or non-medical treatment and will refer you to the appropriate medical specialist when necessary. The Doctor of Audiology will identify, diagnose, treat and manage your hearing loss.

What can I expect from an audiological evaluation?


The audiologist will perform a thorough assessment of the hearing mechanism, beginning with a history interview. History questions will focus on the following areas:

  1. Conditions at birth or during adolescence that may have an impact on hearing.
  2. Exposure to workplace, military, or recreational noise.
  3. Medications prescribed for medical conditions.
  4. Past surgeries.
  5. Family traits and hereditary anomalies that may be associated with hearing loss.


Following the history, the Doctor of Audiology will examine the outer ear with an otoscope or video otoscope. The doctor can observe any damage caused by the use of cotton applicators ("Q-tips"), trauma, or chronic infection. The doctor can also observe the condition of the ear drum and determine whether the ear canal may have a buildup of earwax causing a hearing loss.


After considering a patient's history and performing a visual inspection of the outer ear, the audiologist will perform an audiological evaluation composed of a series of tests. These tests may include but are not limited to:

  1. Tympanometry to assess the status of the middle ear.
  2. Pure tone thresholds by air conduction and by bone conduction to determine the degree and type of hearing loss.
  3. Tests of speech threshold and speech recognition to assess comprehension of complex signals.
  4. Special tests of auditory function, such as otoacoustic emissions.

How do I know if I need a hearing aid(s)?


The results of the audiological evaluation are a critical factor in helping to determine the need for hearing aid(s), the type of hearing aid(s) and whether one or two aids are needed. The Doctor of Audiology will review the results of your evaluation and provide various options and recommendations for remediation, if needed.


Although the audiological evaluation is necessary to determine a course of action, it does not tell the entire story. Doctors of Audiology also consider and weigh the patient's personal preferences as well as their overall health. Patients may not be ready to try hearing aids initially, but they will be asked to truthfully assess their degree of communicative difficulty.

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.

How can hearing aids help?

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.

What kinds of hearing aids are available?

Hearing aids are available in a variety of sizes and shapes, from instruments that fit behind the ear to instruments that totally fit within the ear canal and are minimally visible. Electronic circuitry has advanced significantly in the recent past, allowing patients greater sound comfort and improved speech recognition in noisy situations, to name a few. Digital hearing aids, which are adjusted via a computer connection, provide the most flexibility, allowing the Doctor of Audiology to custom fit the response of the device to a specific hearing loss. Digital hearing aids can be modified if hearing changes or as your listening needs change. Your Doctor will help you choose the best instrument according to your needs and your budget.

Are there different styles of hearing aids?

Hearing aids are available in more styles and sizes than ever before, thanks to miniaturization of electronics and a new focus in the hearing industry on style and design. Now, more and more people can wear tiny, nearly invisible models, or sleek styles that are much less conspicuous than the latest Bluetooth headsets.

In-the-Ear Styles

Hearing aids worn in the ear are usually custom-fit, based on a cast or impression of the ear. They're available in different skin tones to camouflage with the outer ear. There are several styles – each is listed below, ranging from smallest to largest.

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Invisible-in-the-Canal (IIC)

The smallest hearing aid style is the IIC. This fits deep in the ear, completely out of view past the second bend of the ear canal, providing an invisible fit. The cosmetic advantages of this hearing aid can appeal to a wide variety of people who do not prefer a more visible option. They fit mild to moderately severe hearing losses.

Completely-in-the-Canal (CIC)

The smallest custom style, CIC instruments fit deeply and entirely within the ear canal. They fit mild to moderate hearing losses and offer high cosmetic appeal as they're nearly invisible when worn.


In-the-Canal (ITC)

ITC instruments sit in the lower portion of the outer ear bowl, making them comfortable and easy to use. Because they're slightly larger than CIC models, they have a longer battery life, and can host additional features such as directional microphones for better understanding in noisy environments, and controls such as volume controls. They fit mild and moderate hearing losses.


Half Shell (HS)

Half shell models fill half the bowl of the outer ear. Like ITC models, their size enables the addition of features such as directional microphones, volume controls and push buttons to activate special settings for different listening environments. Because of their size, they may be easier than smaller models to handle for some people and yet are still often disguised by hairstyles or sideburns. This hearing aid style looks similar to the ITC hearing aid when worn on the ear, but is slightly larger.

Full Shell or In-the-Ear (ITE)

Full shell models sit flush within the outer ear bowl. Their size allows the maximum number of additional controls and features such as directional microphones, which require space on the outer portion of the instrument. They use a larger battery size than the smaller styles, and can fit a larger receiver with enough power for even some severe hearing losses. Because of their flexibility, they're widely recommended for mild to severe hearing loss.


Behind-the-Ear Styles

Behind-the-Ear (BTE) models sit behind or on top of the outer ear, with tubing that routes sounds down into the ear that connects to an ear tip or earmold to secure them in the ear canal. BTEs come in colors to blend with hair or skin tones, and even chrome colors, patterns and other fun designs to suit personal styles. Different BTE sizes accommodate different features, controls, battery types and degrees of power (larger instruments generally have more power than smaller ones). While many people choose discreet BTEs that are unnoticeable when worn, others are tempted to show off the cool designs.


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Mini BTE with slim tube and tip

Mini BTEs are designed to hide behind the outer ear, and have ultra-thin tubing to discreetly route sound into the ear. The tubing connects to a soft tip that sits in the ear canal but doesn't occlude it. The result is a natural, open feeling as airflow and sound enter the ear naturally around the tip, while amplified sound enters through the tip. This is known as "open fitting" and is recommended for mild to moderate high frequency losses.


Receiver in the ear (RITE)

RITE models, also known as RIC (receiver-in-canal) models, are mini BTEs that have the speaker of the instrument incorporated in the ear tip, instead of in the main body of the instrument. RITE instruments fit mild to severe hearing losses. This hearing aid style looks similar to the Mini BTE when worn on the ear.

BTE with earmold

BTEs with earmolds fit mild through profound hearing losses. Their longer shape, following the contour behind the outer ear, generally can house more features, controls, and power than custom models. The earmold color and style, as well as the wearer's hairstyle, determine exactly how they will look on each person.



What is 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 a hearing aid compatible 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. Telecoils are not available in smaller hearing aids due to size constraints.

Which hearing aid will work best for me?

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 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 Doctor of Audiology should select a hearing aid that best suits your needs, budget and lifestyle.  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 hearing to normal. 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.

Why do hearing aids cost so much?

In order to receive maximum benefit from hearing aids, a professionally trained Doctor of Audiology is involved in the fitting process which typically involves an average of five direct contact hours during the first year. Hearing Associates will provide unlimited hearing aid service during the warranty period (from one to three years), for no additional charge. Hearing aids are typically fit as part of a package that includes professional services such as verification of the hearing aid fitting by real ear (or probe tube) measurements,  ear impressions, selecting/ fitting/ adjusting/ reprogramming the hearing aid and follow-up appointments as needed.  Patient and family counseling regarding hearing aid use, maintenance, and realistic expectations and participation in our Learning to Hear Again classes is also included.

Mail order or budget clubs may sell hearing aids at lower prices because they are often placed on the user with minimal or no instructions and/or adjustments. (Their components may be less expensive, too.) The user may be charged for return visits including minor tubing changes and adjustments. In the long run, the patient may pay as much or even more than they would from a full-service audiology practice.

The minimum training required for a dispensing audiologist has been a master's degree, which is now transitioning to a doctoral degree (Au.D.). Mail order discount centers, by contrast, are often staffed by sales people with minimal technical training. Why does it matter? Audiologists know that the most important consideration in hearing aid selection is not the hearing itself; rather, it is the skill and knowledge of the professional dispensing the hearing aid. The audiologist's responsibility is to ensure that a suitable instrument is selected and to provide an understandable explanation of its merits and limitations.

Hearing aids are sold in relatively low volume when compared with other electronic devices. For example, approximately 1.7 million hearing aids are sold in the U.S. per year as compared to several million stereos; yet, the amount of time and resources manufacturers spend on development and research is considerable. One manufacturer reported spending more than forty million dollars developing a single model.

"Return for Credit" policies are standard among hearing aid manufacturers and required by state and federal hearing aid guidelines, allowing new hearing aids to be returned within an established evaluation period. The costs associated with these policies are considerable, especially for custom products, and naturally must be absorbed in the overall pricing structure.

Communication is vital to human existence. According to a groundbreaking study published by the National Council on Aging (1999), "Untreated hearing loss has serious emotional and social consequences for older persons." The benefits hearing aid users reported in their lives ranged from improved relationships at home and sense of independence to improved social and family life. According to the study, the families of hearing-aid users noticed improvements in every dimension the survey measured. An additional "Beyond Fifty" survey conducted by the AARP and Harris Interactive (2003) found that the ability to stay connected to family and friends contributed to quality of life more than overall health. So if wearing hearing aids allows you to resume activities you enjoy, improve relationships with friends and family, retain your independence, etc. the cost becomes a lot more justifiable.

What can I expect as I adjust to my new hearing aids?

Besides helping you to hear and understand voices better, properly adjusted hearing aids will allow you to hear sounds that previously may not have been audible. You may notice that your own voice is louder, too. Your entire auditory system will adjust to the new sounds that have not been heard for a long time. The sound of wrinkling newspaper or water running may be annoying at first. However, after about 2-3 weeks, you will notice an adjustment to these environmental sounds. Gradually increasing the amount of time you wear the hearing aids and following the schedule provided by your Doctor of Audiology will result in an easier transition to amplified sound. During the initial adjustment period, you may be asked to visit Hearing Associates several times so that your Doctor of Audiology may monitor your progress and adjust the controls of your hearing aid(s), if needed. These follow-up visits are crucial to your success with amplification.

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.
  • Open the battery door to 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.