More than 35 million Americans suffer from some degree of hearing loss. If you’re one of them, you may be shopping for an assistive device. Before you buy any product to enhance your hearing, it’s important to understand the various types of hearing loss, the differences between a hearing aid and a personal sound amplification device, and what to consider when you’re shopping so you get the product that’s most appropriate for your particular kind of hearing loss.

What are the common types of hearing loss? Three types of hearing loss are the most common:

• Conductive hearing loss, which involves the outer ear, the middle ear, or both. It usually results from a blockage from earwax, fluid in the middle ear, or a punctured eardrum. Conductive hearing loss often can be corrected surgically.
• Sensorineural — or “nerve” — hearing loss, which involves damage to the inner ear. It can be caused by disease, illness, age, injury from exposure to noise or certain medicines, or a genetic disorder. Usually, sensorineural hearing loss can’t be repaired surgically, but it can be corrected with a hearing aid.
• Mixed hearing loss, which is a combination of sensorineural and conductive hearing loss. Only a small portion of adult hearing problems, like ear infections and middle ear diseases, are medically or surgically treatable. If the hearing loss can’t be treated medically or surgically, a hearing aid may be beneficial.

Sound Advice: If you think you are losing your hearing, see your doctor. You may be referred to a health care professional who specializes in ear health and hearing loss.

What is a Hearing Aid?

A hearing aid is a small electronic device worn in or behind the ear. The device has three parts: a microphone, an amplifier, and a speaker. It receives sound through the microphone, which converts the sound to electrical signals and sends them to the amplifier. The amplifier increases the power of the signals and sends them to the ear through the speaker.

The device doesn’t work unless you have some ability to hear. And because hearing loss affects people in different ways, you need to get the device that’s appropriate for your condition. For example, if you have hearing loss in both ears, two hearing aids may be recommended because two aids provide a more natural signal to the brain.

The price of a hearing aid can range from hundreds to thousands of dollars, depending on the style and features.

Sound Advice: Price is a factor, but it’s not the only one to consider when you are determining your best option for an assistive hearing device. A more expensive device isn’t always better for your needs.

What Is a Personal Sound Amplification Product?

A personal sound amplification product (PSAP) is a device used by people with normal hearing to amplify hard-to-hear sounds. For example, if you are sitting at the back of a lecture hall, eating in a crowded restaurant, or bird-watching, a PSAP may be helpful.

Sound Advice: If your hearing is impaired, don’t use a PSAP as a substitute for a hearing aid. That may delay the diagnosis of a potentially treatable condition, and cause more damage to your hearing.

Who Can Help Me Determine the Most Appropriate Product?

Your doctor may refer you to a hearing health professional for an examination and evaluation. It may be an otolaryngologist, an audiologist, or a hearing aid dispenser. Only two types of people are authorized to measure hearing loss and fit and dispense hearing aids in the U.S.: an audiologist and a hearing aid dispenser.

• An otolaryngologist is a physician who specializes in diagnosing and treating diseases of the head and neck, especially those involving the ears, nose, and throat (ENT).
• An audiologist is a trained professional who measures hearing loss and can fit hearing aids. An audiologist has at least a master's degree and has specialized training in hearing loss; many now have an AuD (doctorate) degree, too. Some may even have a PhD.
• A hearing aid dispenser is someone authorized by the state to measure hearing and to fit and sell hearing aids. The credentials for becoming a hearing aid dispenser vary by state, but typically involve working as an apprentice to an already certified dispenser for some period of time and passing a test about hearing aids. A hearing aid dispenser is not an audiologist and does not have to have a college degree related to hearing loss.

Sometimes, hearing loss can be a symptom of a medical condition. A medical examination may uncover any underlying illnesses or medical problems associated with your hearing loss. In fact, a medical evaluation is so important that the U.S. Food and Drug Administration (FDA) requires hearing aid sellers to tell you about your need for a medical examination before you buy a hearing aid. If you decide to forgo an evaluation, you must sign a waiver.

Sound Advice: Don’t patronize a business that dismisses the need for a medical examination prior to the purchase of a hearing aid.

What’s a Good Way to Shop for a Hearing Aid?

Once you’ve had a medical examination and determined that a hearing aid will help you, look for a hearing health professional who offers products from several manufacturers. You can check out sellers with your local Better Business Bureau, your state or local consumer protection agency, your state Attorney General, your state licensing or certification boards, or the American Speech-Language-Hearing Association (ASHA). These organizations may have records of complaints against licensed hearing health professionals, and can tell you how they responded to the complaints. You also may be able to enter the professional’s name and the manufacturer’s name into a search engine online, and find out what other people have to say.

What About a Purchase Agreement?

Your contract should contain information about the following items:

• Trial Period – Most states require a 30- to 60-day trial period. Most hearing health professionals offer this even in states that don’t require it. Find out what fees are refundable if you return the aid during the trial period. Make sure that’s written into the purchase agreement.
• Warranty – Get the details. How long is the warranty? Can it be extended? Does it cover maintenance and repairs? Is it honored by the manufacturer or by the licensed hearing health care professional? In some cases, a manufacturer may not honor its warranty unless the hearing aid is purchased from an authorized seller. You also may be protected by implied warranties created by state law.
• Loaner – Ask if you’ll get a free loaner hearing aid if your device needs servicing or repair.
• Total Price – Check whether the price quoted includes testing and other services, as well as the hearing aid.

While health insurance plans, including Medicare, typically pay for diagnostic hearing evaluation, many plans do not cover hearing aids. If you can’t afford a hearing aid, contact the National Institute on Deafness and Other Communication Disorders (NIDCD) for information about organizations that offer financial assistance.

Sound Advice: Take your time when you are shopping for a hearing aid. Resist sales pressure. It’s an expensive purchase, so buy only when you’re satisfied with the answers to your questions. Make sure the person you are dealing with puts any promises or guarantees about service and maintenance into the purchase agreement.

What are the Government's Standards for Hearing Aid Sales?

The FTC enforces regulations that prohibit the use of misleading sales and advertising practices, including giving inaccurate information about hearing loss, hearing aid performance, refund policies, or warranty coverage.

The FDA enforces regulations that deal with the manufacture and sale of hearing aids. Before selling a hearing aid, a dispenser must:

1. get a written statement from the patient, signed by a licensed physician. The statement must say that the patient’s ears have been medically evaluated, and that the patient is cleared for fitting with a hearing aid. The medical evaluation must have taken place in the preceding six months.
2. avoid encouraging the patient to waive the medical evaluation requirement. Dispensers also must advise the patient that waiving the examination is not in his best health interest.
3. advise patients who appear to have a hearing problem to consult a physician promptly.
4. provide an instruction brochure with the hearing aid that illustrates and describes its operation, use, and care. The brochure must list sources for repair and maintenance, and include a statement that the use of a hearing aid may be only part of a rehabilitative program that might also need to include auditory training and instruction in lipreading.

Many states also have laws governing hearing aid sales and implied warranties. Your state Attorney General’s office can tell you what laws apply in your state.

Sound Advice: Buying a hearing aid online or through the mail is risky. In fact, some states don’t allow hearing aids to be sold through the mail at all. That’s because an aid needs to be custom fitted and tested to be sure it’s working properly.

Where Can I Get More Information?

Food and Drug Administration (FDA)

National Institute on Deafness and Other Communication Disorders (NIDCD)

What If I Want to Complain About a Device?

To report problems with medical devices, including hearing aids, contact the FDA via the MedWatch program (MedWatch Online Reporting Form 3500).

To report deceptive business practices or other types of consumer fraud, contact:

Federal Trade Commission

Your state Attorney General

Better Business Bureau

Your local consumer protection office

This article was previously available as Sound Advice on Hearing Aids.