Hearing Aids 101
A hearing aid is a medical device that is worn behind or within the ear canal. Hearing aids can be classified as either prescription, purchased through a hearing professional (audiologist, hearing aid specialist, or ENT); or over-the-counter, hearing aids intended for use by adults (age 18 or over) with mild to moderate hearing loss that may be purchased online, through the mail, or in a retail location without the intervention of a licensed hearing professional.
Hearing aids are built with the same basic parts: the microphone, the processor, the receiver (or loudspeaker), and the battery.
The microphone(s) captures the natural sound surrounding the hearing aid user. Microphones can be either directional, picking up sound in front of the wearer, or omni directional, where sound is captured from every direction. When a microphone captures sound, it is converted to a digital message and sent to the processor.
The processor reads the microphone's digital message and customizes what is amplified. Depending on the device's capabilities and settings, the processor enhances speech recognition, amplifies certain sounds, reduces or cancels feedback and reduces background noise.
The receiver/loudspeaker sends a soundwave from the processor to the ear canal. The hearing aid alters sounds in the environment to be clearer and more recognizable to the user.
The battery keeps the hearing aid on and functioning. Depending on the hearing aid style and capabilities, disposable batteries can last anywhere from 3-20 days. Rechargeable batteries are also available in many hearing aids and are created to provide power throughout the day after an overnight charge.
Styles of Hearing Aids
There are three main styles of hearing aids that you can choose from today: Receiver-in-the-Canal (RIC), Behind-the-Ear (BTE), and In-the-Ear (ITE). Choosing which style of hearing aid is most suitable for you depends on your type of hearing loss and lifestyle needs.
Receiver-in-the-Canal Hearing Aids
Receiver-in-the-Canal (RIC) hearing aids are a discreet hearing aid option that sits behind the ear. The case behind the ear holds the hearing aid's microphone(s), battery, and other components. A small, nearly invisible tube connects the case of the device to the receiver that sits inside the ear canal. RIC hearing aids come in a variety of colors and can treat nearly all levels of hearing loss.
Behind-the-Ear Hearing Aid
The Behind-the-Ear (BTE) hearing aids are similar to RIC hearing aids with the battery compartment, microphone, receiver and digital controls sitting behind the ear. Because some BTE models can house larger batteries for greater amplification and the speakers in BTE models are also located in the casing behind the ear, BTE models are typically larger than RIC models. When sound is captured by the BTE hearing aids, it travels into the wearers ear via a thin tube to a flexible ear dome or custom earmold. The casing that sits behind the ear can be purchased in various colors to match the wearer's skin tone, hair color, or fashion choice. The BTE style is available in power levels suited for those with mild to profound hearing loss.
In-the-Ear Hearing Aids
In-the-Ear (ITE) hearing aids sit inside of the canal in a lightweight plastic shell. ITE hearing aids can be custom fit to the outer portion of the wearer's ear with the use of an ear impression. There are also In-the-Canal (ITC) options that are more discreet, fitting inside the ear canal with a smaller portion visible in the outer ear. The Completely-in-the-Canal (CIC) option is even smaller and hardly visible to someone looking at the wearer’s ear, with a fully Invisible-in-the-Canal (IIC) also an option. ITE and ITC hearing aids are made for mild to severe hearing loss, while CIC and IIC are made for mild to moderate hearing loss.
New and Alternative Treatment Options
As technology advances, so do the options for hearing loss treatment. Depending on your level of hearing loss and specific listening needs, the technology described below provides additional options that have benefitted many with hearing loss.
Over-The-Counter Hearing Aids
On August 17, 2022, the final OTC rule issued by the FDA was published in the Federal Register. The final rule establishes a category for over-the-counter hearing aids and updates requirements for prescription hearing aids. The rule can be found here. The effective date of the final rule is October 17, 2022, 60 days after publication in the Federal Register. Self-fitting might be the right solution for some adults with hearing loss. However, we still urge consumers to visit a licensed hearing professional for a hearing test to understand the extent of their hearing loss and options that would best benefit and preserve their hearing health. Read the FAQ
Hearables
Some individuals with mild to moderate hearing loss have the option to use earbuds equipped with Bluetooth and hearing enhancement features. With hearables, you can fine-tune the device to enhance various listening situations and control the settings from an app on a smartphone.
Earlens®
For adults with mild to severe hearing loss, Earlens® is a revolutionary treatment option that utilizes a tiny, custom-built "Lens" placed directly on the eardrum to activate the natural hearing process. Earlens captures sound through a processor that sits behind the ear similar to a traditional RIC described above. However, instead of using a tiny speaker to amplify sound like traditional hearing aids, the Lens receives a wireless signal and then gently vibrates the eardrum. By doing away with the traditional acoustic speaker, Earlens provides dramatically better sound quality, enhances speech understanding in background noise and eliminates acoustic feedback. Earlens is fully rechargeable and offers Bluetooth functionality so that patients can listen to calls and music directly from their iPhone. The placement of the Lens does not require surgery and is done by a trained ear, nose and throat (ENT) physician. Once the Lens is placed, a trained audiologist will fine tune the processor to optimize your hearing experience.
Middle Ear Implant
A middle ear implant may be a helpful solution for those who cannot benefit from conventional hearing aids, whether that be from skin sensitivities, deformed ear canals, or unique hearing needs. The middle ear implant consists of a processor that sits externally on the head and an implanted receiver that sits just below the skin. When the processor picks up sound, it sends it to the receiver and the sound travels down to the middle ear implant which either moves the tiny bones in the middle ear or vibrates the membrane of the cochlea. By these movements, the wearer is able to perceive sound more clearly than they would be able to without the implant technology. To understand if you are a candidate for a middle ear implant, speak with an ENT physician and a licensed hearing professional.
Cochlear Implant
Cochlear implants can help adults of all ages with moderate to profound hearing loss who still struggle to hear when wearing hearing aids. They are also approved for children ages 9 months and older who have severe to profound hearing loss in both ears that have limited benefit from hearing aids. Instead of amplifying sound to be detected by the ear, a cochlear implant bypasses damaged structures in the inner-ear. Similar to the middle ear implant, the processor sits behind the ear, captures sound signals, and sends them to a receiver implanted under the skin behind the ear. The receiver then sends the sound signals to electrodes implanted in the snail-shaped inner ear (cochlea). Once the cochlea is stimulated, the electrode vibrations are then read by the brain as sound. Speak with a licensed hearing professional to have your hearing tested and see if you are a candidate for a cochlear implant.
FAQ on Over-the-Counter Hearing Aids
The introduction of new hearing devices and additional pathways for purchase will allow for increased access to hearing care options and help meet the needs of certain consumers who are ready, willing, and able to address their hearing loss. Hearing loss is unique to each individual and, in support of best practice, it is best to see a hearing professional to understand your individual hearing loss prior to making a purchase, whether OTC or prescription.
Hearing plays a crucial role in healthy living and healthy aging. A growing body of research links untreated hearing loss to multiple dimensions of mental and physical health, including a higher risk of depression, dementia, social isolation, falls leading to hospitalization, and more.1
Hearing loss is a medical condition. Hearing aids are medical devices. Choosing a hearing aid is an important decision best made with the advice and counsel of a hearing professional.
Hearing loss can be caused by aging, extended exposure to loud noises, an underlying medical condition, medical treatment, or even earwax. The cause and type of each hearing loss is unique and seeing a hearing professional, such as an ENT physician, audiologist, or hearing instrument specialist, can help you fully understand the nature of your hearing loss. These hearing professionals can also ensure your treatment provides customized sound quality that best benefits your unique hearing needs.
On average, prescription hearing aids purchased through a hearing professional range from $1,000 to $4,000. The total price includes the cost of the hearing aids (whether it be basic, mid-level, or advanced technology), the professional fitting, follow-up treatment, maintenance, troubleshooting visits, and sometimes batteries for the lifespan of the hearing aid(s).
Because over-the-counter (OTC) hearing aids do not require the service of a hearing professional, this will impact the overall price of the devices. Providing options at a wider range of price points will allow adults with mild to moderate hearing loss access a broader range of treatment options.
While traditional Medicare does cover certain hearing services, such as diagnostic hearing, balance exams, and/or cochlear implantation for individuals who meet specific selection criteria, that coverage does not extend to hearing evaluations for the purpose of obtaining a hearing aid, nor does it cover hearing aids or services related to the fitting or servicing of hearing aids. Multiple legislative proposals have been introduced, but none have advanced.
Under Part C Medicare Advantage (MA), approximately 97% of enrollees have access to some hearing health benefits and, of that, 95% of MA enrollees are in plans that provide access to both hearing exams and hearing aids.2 Some programs also provide an OTC allowance for select items at no additional cost.
According to MarkeTrak 2022, just over half of hearing aid owners had some assistance covering the cost of their hearing aids through Medicare Advantage, private insurance, Veterans Administration, Medicaid, union, or other.
Several states currently require that health benefit plans cover hearing aids for children. Some states are also moving to require minimum insurance coverage for adults with hearing loss, including Arkansas, Connecticut, Illinois, New Hampshire, Rhode Island, Maine, and Vermont.
References:
1 The Hidden Risks of Hearing Loss.” Johns Hopkins Medicine. https://www.hopkinsmedicine.org/health/healthy_aging/healthy_body/the-hidden-risks-of-hearing-loss Accessed August 16, 2018.
2 Meredith Freed, J. C. F. @jcubanski on T., & 2021, S. (2021, September 21). Dental, hearing, and vision costs and coverage among Medicare beneficiaries in traditional Medicare and Medicare advantage. KFF. https://www.kff.org/health-costs/issue-brief/dental-hearing-and-vision-costs-and-coverage-among-medicare-beneficiaries-in-traditional-medicare-and-medicare-advantage/#:~:text=In%202021%2C%2097%25%20of%20Medicare,%2C%20or%20over%20the%20ear).