Which hearing aids work best?


When Roger Draper was about 10 years old, a dose of antibiotics damaged his hearing. At first his mother couldn’t take in the sad news. “She would say, ‘Roger, do the dishes,’ and when I didn’t respond, she’d accuse me of ignoring her,” he recalls.

Roger Draper
Roger Draper 

Draper, who works as an editor in New York City, was soon diagnosed with a profound hearing loss. “I think her sister convinced her that I couldn’t hear. My aunt also had a profound hearing loss,” he says. He relies on hearing aids and owns an amplified telephone he uses rarely.

Although hearing loss is common, affecting nearly a quarter of all Americans age 12 and up, in most cases it is mild. But more than two million Americans live with hearing loss that is severe or profound, as defined by the World Health Organization (WHO).  

What is severe or profound hearing loss?

According to WHO, if the quietest sound you can hear with your better ear is between 60 and 80 decibels, your loss is severe. It will be at least 80 decibels if your loss is profound. In the United States, a stricter definition is often used, so that someone who can’t hear a sound less than 90 decibels would be considered to have a profound loss.    

Degrees of hearing loss

With either definition, if you have profound hearing loss, you won’t hear most everyday sounds without amplification, just loud sounds. You might catch a 100-decibel ambulance siren if your car window is open—but not someone calling you from behind. 

People with profound hearing loss can’t hear sounds quieter than about 90 decibels. Ordinary conversation tends to be about 60 decibels.

Profound hearing loss usually stems from a birth defect or an illness or injury, not from age. Many people in this group read lips or use sign language as they cannot typically hear speech.

However, like Draper, people with severe or profound hearing loss can still benefit from hearing aids. 

Your hearing aid options  

Oticon Dynamo power hearing aid
This woman is wearing the Oticon 

Dynamo super power hearing aid
Image courtesy Oticon

All the major hearing aid manufacturers offer “power” or “super power” aids for both adults and children. These aids are slightly bigger than others because they contain more circuitry. But aids for severe-to-profound hearing loss have become smaller in recent years and can be fit even on babies, says Catherine Palmer, president-elect of the American Academy of Audiology and director of Audiology and Hearing Aids at the University of Pittsburgh Medical Center. They typically run on a 675 battery or the smaller 13 battery and rest behind the ears (known as BTE), attached to a full earmold.

Hearing aids that nestle inside the ear (known as ITE) won’t do the job, Palmer says. Unless one ear is fine, you will need hearing aids for both ears.   

Hearing aids for people with severe-to-profound hearing loss are known as power or super power hearing aids. They’re a little larger than other aids, and usually worn behind-the-ear with a custom earmold. 

If you have severe hearing loss, your audiologist’s most important task will be to make sure the sound is loud enough so you can hear but not so loud it damages your natural hearing. After programming a hearing aid for you, your audiologist will test it for safety and accurate amplification. Don’t worry: The test shouldn’t be uncomfortable or damage your hearing. While you’re wearing your aid, your audiologist will put a microphone in your ear canal and measure the aid’s output.

“A person could be tolerant of a decibel level that could be damaging,” Palmer says. “That is why we measure rather than asking someone how things sound.”  

Other profound hearing loss treatments

For some people, power hearing aids might not be the best option. Other treatments for severe-to-profound hearing loss include bone-anchored hearing systems and cochlear implants

A good fit is key

The next most important task is to minimize feedback, that whistling sound when amplified sound leaks out of the ear, reaches the hearing aid microphone, and is re-amplified. “The feedback control systems are sophisticated and better than ever,” Palmer says. A loose earmold will cause feedback, so you’ll need careful fitting, she says. Your audiologist will use silicone to create an exact mold of your ear. Children will need new earmolds as their ears grow. In five years, Palmer predicts, audiologists will be using scans of the ear to make the fit even more precise. “Currently, the equipment is expensive but the price will come down over time,” she says.

Your audiologist also may be able to move higher pitches, which tend to be harder to hear, into a more audible range for you, a process called “frequency lowering.”

When choosing an aid, you and your audiologist will consider how much power it offers, how well it controls feedback, and its circuitry. Some hearing aids include two or three microphones that help you distinguish sound coming from different directions. A telecoil links the hearing aid to a hearing loop system, which are found in many theaters, churches, airports and major venues. Most aids have these important features, so other factors you might consider include how moisture or dust resistant it is, the length of the warranty and the track record on repairs.

Assistive technology

To hear in a noisy setting, Palmer suggests using an additional microphone near the sound you wish to hear that will send signals to your hearing aid.  

Hearing aids can be wirelessly connected to smartphones, but people with severe-to-profound hearing loss may need a phone with automatic captioning. State programs may allow you to get one for free. Video applications like FaceTime, Facebook Messenger and Skype allow you to see facial expressions and read lips. Phone apps also provide captions.

Many new apps can turn your smartphone into a customized alarm system or provide other assistance. Tunity scans a television screen and runs the amplified sound through your headphones. Ava provides subtitles for conversations in the room. Your phone can give you text messages, vibrate, flash a light or make a low sound to pick up noise from a smoke detector, doorbell, phone or alarm clock. There are also plenty of other assistive listening devices to augment your hearing aids, including FM systems and vibrating bed shaker alarms.

During your visit to an audiologist, speak up! Palmer suggests describing in detail—from morning to night—a weekday and your weekends. Identify any situations in which you now find it hard to hear and your current solutions. Your audiologist can vary your aid’s programming and teach you how to use features to make your hearing aid work best for you.  

Getting help

For any type of hearing loss, regular hearing care is key. Our large online directory of hearing care professionals is a good place to start your journey to better hearing.


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