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If you suspect you have hearing loss, consult a physician first to rule out any medically correctable cause. A physician can tell whether your hearing loss might be corrected by something as simple as removing wax or whether your hearing impairment is a sign of something more serious.
Your family physician may refer you to an otolaryngologist (an ear, nose and throat specialist) for specific tests and treatment.
If your physician determines a hearing aid is needed, s/he will most likely refer you to an audiologist (a non-physician specialist with a graduate or doctorate degree in the measurement and treatment of hearing impairment) for further testing.
When testing is complete, the audiologist will be able to recommend and sell you a hearing aid, if appropriate. The audiologist's title should include the letters CCC-A, which stand for Certificate of Clinical Competence-Audiology, to indicate certification from the American Speech-Language Hearing Association.
The U.S. Food and Drug Administration requires that a licensed physician evaluate your hearing within six months before you buy a hearing aid, unless you sign a waiver. A hearing aid dealer is legally required to tell you that it would not be in your best interest to forego the medical evaluation.
Hearing aid cost
Fitting a hearing aid is more complex than fitting a pair of eyeglasses. It requires careful testing to determine the precise nature of an individual's hearing loss, and to select and program a device that will offer the greatest help. Even under the best of circumstances, a hearing aid requires a significant investment (usually over $1,000 per aid).
Marking hearing aids more affordable
Please check with your insurance company prior to your hearing aid evaluation to determine if you have coverage for hearing aids. If you or someone you know can't afford the cost of better hearing, check with the following resources for information on financial assistance.
Department of Social Services
Quota International Club
Some cities have non-profit organizations that charge less for hearing aids and offer financial assistance. Your hearing-aid dispenser may also be able to suggest local agencies that offer financial assistance.
Check with the Department of Health for information on Medicaid, vocational rehabilitation agencies, the sate agency on aging, or the state office or commission on deafness.
The Veterans Administration (for veterans)
Easter Seals Society
Hearing aid selection and types
There's a wide range of hearing aid technologies available on the market today. Learn about the process of getting evaluated for a hearing aid, the various types of hearing aids, and the fitting process from the following resources:
Determining whether hearing aids are right for you
The first step in your hearing health care will be a complete hearing test (audiological evaluation).
At UW Hospital and Clinics, complete audiological evaluations are conducted in a specially sound-treated booth. The evaluation is performed by an audiologist and usually takes about 30 to 60 minutes. The hearing test will define the type and degree of hearing loss you have.
Following the evaluation, the audiologist will discuss test findings with you. If the audiologist feels you may benefit from the use of hearing aids, it will be briefly discussed at this time.
Some hearing losses can be a sign of an underlying medical problem, and approximately 10 percent of all hearing loss can be helped with medical treatment. For these reasons, it is important that you undergo a complete medical examination of your ears by an otolaryngologist (ear, nose and throat specialist) or nurse practitioner before you purchase a hearing instrument.
If you are younger than 19 years of age, federal and Wisconsin state laws require that a licensed physician, preferably an ear specialist, examine your ears before you purchase hearing aids.
If you are 18 years of age or older, you may sign a waiver declining a medical examination. However, it is not in your best interest to do so. Therefore, our policy at UW Hospital and Clinics requires an examination by an ear, nose, and throat specialist (ENT or otolaryngologist) or nurse practitioner working under the supervision of an ENT specialist at this facility within six months prior to the hearing aid fitting.
If the physician or nurse practitioner determines that medical treatment is not warranted, he or she will sign a consent form indicating that your ears were examined and you are medically cleared to be fitted with a hearing instrument (hearing aid).
Choosing and fitting hearing aids
Once the physician or nurse practitioner and audiologist determine that a hearing aid would be appropriate for you, and once you have decided to pursue amplification, your next step will be to schedule a hearing aid evaluation appointment.
Hearing aid evaluation appointment
At UW Hospital and Clinics, we see a large number of patients who live outside of the Madison area. If you live outside of the Madison area, we frequently recommend you schedule the hearing aid evaluation at a facility close to your home.
Hearing aids are similar to other types of electronic instruments in that they may need frequent service and care. Some individuals also need adjustment and changes made to their hearing aids that may require several follow-up appointments with their hearing aid dispenser.
We have also found that our patients find it helpful to bring a friend or relative with them to the hearing aid evaluation. You will receive a wealth of information regarding hearing aids, prices and purchasing policies at this appointment. It is often beneficial to have a "second set of ears" at this appointment to help you remember the information that was discussed.
You are not required to purchase a hearing aid at this time. This appointment is valid for up to six months. After six months you will be required to undergo a new audiological evaluation and medical examination.
Styles of hearing aids
There are several different styles of hearing aids and many different brands of hearing aids on the market. Not all types of hearing instruments are suitable for all hearing losses, or all people.
During the hearing aid evaluation, the audiologist will discuss the various types of hearing aids with you. The appropriate style, brand and characteristics of the hearing aids will be determined based upon your hearing loss as well as your preferences and specific needs.
The audiologist will take an impression or cast of your ears so that the hearing aids will be custom fit. Some additional testing may also be administered to further define your hearing loss.
The ear impressions are then sent to the laboratory and your hearing aids will be ordered. You will be informed of the cost for professional services as well as the cost of the hearing instruments on the day of the evaluation.
It generally takes two to three weeks for the hearing instruments to arrive from the manufacturer. At that time you will need to return to your audiologist for your hearing aid dispensing and fitting appointment.
Hearing aid dispensing and fitting
Your hearing aids will be custom-fit to your ears. Adjustments and modifications will be made to optimize hearing performance, sound quality and comfort. At this time, you will be instructed on the use and care of the devices. You will be provided with batteries for your trial period.
At UW Hospital and Clinics, we require full payment for the hearing aids at the time of your fitting. Other facilities may have different payment arrangements.
According to Wisconsin state law, you will be allowed a minimum of 30 days to try your new hearing aids. During the trial period, you should wear the hearing aids in as many different listening situations as possible.
You should also wear the hearing aids as much as possible, so you can make a decision as to whether the hearing aids are helpful. If you find that you are not satisfied with your hearing aids, your audiologist may be able to make adjustments to them. He or she may also suggest a trial period with a different hearing aid.
If at the end of your trial period you are still not satisfied with the hearing aids, by Wisconsin state law you may return the hearing aids for a refund, less a fee for professional services provided during the trial period. In addition, custom-made earmolds, which are used with behind-the-ear hearing aids, are generally non-refundable.
If you have further questions regarding this process, please feel free to call one of our audiologists at (608) 263-6190.
Hearing aid types and size options
Once your hearing problem has been diagnosed and the pattern of hearing loss has been analyzed, the hearing-aid dispenser should offer a choice of several types of devices.
Hearing aids are simple in principle: all consist of a tiny microphone, amplifier, speaker, and a battery to power them. But hearing aids vary in their levels of electronic complexity and their overall size and design — both of which affect price.
The price of hearing aids varies widely. Your audiologist will meet with you to discuss types of hearing aids, communication needs and expectations for hearing aid use. She or he will help you to decide what hearing aid is best for you. All the audiologists at UW Hospital and Clinics are licensed by the state to fit/dispense hearing aids.
Hearing aids have generally become smaller in recent years. This is a cosmetic advantage for those who don't want others to know they are wearing hearing aids.
However, smaller devices generally cost more and have several other drawbacks. Their batteries usually expire more rapidly, they need more frequent repair, their controls are more difficult to operate, and they are offered with fewer optional extras. The type of battery you will need varies with the size of the hearing aid.
Size categories, from largest to smallest, are:
Behind-the-ear (BTE) hearing aids
Behind-the-ear hearing aids are coupled to the ear with a custom earmold to ensure proper fit. This type houses the microphone, speaker and amplifier in a curved case that fits behind the ear. A short plastic tube conducts sound from the case to an earpiece that fits inside the ear. The case on some of the newer models is only about one-inch long and no more noticeable than an in-the-ear aid, especially if your hair covers the tops of your ears.
BTE aids offer several advantages. Because they are larger, they can hold larger, longer-lasting batteries that may only need to be changed once per month. BTEs also have room for more circuitry. Their controls are larger and easier to adjust. Finally, BTE aids tend to be more reliable than other types, since their components are protected from wax.
The advantage to the microphone's position outside the ear is in minimizing feedback, the squeal that is produced when some of the sounds form the speaker leaks to the microphone. The disadvantage is that the external microphone sometimes picks up and amplifies the whistling of the wind.
In-the-ear (ITE) or all-in-the-ear hearing aids
With this type of aid, a custom-molded housing that contains all of the components fits directly in the ear. The aid itself, the volume control, and the battery compartment are all smaller on an in-the-ear model and so may be harder for some people to operate.
Canal hearing aids
Canal aids are barely visible. They are more expensive and have tiny controls, and may require more frequent repair. These small devices fit entirely within the ear canal and are barely visible from the outside. Cosmetic appeal is the main advantage of canal aids, which former president Ronald Reagan made popular in the early 1980s.
Canal aids can be made smaller than other models because they sit deeper in the ear canal and do not need to amplify sound as much as other types do. Still, they are too weak to correct for severe hearing loss. Changing the battery may take a great deal of dexterity. Canal aids cost more than most other types. They also tend to require extra cleaning and more frequent repair because of wax buildup on the tiny components.
Completely in-the-canal (CIC) hearing aids
Completely in-the-canal aids are deeply inserted and are cosmetically appealing. These custom, miniaturized hearing aids have shown increased sales in the United States.
Hearing aid circuitry options
There are four basic levels of circuitry sophistication available:
Low-level analog hearing aids
Advanced-level analog and multi-channel compression hearing aids
And hearing aids that use digital technology
Level I product: Low-level analog instruments
The standard analog hearing aid has linear amplification. These devices are the most basic form of hearing aid. They typically amplify both weak and strong speech sounds by the same amount (much like using a single magnifying glass).
Then the volume control is increased to make soft speech audible, stronger sounds (such as background noise) are frequently over-amplified. Relative to other products, linear hearing aids sound more distorted.
Level II product: Advanced-level analog instruments and multi-channel compression instruments
These hearing aids have compression circuits that automatically adjust the loud sounds coming into the hearing aid (AGC). Some also provide greater amounts of amplification for soft sounds, where hearing-impaired people have the most difficulty, and less amplification for loud sounds (K-amp). These circuits provide lower levels of distortion than do linear aids.
They provide good speech understanding in quiet listening situations and low levels of background noise (small groups). There may be two or three channels of different sounds. These hearing aids are not programmed by a computer, but they are more flexible than Level I products.
Level III product: Computer-programmable instruments
These hearing aids have multi-channel capability and compression capability as in Level II instruments. However, they are programmed for the patient's hearing loss via computer. This gives the audiologist more fine-tuning capabilities.
They may have multiple memories the patient can select depending on the listening situation (restaurant, TV, telephone, music). They may adjust incoming sound automatically without a volume control. They are advantageous for progressive or fluctuating hearing losses because the hearing aid can be reprogrammed in the office.
These products have great flexibility and the latest analog technology. Dual microphones have shown to help in understanding of speech in noise.
Level IV product: Digital technology
These instruments are among the newest technology on the market. They tend to be more flexible without introducing distortion. These hearing aids are computers. They offer the advantages of a Level II product with less distortion. The best analogy to illustrate the enhanced sound quality provided by digital technology is to compare the high-fidelity sound from a CD recording to that from an audiocassette tape.
Feedback or whistling tends to be less of a problem in these devices. Dual microphones have been shown to help understanding of speech in noise. These hearing aids may have multiple memories, multiple channels or bands, and/or multiple microphones.
For specific information on the price ranges of these hearing aids, please consult your audiologist.
Adjusting to your hearing aid/realistic expectations
If you've grown accustomed to living with hearing loss, you may find at first that a hearing aid bombards you with sound. All the background noises people take for granted suddenly overload your ears. Eventually, you will learn to tune out unwanted sounds again.
Use your trial period to field-test your hearing aid thoroughly. Make sure you can work the controls and change the battery, and see how well you can understand speech in a variety of situations. Don't hesitate to return to the person who sold you the hearing aid. Most people take more than one visit to find the optimal model and to have it adjusted correctly.
Make use of aural rehabilitation, which your audiologist may offer. Especially if your hearing loss is moderate to severe, you will find the world sounds very different when amplified through a tiny acoustical device. A good rehabilitation program will train you to pick out speech against a variety of background noises.
In addition, it will teach you how to sharpen your awareness of visual cues to add to your new auditory information. Finally, the program should offer counseling, support and advice to you and your family on coping with the psychological and social problems of hearing loss.
For more advice, you may want to contact your local chapter of self help for the hard-of-hearing, a national organization that offers information, counseling, and group support.
Before you begin the process of obtaining hearing aids, it is important to have realistic expectations. Hearing aids will allow you to:
Hear many sounds that you may not be able to hear, or may not hear clearly, without amplification. Examples of such sounds include soft speech, children's voices and other quiet sounds.
Understand speech more clearly, and with less effort, in a variety of listening situations
Prevent normally loud sounds from becoming uncomfortably loud. Sounds that are uncomfortably loud for normal-hearing individuals may also be uncomfortable when using hearing aids.
Understand speech more clearly in some types of noisy situations
Hearing aids will not do the following:
Restore your hearing capabilities to normal or to pre-existing levels
Filter out background noise. Some hearing aids can reduce amplification of some types of background noise, but may have a similar effect on speech information. Nonetheless, this will often produce improved sound quality and a more comfortable listening experience in many types of noisy environments.
In addition, hearing aids will require time to get used to and to attain your maximum performance potential as you gradually become accustomed to amplification.
Helping a friend or relative buy a hearing aid
If you are helping a family member buy a hearing aid rather than shopping for one yourself, here are a few ideas that can be particularly helpful:
Go along for the exam and the fitting, and be prepared to be an advocate for your relative
Make sure that he or she is not being sold a more complex device than necessary
Choose a hearing aid of a size and type appropriate for your relative's physical capabilities. A tiny device that fits in the ear canal may be cosmetically attractive, but its small controls would make a poor choice for someone with limited manual dexterity. Controls should be straightforward and large enough to manipulate with ease. Changing batteries, which may be needed as often as once a week, should be simple.
Offer your relative or friend plenty of support and encouragement during the adjustment period
Help him or her field-test the aid in different situations and encourage him or her to continue working with the dispenser to get the best results
Mandatory trial period
According to Wisconsin state law, you will be allowed a minimum of 30 days to try your new hearing aids. During the trial period, you should wear the hearing aids in as many different listening situations as possible. You should also wear the hearing aids as much as possible, so you can make a decision as to whether the hearing aids are helpful.
If you find that you are not satisfied with your hearing aids, your audiologist may be able to make adjustments to them. S/he may also suggest a trial period with a different hearing aid. If at the end of your trial period you are still not satisfied with the hearing aids, by Wisconsin state law you may return the hearing aids for a refund, less a fee for professional services provided during the trial period. In addition, custom-made earmolds, which are used with behind-the-ear hearing aids, are generally non-refundable.
Hearing instrument specialists
In addition to an audiologist, you may also see a hearing instrument specialist for hearing aid services. These dealers have less formal education than audiologists and generally use more limited diagnostic equipment. Nonetheless, they have a great deal of practical experience in fitting hearing aids.
If you do go to a dealer, make sure s/he is licensed or registered (unless you live in Colorado, Massachusetts, or Minnesota, where this is not required) and check to see that the dealer is certified by the National Board for Certification of Hearing Instrument Sciences (indicated by the letters BC-HIS). If possible, ask your physician to recommend a dealer.
Whether you go to an audiologist or a hearing aid dealer, you need someone who will work with you over several visits to find the right hearing aid, teach you to use and maintain it, and then be available to service it for months and years to come. If you have any doubts about their qualifications, check your local Better Business Bureau, your state attorney general, or the licensing board in your state capitol for a record of any past consumer complaints.