Is Now the Right Time for an Over-the-Counter Hearing Aid?

The latest hearing aids provide better natural sound, amplification, and elimination of background noise, says Yale Medicine otology & neurotology and skull-base surgeon Nofrat Schwartz, MD. “The technology of hearing aids is always advancing and getting better,” she says.

There are many models available, and it’s helpful to visit a practice that provides many options so you can choose the best one for your type of hearing loss and lifestyle concerns, Dr. Kveton says. For instance, you may want a device that can be tailored to your environment—you can put it on a quiet setting at home or you can set it to mask background noise in a restaurant.

• How they are worn: It depends on the hearing aid—you may get one that is worn behind the ear, in the ear, or in the ear canal.
• How they work: A hearing aid is a three-part, battery-powered system that includes a microphone, an amplifier, and a loudspeaker. Its job is to amplify sound. Sounds travel through the microphone, which are then converted into electrical signals. The amplifier increases the power of those signals and sends them to the speaker, allowing you to hear them.
• Who they can help: Hearing aids can help anyone at any age, from infants to adults, for a wide array of different types­—and severity—of hearing loss. Traditionally, they are used in cases of “sensorineural hearing loss,” which is caused by damage to the small sensory cells (known as hair cells) inside the inner ear.
• Another thing you should know: Other listening devices—called assisted listening devices—can be invaluable companions to hearing aids. (Even people who don’t wear hearing aids benefit from some of them.) These help with the management of everyday sounds. Examples are phone amplifiers, innovations that help with tinnitus relief, and flashing or vibrating alarm clocks or fire alarms. “This includes things that people with hearing loss, especially those with profound hearing loss, should be aware of for safety,” Dr. Schwartz says.

Bone-conduction devices—designed for people with a middle ear problem that interrupts the conduction of sound—have been available for years, but they too have evolved to include Bluetooth capabilities and other lifestyle improvements. “Some people have the previous generation of these devices with a fixture surgically implanted in the bone behind the ear, protruding through the skin to an external processor. A newer version is housed almost completely under the skin and is less conspicuous,” says Dr. Schwartz.

• How they are worn: Small implanted devices work together with external components that are more or less visible, depending on the type of bone-conduction device you get. Previous-generation versions (that protrude through the skin) are implanted with a surgical procedure that takes about 7 minutes. Newer options go completely under the skin, with a device worn behind the ear that pairs magnetically to the implant; this requires a 90-minute surgical procedure under general anesthesia. After about four weeks, the device can be activated and programmed to fit the patient’s needs fairly quickly, Dr. Schwartz says.
• How it works: This is a sound delivery system. It transfers sound by bone vibration, bypassing the outer and middle ear. Through microscopic vibrations, it activates the hair cells of the cochlea—which is the organ of the inner ear that is responsible for hearing—to provide an extremely natural-sounding hearing solution.
• Who it can help: Bone-conduction devices are Food and Drug Administration (FDA)-approved for children 5 years and older, as well as adults, and they can help people with conductive and mixed hearing losses. A patient may have a congenital ear deformity, such as a missing eardrum or ear canal, or an infection may have caused conductive hearing loss. While the underlying problem can sometimes be resolved with reconstructive surgery, for many patients a bone-conduction device is very effective, Dr. Schwartz says.
• Another thing you should know: Doctors have started using bone-conduction devices in patients who are deaf in one ear, allowing for some compensation from the ear that can hear well. (In some cases, this is in combination with a hearing aid in the hearing ear.) Being able to hear with both ears is a vital part of our ability to locate sounds, as well as to understand speech and distinguish a speaker from ambient sound, explains Dr. Schwartz. “Sound coming in through one ear is not enough,” she says. And unlike cochlear implants, which can require multiple visits to an audiologist for programming and fine-tuning, bone-conduction devices produce a natural sound quickly, Dr. Schwartz says. “It gets very close to normal hearing.”

Some people with mild hearing loss may find they do well enough with simple approaches, such as lip-reading or using closed captioning while watching TV. 

If possible, Dr. Kveton suggests talking to both a specialist and an audiologist—the latter can provide additional support and will be adept at explaining the types of hearing devices and helping with any issues that come up.

Any device you get depends on the type of hearing loss you have, your lifestyle, and other factors, he says. “Some patients are born with severe hearing loss and need help early. Others develop it slowly over time. Obviously, as we age into our 60s, 70s, and 80s, the number of people with hearing loss that needs some type of management or therapy increases.”

A simple first step is to get a hearing test—and take the results seriously, says Dr. Schwartz. “A lot of people don’t treat their hearing loss, which is a mistake because it’s a very important sense,” she says. “Treating it is very important and should not be neglected.”