Hearing Loss, Tinnitus, and Hearing Aid Resources

Looking for information on hearing loss, tinnitus, or hearing aids? Check out some of the introductory articles below to get started! Want to take a deep dive? Read some consumer reviews for hearing aids, check out our Expert Answers area, or stay up to date with our Hearing Aid News blog. We also host a curated list of external resources.

Table of Contents

Hearing Loss Articles

• What are the symptoms of hearing loss?
• What are the causes of hearing loss?
• What are the types of hearing loss?
• What are the consequences of untreated hearing loss?
• How is hearing loss treated?
• What is the prevalence of hearing loss?
• How can hearing loss be prevented?
• Does hearing loss cause dementia?
• Who are some celebrities with hearing loss?
• How do I know if I have hearing loss?
• How can I cope with my hearing loss?
• How do I read a hearing test?

Tinnitus Articles

• What are the symptoms of tinnitus?
• What are the causes of tinnitus?
• What are the consequences of untreated tinnitus?
• What are the types of tinnitus?
• How is tinnitus treated?
• How do I relieve and cope with tinnitus?
• How is tinnitus prevented?

Hearing Aid Articles

• How do hearing aids work?
• What is unbundled hearing aid pricing?

What are the symptoms of hearing loss?

Symptoms of hearing loss can be difficult to identify, particularly if the onset is gradual.  Many times a loved one notices a problem before the person with the hearing loss does.  Symptoms of hearing loss may include difficulty hearing in background noise. Examples of noisy environments may include social settings with several people speaking at once, such as restaurants, grocery stores, churches, movie theaters, sporting events, etc.  Hearing in the car can be especially difficult due to two factors.  One, is the road noise can seem as if it is drowning out the conversation, and the second factor is the inability to face the person you are speaking with.  Without visual cues, you may find it difficult to hear conversational speech in the car.  All of us, even those of us with normal hearing, benefit from good communication strategies such facing the person you are speaking with.  Those of us with hearing loss have an especially difficult time hearing what someone is saying when that person is not facing you. You may find that you are unable to follow conversation without face-to-face visual cues and particularly struggle when someone speaks to you from another room.  Additionally, you may find that you need more volume than others to listen to the television or radio.  

Another symptom of hearing loss is feeling as if people seem to mumble. You may frequently find yourself thinking “if so-and-so could just enunciate or slow down, I’d have no problem hearing.”  Frequently asking for repetition is common.  It’s possible you may not even hear that someone is speaking to you in the first place, or you may find that you frequently ask people repeat themselves because you weren’t able to understand what they said to you.  A general difficulty following conversation can cause to listening fatigue is another symptom of hearing loss.  Many people tell me they are so exhausted from filling in the blanks of what they cannot hear, that they prefer to just not even try to participate in conversation.  Hearing loss can be exhausting to both the speaker and the listener.  Isolation and withdrawal from social activities are quite common when a hearing impaired person finds engaging in conversation to be too difficult to keep up with.  

Tinnitus, which can be described as a ringing or buzzing sound in the ears, is another symptom of hearing loss.  Research indicates that hearing loss is the most common cause of tinnitus.  However, it is important to note that there are a variety of other factors that cause tinnitus.  If you are experiencing some or all of the above symptoms, speak with your doctor to schedule a hearing evaluation.  This is the only way to know for sure if the symptoms you may be noticing are possibly related to hearing loss.

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What are the causes of hearing loss?

Hearing loss refers to a decrease in sensitivity to sounds that are audible to those with normal hearing.  Hearing loss can also be described as a breakdown in the ear which affects the brain's ability to identify sounds. There are several types of hearing loss, and numerous possible causes.  Hearing loss is often described by the location of where the loss occurs, the degree of hearing loss, and the configuration or what sounds are affected.

Conductive Hearing Loss

A conductive hearing loss is due to the sound signal is not being directed properly to the inner ear.  This can occur in the outer or middle ear.   This type of hearing loss is not typically a complete deafness, but a reduction in the loudness of sounds.   Conductive hearing loss can be present at birth (or congenital) or can be acquired during a person’s lifetime.  Causes include:

• Ear wax blockage
• Foreign body in the ear canal
• Fluid in the middle ear space
• Disruption in the bones of the middle ear
• Outer ear infection (such as “swimmers ear”)
• Middle ear infection
• Cholesteotoma, (an abnormal, non-cancerous growth of skin cells)
• Allergies
• Benign tumor (such as a vestibular schwannoma)
• Otosclerosis (an abnormal growth of bony tissue in the middle ear)
• Perforated ear drum
• Eustachian tube dysfunction
• Congenital conductive malformation such as an absence of the external auditory canal

This type of hearing loss is most likely to be treated by means of medication or surgery, and will often require a referral to an ENT physician.  Treatments may include antibiotics, OTC decongestants, surgical intervention such as myringotomy and placement of PE tubes, use of osseointegrated hearing devices, or traditional hearing devices.    

Sensorineural Hearing Loss

A sensorineural hearing loss occurs in the inner ear, or along the auditory pathway as sound signals travel to the brain.  Without extensive testing, it is difficult to pinpoint whether the loss is in the cochlea (the inner ear) or in the auditory nerves between the ear and brain pathway.   Causes of sensorineural hearing loss include:

• Excessive exposure to loud noise (greater than 85 dB)
• Ototoxic drugs (these include some antibiotics, ED drugs, and combinations of certain drugs with loop diuretics)
• Head trauma
• Autoimmune inner ear disease
• Meniere’s disease
• Benign tumor (acoustic neuroma)
• Viral or bacterial diseases (measles, mumps, meningitis, rubella, herpes)
• Heredity
• Genetic syndromes (Ushers Syndrome, Down Syndrome, Waardenburg Syndrome)
• Uncontrolled blood sugar
• High blood pressure
• Heart or vascular problems
• Kidney disease
• Large vestibular aqueduct
• Superior canal dehiscence syndrome

Sensorineural hearing loss can be treated medically, where there is an underlying cause such as disease or tumor.  Most noise-induced or inherited losses are treated through traditional hearing amplification and auditory rehabilitation.

Auditory Processing Disorders

Some hearing loss occurs not in the middle or inner ear, but in the pathway to the brain or in the processing areas of the brain responsible for hearing and language.  The causes of these types of hearing disorders are more elusive, but can occur due to

• Stroke
• Anoxia
• Developmental disorders
• Head trauma

Treatment for auditory processing disorders may include listening therapy, use of assistive listening devices, and/or various forms of hearing amplification.

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What are the types of hearing loss?

The human ear is a fascinating and complex piece of engineering.  In a normal functioning ear, sound arrives at the outer ear, or pinna, and travels down the ear canal, where it meets the tympanic membrane, also known as the eardrum.  The sound waves vibrate the eardrum, which in turn vibrates three tiny bones in the middle ear in a chain reaction.  These three tiny bones, the tiniest in the human body, are called the malleus, incus, and stapes.  The vibration of these three bones culminates in a pumping motion that causes movement in the cochlea in the inner ear, a small, snail-shaped organ that is filled with fluid.  Hair cells inside the cochlea are stimulated by the movement of the fluid in the cochlea, sending a signal to the auditory nerve, which in turn, carries the signal to the brain, where it is interpreted and recognized as sound.  The entire process takes a split second to complete.¹

Obviously, in a system this complex, sometimes things can go wrong. There are three types of hearing loss, conductive, sensorineural, and mixed hearing loss (a combination of conductive and sensorineural).  A comprehensive audiologic evaluation is necessary to identify which type and severity of hearing loss an individual has, as well as treatment steps.  

Conductive hearing loss occurs when there is a disturbance to one or more of the structures in the outer or middle ear.  Causes of conductive hearing loss can include fluid in the middle ear space from congestion due to allergies or colds, perforations (holes) in the eardrum, benign tumors, impacted cerumen (earwax), presence of a foreign body in the ear canal, infection in the outer ear canal (often called Swimmer’s Ear), poor Eustachian tube function, or absence or malformation of the outer ear, ear canal, or middle ear.  Another common cause is otosclerosis, or a stiffening of the chain of bones in the middle ear.  Conductive hearing loss results in a reduction of the intensity of the sound that reaches the inner ear, but where the inner ear itself is intact.  This means that an individual with conductive hearing loss would usually find that as long as a sound is loud enough, they are able to hear it clearly and without distortion.  The cause of conductive hearing loss can be often identified and treated medically or surgically, and partial or total improvement to the hearing loss is often possible.² 

Sensorineural hearing loss occurs when there has been damage or dysfunction of the inner ear, or the auditory nerve.  The most common form of sensorineural hearing loss is age-related hearing loss, also known as presbycusis.  Other common causes of sensorineural hearing loss can include noise trauma, genetic hearing loss, medications that are toxic to hearing, head trauma, malformation of the inner ear, illnesses and/or high fever, and even tumors on the auditory nerve.  This type of hearing loss can be sudden or gradual.  Sensorineural hearing loss includes a reduction in the loudness of the sound like conductive hearing loss, but unlike those with conductive hearing loss, a reduction in speech understanding ability is often present.  It is usually irreversible and permanent.

Mixed hearing loss is a combination of both conductive and sensorineural hearing losses, and is often reflective of two or more different conditions affecting the ear in both the inner ear, and the outer or middle ear.  It may require a combination of treatments.³

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What are the consequences of untreated hearing loss?

Recent data suggests that while at least 10% of the population self-reports some degree of hearing loss, only about 3% actually wear hearing aids.¹ Taking the initial steps towards management of a hearing loss is often one the most challenging aspects of the process. Reports suggests it takes an average of seven years after hearing loss is suspected for an individual to do something about it despite many well-documented consequences of untreated hearing loss and its significant impact on communication, interactions with others, and overall quality of life.²

In general, those with hearing loss who do not wear hearing aids are more likely to report feelings of depression, loneliness, isolation, worry, and dissatisfaction with family life. Difficulty communicating often leads to loss of interest in participating in social activities. Often times the person with hearing loss may not realize they are not participating in the conversation around them and eventually choose not to even attend the birthday celebration or dinner with friends due to struggles with hearing and communication. Sergei Kockin demonstrated that while hearing aid wearers and non-wearers participate in similar numbers of solitary activities, the hearing aid wearers were far more likely to participate in organized social activities compared to the non-hearing aid user group.³ This withdrawal from social activities also limits loved ones socially; having either to go alone or serve as the interpreter for their partner. Untreated hearing loss has also been documented to lead to added marital stress and ultimately feelings of frustration and depression for both parties.

Safety is also a concern for those with hearing loss. When one cannot hear alarms, doorbells, someone entering their home, or cannot successfully converse over the phone, this creates barriers to maintain independence and a safe environment in the home. Feelings of paranoia, worry, and anxiety are often reported by those with hearing loss due to less access to important alerting sounds in their environment.³

Finally, walking around with an untreated hearing loss can have consequences on physical and cognitive health. Strong associations have been found linking hearing loss to reduced cognitive function including potentially exacerbating the symptoms of dementia; researchers do not suggest that hearing aids can prevent dementia but suggest use of amplification may reduce or delay consequences such as reduced function because of the disease. Individuals with hearing loss who do not wear hearing aids report more fatigue and exhaustion at the end of the day due to the extra effort put forth in trying to listen and understand all day. Kochkin and Ciorba also reported that hearing aid wearers reported overall better health than their non-hearing aid wearing counterparts.³

Unaddressed hearing loss leads to reduced awareness of the environment, reduced ability to understand speech, and reduced communication which is often the pillar of relationships and many aspects of life. These consequences not only affect the individual who has hearing loss but those around them; too frequently, these consequences are gradual and go unnoticed. The good news is those who wear hearing aids, and their family members, report a reduction in feelings of anger, frustration, and depression with the use of hearing aids. Hearing aid wearers, and their family members, also self-report significant improvements in areas such as relationships at home, feelings about themselves, and quality of life overall compared to those who do not wear hearing aids.³

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How is hearing loss treated?

The manner in which hearing loss is treated depends greatly on the type and degree of hearing loss an individual has been diagnosed with. Hearing loss is broken into three categories: conductive, sensorineural, and mixed.

Conductive hearing loss occurs when there is some sort of obstacle in the outer ear or middle ear preventing sound from being conducted to the cochlea (inner ear). Common causes of conductive hearing loss include cerumen (wax) occluding the outer ear (ear canal), a perforation in the tympanic membrane (eardrum), an ear infection, or a disruption of the ossicles (the bones in the middle ear that conduct sound from the eardrum to the inner ear).

Treatment for conductive hearing loss typically involves removing or repairing whatever it is that is preventing the conduction of sound. In the case of impacted cerumen, an audiologist or physician may remove it. In the cases of infections, perforations in the tympanic membrane, or disruptions to the ossicles, physicians perform surgical procedures or prescribe medications. In some instances, where these treatments are ineffectual, an audiologist will provide hearing aids. Hearing aids, if medical and/or surgical options are exhausted, are usually quite beneficial with conductive hearing losses.

Due to decades of medical advancements that have allowed for very effective treatments of infection, the most common type of hearing loss is sensorineural; according to the National Institute on Deafness and Other Communication Disorders (NIDCD), 90% of all cases of hearing loss are sensorineural in nature. Sensorineural hearing loss occurs when there is a decline in the performance of sensory cells in the cochlea, the cochlea’s connection to the auditory nerve, or to the auditory nerve itself. Causes of sensorineural hearing loss include age, side effects of medications, symptoms of other health conditions such as heart disease, diabetes, thyroid conditions, kidney conditions and others.

In very rare cases, benign tumors may be present on the auditory nerve, and these cases, once discovered, require monitoring by audiologists and physicians. Sometimes, after monitoring, surgical removal eventually becomes a necessity due to the proximity of these tumors to the brainstem.

At this point in time, with the exception of a few very rare circumstances, there are no pharmaceutical or surgical interventions that can reverse sensorineural hearing loss, and hearing aids are the most common treatment. Individuals with severe to profound amounts of sensorineural hearing loss who receive little to no benefit from hearing aids are often candidates for cochlear implants. The technology of both hearing aids and cochlear implants have advanced significantly in the digital age and in recent years, devices that are a hybrid of cochlear implants and hearing aids have been introduced to the market.

Hearing aids, in most states, are provided with a trial period during which an individual can ensure that the devices are meeting their listening needs. The devices are programmed and dispensed by hearing instrument specialists or audiologists. Cochlear implants are surgically implanted by otologic surgeons and after post-operative healing, programmed by audiologists.

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What is the prevalence of hearing loss?

People who have a hearing loss are often embarrassed by it, thinking that they are alone in their communication difficulties, but statistics show that hearing loss is far from an uncommon problem.  In fact, hearing loss is the third most common physical health problem in the United States, behind such common ailments as heart disease and arthritis.  According to the National Institute for Deafness and other Communication Disorders (NICDC), approximately 15% of adults (or 37.5 million people) over the age of 18 in the United States report some difficulty in hearing.¹  About two or three out of every 1,000 children are born with a detectable level of hearing loss as well.  Overall, the greatest predictor of hearing loss of adults aged 20-69 is age, with adults aged 60-69 demonstrating the greatest degree of hearing loss, although hearing loss affects all age groups.  Men in this 20-69 age group were found to be almost twice as likely as women to have hearing loss.  Among that same age group, as far as race is concerned, non-Hispanic, white adults are more likely than any other ethnic or racial group to have hearing loss, and non-Hispanic, black or African American adults were found to have the lowest prevalence of hearing loss.  Almost 25% of adults aged 65-74 were found to have “disabling hearing loss,” defined by the NICDC as hearing loss where hearing was 35 decibels or poorer, generally the level at which a person can benefit from hearing aids.  Estimates show that rate rises to nearly 50% of adults aged 75 and older who were identified with disabling hearing loss. 

The World Health Organization (WHO) estimates that over 5% of the world’s population, or 360 million people (183 million males and 145 million females), have disabling hearing loss, and 32 million of them are children.  Roughly one-third of the world’s population over the age of 65 is affected by disabling hearing loss.  The greatest majority of people with disabling hearing loss are found in low- and middle-income countries; in fact, the prevalence of disabling hearing loss in both children and adults over the age of 65 is greatest in the areas of South Asia, Asia Pacific, and Sub-Saharan Africa.² 

While the cause of many types of hearing loss may be unavoidable, the World Health Organization finds that in children under 15 years of age, 60% of childhood hearing loss could be prevented.³  This figure is higher in low- to middle-income countries at 75% than in high-income countries at 49%, and factor in infections such as mumps, measles, rubella, cytomegalovirus and chronic ear infections, complications during childbirth, use of medications that can be damaging to the auditory system by expecting mothers and infants, and other factors as reasons for this.  WHO has also found that 1.1 billion young people from ages 12 to 35 years old are at risk of hearing loss due to noise exposure, most often from recreational activities.

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How can hearing loss be prevented?

A common cause of hearing loss is loud noise. Noise at damaging levels can cause both permanent and temporary hearing loss, particularly for sounds above 85 decibels.¹ It is probably no surprise to you that the best way to prevent hearing loss is to avoid sounds at or exceeding damaging levels, both at work and home. The Occupational Safety and Health Administration (OSHA) advises that 85dB is the loudest sound that worker should be exposed to over an 8 hour period. OSHA also outlines that as the damaging sound gets louder, a worker must spend less time exposed to the sound to avoid hearing damage.² It is also a good idea to also consider sounds that you may be exposed to outside of your workplace. Be aware of common sounds such as appliances, traffic, flights, machinery and equipment, firearms, and listening to music or attending concerts. Consider loud sounds in your environment that you are both frequently and infrequently exposed to. Some may assume that frequent exposure to loud sounds is required to cause noise induced hearing loss. However, exposure to a loud enough sound, even one time, could potentially cause hearing damage.

Unless you have a sound level meter or a smartphone application to measure sound level, it may be difficult to identify if you are in a situation that is loud enough to potentially cause hearing damage. The question that comes to mind is, how does one identify a sound that may cause hearing damage? One option is to measure the sound. If you have concerns, you could consider downloading a smartphone application such as The NIOSH Sound Level Meter (NIOSH SLM) application for iOS devices. This is a free option that was created by the Centers for Disease Control and Prevention.³ If you do not have a way to measure sound, there are other guidelines available that may help you decide if you are in an environment with potentially damaging sound levels. The American Speech-Language-Hearing Association identifies possible signs that your environment is too loud as: “you must raise your voice to be heard, you can't hear someone 3 feet away from you, speech around you sounds muffled or dull after you leave the noisy area, and you have pain or ringing in your ears (this is called 'tinnitus') after exposure to noise¹.” If you notice any of these concerns in your environment, consider reducing the sound level when possible or simply leaving the noisy situation.

The best way to prevent hearing loss is to reduce your exposure to loud sounds. Consider wearing properly fitting hearing protection, lowering the level of the sound, avoiding loud sound exposure when possible, reading labels to find out what the reported sound levels are for products, and advocating for yourself and others if you have concerns that a local restaurant, bar, health club, etc, may be exposing patrons and employees to dangerous sound levels.

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Does hearing loss cause dementia?

This is a commonly asked and important question. Unfortunately, what we are seeing in often reported in the news can be a stretch. The important term to distinguish here is the term “cause”. There is currently no evidence to show that hearing loss causes dementia. What there is evidence to support is that individuals with worse hearing tend to demonstrate poorer cognitive function. Research also indicates a higher rate of comorbidity of hearing loss and dementia; meaning they often occur in the same individuals.¹ Dr. Frank Lin’s is a leading researcher in this topic area and has demonstrated accelerated cognitive decline by 30-40% in those who have hearing loss compared to those who have normal hearing. He has also shown increased risk of dementia in older adults with hearing loss and that the greater the degree of hearing loss, the greater the likelihood of dementia.²

Why we see this between hearing loss and reduced cognitive abilities is a topic still being heavily researched, however there are some proposed theories. For one, we know that individuals with hearing loss tend to require more effort listening compared to those who do not have hearing loss. This extra cognitive effort may lead to fewer cognitive resources available for other tasks, presenting as decreased memory or cognitive function. Another possibility is an indirect association between hearing loss and cognition; it is well established that untreated hearing loss can lead to social isolation, depression, and reduced self-efficacy. These characteristics are also known to be linked to having an increased risk of dementia1. Anecdotally, as a clinician, I have seen many patients brought in for their initial appointment by a family member who also expresses concern for memory loss. The individual is found to have a hearing loss, we pursue the appropriate form of management, and both the family and myself are shocked by the change in the individual with hearing loss’s personality, involvement in the conversation, demeanor, and overall functional ability simply because they have greater access to communication and their environment.

Another commonly proposed theory linking hearing loss and cognitive decline is auditory deprivation. We know that when individuals live with untreated hearing loss for extended periods of time, their auditory system is deprived of critical input. Eventually the auditory system loses its ability to process this input, even when it is loud enough to hear. Think of this like exercise and the importance for your muscles and body to keep moving and exercising. The longer you go without movement, the more your muscles atrophy and the harder it is to comeback and rebuild strength. It has been suggested that this auditory deprivation, from lack of hearing, may have an impact on cognitive abilities. Finally, the ‘common cause’ hypothesis suggests that age-related changes and degeneration lead to both hearing loss and cognitive decline.³

Ultimately, someone who has age-related hearing loss does not necessarily need to fear that they will suddenly or certainly develop dementia. Rather than saying “hearing loss causes” dementia, it is more appropriate to say is that there is an association, or possible link, between cognitive function and hearing loss. Based on the current research, it is recommended that an individual showing signs of memory loss or cognitive decline consider having a hearing evaluation and address hearing loss and communication as one step of the process.

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Who are some celebrities with hearing loss?

Many celebrities suffer from hearing loss and have been open about their experiences with it. AARP lists the following celebrities that have hearing loss:

• Whoopi Goldberg: The Academy Award winner has spoken out encouraging others to protect their hearing, citing excessive noise exposure during concerts as the possible cause for her hearing loss.
• Luis Miguel: The singer suffers from tinnitus, and even had to cancel some of his performances due to the impact tinnitus was having on him.
• Lou Ferrigno: TV’s Incredible Hulk actor and former bodybuilder has suffered from hearing loss since a young age. He attributes his loss of hearing to an ear infection that had had lasting effects. As an adult, Ferrigno opted for an implantable Esteem Device, which he says has made his hearing better than he could have hoped for.
• Rob Lowe: The actor reportedly lost hearing in one ear as an infant, and has been open about the difficulty he experiences hearing in background noise.
• María Antonieta de las Nieves: The actress, comedian and singer wears hearing aids, but still finds that she struggles to hear in certain environments. She announced that she will no longer give telephone interviews due to her hearing loss.
• Bill Clinton: The former President noticed his hearing worsening slowly overtime, and it became worse with age. He noted that his his was especially troublesome when communicating in background noise, causing him to have a difficult time distinguishing sounds. The former President now uses two hearing aids to make communication easier.
• Halle Berry: The actor has spoken out about an abusive relationship she had 20 years ago that resulted in the loss of hearing in her left ear. By sharing her experience, Berry hopes to raise awareness about domestic violence.
• Stephen Colbert: The political satirist has hearing loss in one ear that he has had since childhood. The loss of hearing is reportedly due to a growth in his ear that required surgery that resulted in the loss of his eardrum.
• Rush Limbaugh: The talk show host suffers from severe loss of hearing in both ears. The cause is up for debate, and includes autoimmune disorder of the inner ear as well as opioid abuse.
• Pete Townshend: The songwriter and guitarist suffers from both hearing loss and tinnitus that he attributes to years of exposure to loud music.
• Jane Lynch: The actor has hearing loss in one ear that she first noticed when she was seven years old could not hear her radio equally from each ear.
• Robert Redford: The actor suffered an ear infection after continual water submersion for a role he was playing in a film. Unfortunately, the ear infection caused permanent hearing loss in one ear.
• Holly Hunter: The Academy Award winner has hearing loss in one ear due to suffering from mumps as a child. She reportedly finds that she must pay closer attention to compensate for her hearing loss, and that she is then more aware of details in conversation.
• Jodie Foster: The actor has been spotted wearing a hearing aid and has admitted that she could be better about seeking hearing healthcare. She also has suffered from vertigo.

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How do I know if I have hearing loss?

There is no way to know for sure without a completing a hearing test by an audiologist, however, there are some warning signs that may indicate if you have a hearing loss. Ask yourself the following questions and if the answer is to any of the questions, you likely have a hearing loss and should have your hearing evaluated by an audiologist:

• Do I hear a ringing in my ears or head that is not present in the environment? If the answer is yes, you are experiencing tinnitus, which is highly correlated with hearing loss. (Typically, tinnitus is associated only with hearing loss, but it can be a sign of other health issues or a side effect of medications, so be sure to contact a health professional.)
• Does it seem as if other people are mumbling? This is a classic sign of hearing loss. Often, when someone has a hearing loss, some sounds of speech are more audible than other sounds, which is perceived as mumbling.
• Do I hear better out of one ear than another? Normal hearing individuals have the same degree of acuity in each ear. If one ear appears to hear better than the other, that means that at least one ear likely has hearing loss. (Similar to tinnitus, hearing loss in one ear can also be a sign of other health issues and you should consult with a health professional.)
• Has there been a rapid decline or fluctuation in my hearing? In normal hearing individuals, hearing does not fluctuate very much, if at all, and so this is likely a sign that your hearing is declining. And, if your hearing is fluctuating frequently, you should visit an audiologist or physician relatively soon so as to possibly avoid permanent hearing loss.
• Have I been exposed to high intensity noise? Frequent exposure to moderately high levels of noise, or, a single instance of very high levels of noise can cause temporary or permanent hearing loss.
• Is there a history of hearing loss in my family? Some forms of hearing loss are genetic in nature, and if certain family members have or have had hearing loss, you may be at risk yourself.
• Am I in good health? Heart disease, diabetes, thyroid conditions and side effects of many medications can cause temporary or permanent hearing loss.
• Am I over 50 years of age? This question should be pretty easy to answer. If the answer is yes, then the chances that you have at least a small degree of hearing loss rises significantly. Most individuals over the age of 70 have at least a mild hearing loss.

Again, the surest way to know if you have a hearing loss, of course, is to have a comprehensive hearing evaluation by a licensed audiologist. Most audiologists participate with insurance carriers and most carriers cover the cost of a hearing test. However, even if you do not have insurance coverage, the cost of a basic hearing test is typically less than $150 and often less than $100.

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How can I cope with my hearing loss?

The question of ‘how do I cope with hearing loss?’ is an interesting one. The Oxford dictionary defines the word ‘cope’ as to deal effectively with something difficult.¹ Learning to live well and continue to do the things you want to do with hearing loss is a challenge that takes work and is an ongoing process.

My first recommendation to learning to cope with a hearing loss is consult an audiologist if you have not already. There likely are many options for mediating hearing loss and that is the place to start. Ensure you have a hearing device that is appropriately fit for your hearing loss and are aware of any additional pieces of technology that may be beneficial in your day-to-day life. There are numerous options for listening to music, improving speech understanding in a noisy environment, hearing well over the phone, being safe in your home, and addressing any specific work or recreational needs. These options are constantly changing and improving which is why it is best to consult with an expert in this area to discuss what would be best for you.

Part two of this discussion is addressing the emotional aspects of living with a hearing loss. Most individuals who have a newly acquired hearing loss have to go through a grieving process just like any other type of loss, disease, or disorder. The Kubler-Ross five stages of grief model are denial and isolation, anger, bargaining, depression, and acceptance.² When someone is in the initial phases of grief, they often deny the hearing loss exists or blame communication difficulties on others. This may sound like “She speaks to quietly”, “She never moves his lips when he’s talking”, “Everybody mumbles these days”. In these stages of mourning, a person may become withdrawn, express anger, or may even show signs of depression.1 This is a normal part of the grieving process but the hope and goal is that these stages are brief and allow the individual to move towards acceptance of their hearing loss and seeking out information and options.

Outside of seeking out guidance from a hearing professional, a significant part of living well with a hearing loss is becoming a good self-advocate and creating a good support system. A critical aspect of this process is being open with family members, friends, co-workers, anyone you come in contact with about your hearing loss and what they can do to help with communication. Many people don’t know how to best communicate with someone who has a hearing loss (for example slow down, face me when you’re speaking, get my attention first, don’t yell) but are willing to modify their actions and communication after being informed and have heard frequent reminds. Understand that most family members and communication partners may not know or understand the physical, psychological, and emotional impact of having a hearing loss. It may require patience and multiple honest conversations and education to get there.³ Regular, open conversations with those around you is critical for increased understanding about your hearing loss and how to work together to make communication a positive and successful experience for both of you.

Another excellent option is to seek out a local support group to meet and talk with others who have gone through the same experience. This is often something a hearing professional can guide you to or the national organization Hearing Loss Association of America has many local chapters across the country and may be a good place to start.

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How do I read a hearing test?

You’ve had your hearing tested, now comes time to make sense of the test results. What are those X’s and O’s, triangles and squares, brackets and S’s and U’s? What do those symbols mean – what do they quantify and how do they apply to the real world? It can seem daunting and confusing at first, but once you learn how to read the test it will all make sense.

Down to the Basics

In order to understand the hearing test, one must first understand the basic concepts of sound. Sound is the way we perceive particle vibrations. When something vibrates, it pushes and pulls against the particles around it. Those particles, in turn, push and pull on the particles surrounding them, allowing the sound wave to move through space.

Sound is quantified using three measures: (1) intensity; (2) frequency; and (3) phase. It isn’t important to understand phase for the purpose on interpreting a hearing test, so let’s concentrate on intensity and frequency.

Intensity is the technical term for what we perceive as volume. It’s essentially how much the particles are displaced by the sound wave. The harder the sound wave pushes and pulls on particles, the louder the sound we hear. Intensity is quantified as decibels (or dB) and, while there are different dB scales, the important one to know for your hearing test is dB Hearing Level (dB HL).

Frequency is the technical term for what we perceive as pitch. It’s what allows us to tell the difference between musical notes, or hear inflections in someone’s voice that indicate sarcasm or question, or even tell certain speech sounds apart. Physically, it’s the speed at which the sound particles oscillate, measured as cycles per second or Hertz (Hz).

How Hearing Is Measured

First, we need to establish what frequencies and intensities are important for people to hear. Since we are social animals who use our hearing to communicate with one another, let’s assume that the range of frequencies and intensities people want to hear is that of normal conversational speech. People can hear a frequency range from roughly 20 Hz to 20,000 Hz, but only a small portion of that range contains speech sounds (called phonemes).

We assess how well you hear by finding the softest sounds you hear, called pure tone thresholds, at a range of frequencies (usually 250 Hz to 8,000 Hz). Think of it in terms of sensitivity instead of loudness; the softer the sound you hear, the more sensitive you are to that sound. A normal-hearing person can hear these sounds when they’re as soft as -10 dB HL to 20 dB HL. We display these pure tone thresholds on a graph called an audiogram (see below).

Reading The Audiogram

The audiogram is a graph of pitch along the X-axis and volume along the Y-axis. The low pitches are on the left side of the graph and the high pitches on the right side, like a piano. The soft sounds are at the top and loud sounds at the bottom, so the higher you are on the scale the more sensitive you are to the sounds.

One part of the exam, called air conduction, is plotted on the audiogram using X’s to denote the left ear thresholds and O’s for the right ear thresholds. Air conduction thresholds are how well you hear through the headphones. They tell us how sensitive you are to regular sounds that are presented through the air (as are most of the sounds that you hear).

Occasionally when there is a big difference in thresholds between ears, you may see squares instead of X’s and triangles instead of O’s. These symbols are used when your audiologist has to apply a masking noise to the opposite ear to get your true thresholds. It’s not really necessary for you to understand how masking works, just know that the squares can be a substitute for the X’s (left ear) and the triangles for the O’s (right ear).

Another part of the exam, called bone conduction, is plotted using the symbols “<” for the right ear and “>” for the left ear. This is the part of the test where your audiologist put the headband on you with the little box behind your ear. Bone conduction thresholds are how well your inner ear (the cochlea) hears. When your audiologist uses masking for bone conduction thresholds, the symbols “[“ and “]” are used as substitutes for “<” and “>”.

You may also see symbols like “U” or “M”. These are other types of scores, used to indicate the volumes you found most comfortable or the loudest volumes you’re able to tolerate. These scores are mainly used for prescribing hearing aid settings.

Interpreting The Results

The cutoff for what’s considered normal hearing is 20 dB HL, so any of the scores you see on the graph that are at or above the 20 dB HL line are within normal limits. There is a 5 dB test-retest variability, so some audiologists consider 25 dB HL normal as well. Any of the scores you see below the 20 dB HL line are considered a hearing loss.

There are three types of hearing loss that can be seen on an audiogram. The first type of hearing loss, called sensorineural loss, is most commonly due to damage in the cochlea. There are little hair cells in the cochlea that pick up sound vibrations and convert them into a neurological signal that is sent to the brain. Those hair cells can be damaged by a variety of environmental factors like noise or medications, preventing them from picking up sound as they normally would. Sensorineural loss can also be caused by a blockage along the nerve in rare instances.

Sensorineural hearing loss is seen on the audiogram when the air conduction thresholds (the X’s and O’s) fall below the normal cutoff (20 dB HL) and are within 10 dB of the bone conduction thresholds (< and >). Since there is no significant difference in thresholds between your hearing through the air and hearing when a sound goes straight to the inner ear via bone conduction, the hearing loss is in the inner ear.

The second type of hearing loss, called conductive loss, is essentially a problem with sound getting in to the ear. The hair cells can’t pick up sound because the sound isn’t reaching them the way it should. This includes problems like earwax impaction, ear infection, perforated eardrums, or hardening of the bones in the middle ear. Conductive hearing loss can usually be treated by a physician without the need for hearing aids.

Conductive hearing loss is seen on the audiogram when the bone conduction thresholds are within normal limits, but the air conduction thresholds are not. In other words, you hear normally when sound goes straight to the inner ear via bone conduction, but not when hearing through the air, so something is blocking the sound before it gets to the cochlea.

The third type of hearing loss, called mixed loss, is a combination of sensorineural and conductive losses. The sound is blocked on the way into the ear, but the hair cells are also damaged. Mixed loss is seen on the audiogram when both the bone conduction and air conduction thresholds are below the 20 dB HL cutoff and are separated by 15 dB or more.

What It Means For You

Everyone experiences hearing loss differently, so it’s impossible to generalize in a way that relates to everyone. People who have hearing loss in the higher pitches tend to describe a feeling like they can hear but can’t understand, as though everything is muffled. People who have hearing loss in the lower pitches tend to describe a feeling like sound is too sharp and soft at the same time. Some people describe difficulty telling where sounds are coming from, or just difficulty hearing in noisy environments.

When it comes down to it, the only one who can accurately describe how the hearing problem affects you is you. Your audiologist can help break down the test results, explain why you are experiencing communication problems, and provide recommendations. But it’s up to you to follow along and voice your concerns. Now with your newfound knowledge of how to read the test results, hopefully you can join in on the conversation with ease!

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What are the symptoms of tinnitus?

Tinnitus is the perception of sound by a person when no external source of noise can be identified.  Tinnitus is often described as “ringing”, “buzzing”, “roaring”, or “hissing”.¹

This perceived sound can be classified in one of two ways, subjective or objective.  Subjective tinnitus is only heard by the patient.  A medical professional can help the patient describe and quantify the tinnitus using different sounds or narrow band noise at different levels, as well as loudness levels which are uncomfortable. 

Another aspect of tinnitus is the emotional and physical toll it can bring to a patient’s life.  These symptoms can identified and quantified using specific questionnaires such as the Tinnitus Handicap Inventory or the Tinnitus Severity Index.² These questionnaires are clinically validated and can help both the patient and hearing healthcare professional recognize the burden of tinnitus and then create a treatment plan. 

Objective tinnitus is a very rare form of tinnitus which can be heard via stethoscope by a medical professional.  This type of tinnitus is caused by irregularities in the vascular system, and is often pulsatile or rhythmic and frequently mimics the patient’s heartbeat.³ 

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What are the causes of tinnitus?

Doctor, why do I have tinnitus? What exactly is tinnitus? Where does it come from? What causes it? How can I get rid of it! We hear these questions every day, often, multiple times per day!  For patients, tinnitus can be a troubling diagnosis with numerous underlying causes.  Tinnitus is strongly associated with hearing loss and in most cases, we believe that tinnitus stems from damage to the outer hair cells of the cochlea. These sensory receptor cells can become damaged leading to less auditory stimulation reaching the brain. This lack of auditory stimulation leads the brain to create sound ‘tinnitus’ to fill in the ‘empty space’. Other known causes of tinnitus include, but are not limited to; medication, stress, muscle tension, central pathology, and noise exposure. When tinnitus is associated with medication, it often times will diminish when the medication is stopped. It should also be noted that medication inducted tinnitus can worsen if the medication dosage is increased. Some of the medications that can cause tinnitus include, but are not limited to; some antibiotics, anti-depressants, aspirin, quinine, some forms of chemo therapy, quinine, and diuretics. When stress and muscle tension are the cause of tinnitus, treating those conditions will often times lead to a reduction in tinnitus. 

Tinnitus can further be classified in 2 different ways, subjective tinnitus, the most common form of tinnitus, and objective tinnitus, a rarer form of tinnitus. Subjective tinnitus can only be heard by the individual perceiving it, while objective tinnitus can also be heard by a doctor during an otologic evaluation. The cause of objective tinnitus can be vascular in nature. In cases like this, vascular flow is audible and would warrant further medical work up. Objective tinnitus may also result from middle ear myoclonus. Middle ear myoclonus is potentially related to the tensor tympani or the stapedius tendon. 

The case history is a very important part of the evaluation to attempt to diagnose the cause of a patient’s tinnitus. It is necessary to clearly state symptoms and characteristics of tinnitus during this otologic evaluation.  The more information that your doctor obtains, the more likely they will be to establish a correct diagnosis. Some of the questions you will encounter could include the following:

• Is your tinnitus constant or pulsatile? – Pulsatile tinnitus can be vascular in nature and indicate an underlying problem, warranting a further medical evaluation. 
• What does your tinnitus sound like? – Common answers will be; buzzing, hissing, chirping, and ringing. It is worth noting that what tinnitus sounds like, is a reflection of how a patient perceives their tinnitus, and perception varies from individual to individual.
• How is your hearing? – tinnitus is most commonly associate with age related sensorineural hearing loss, and this should always be ruled out in the presence of tinnitus. 
• Have you had a history of noise exposure? – Noise exposure is also a known risk factor for tinnitus. 
• Do you clench your jaw or grind your teeth? – These behaviors that put tension on the temporomandibular joint are also known risk factors for tinnitus. 
• If your tinnitus has recently changed in severity or characteristic, have you had a significant stress event recently or a change in your hearing? –Stress in our daily lives can exacerbate tinnitus, it can make it seem louder, more constant, of a different pitch, and more troublesome. A change in the tinnitus experience can also be symptomatic of a change in underlying hearing function. 
• Are there other otologic (ear related) symptoms that you have been experiencing, including, but not limited to, dizziness, vertigo, ear clogging, pressure, numbness, or tingling. –Tinnitus coupled with vertigo and or hearing loss, can be an indication of an inner ear problem (pathology). A patient may also present with tinnitus along with other symptoms when experiencing a sudden sensorineural hearing loss, acoustic neuroma (vestibular schwanoma), otitis media (middle ear infection) a TIA or CVA (stroke). 
• Where do you hear your tinnitus? Is it in both ears, your head, or just one ear?  If tinnitus is only heard in one ear, it can be a symptom of an asymmetric sensorineural hearing loss, among other things. It would warrant a further medical evaluation. 

Once all information has been collected and assessed, you doctor will hopefully be able to identify the specific underlying cause of tinnitus and attempt to establish a treatment plan.

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What are the consequences of untreated tinnitus?

Many people with tinnitus incorrectly assume that their health is compromised, and this leads to undue anxiety. The fear associated with an unknown, uncontrollable sound in the ear activates the limbic system, which triggers an emotional response – panic, distress, and sometimes depression. Symptoms of depression such as decreased appetite or sex drive can ensue. Tinnitus may even trigger feelings of PTSD (post-traumatic stress disorder). Feelings of anger, self-guilt, hopelessness, and irritability can arise, which may lead a person to feel miserable overall. Tinnitus sufferers may even avoid situations that they think might provoke their tinnitus, which becomes a form of social anxiety. The tinnitus sufferer may also feel lonely and assume that others do not understand what they are going through.

Since tinnitus is often accompanied by hearing loss, communication impairment is also a common consequence of untreated tinnitus. While hearing loss decreases the volume and clarity of everyday sounds, tinnitus distracts the listener and serves to further confuse the sounds they are trying to hear. This can lead to difficulty at work and put a strain on interpersonal relationships. Untreated tinnitus can also cause difficulty falling asleep or staying asleep, which further causes sluggishness and lack of productivity during the day.

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What are the types of tinnitus?

Tinnitus, that pesky noise in your ears that seems only to appear when you need to concentrate, is an annoyance as well as a symptom of an underlying condition such as hearing loss, noise exposure or that something may be off medically. Tinnitus is the perception of a sound that can only heard by the person experiencing it, and it occurs when there is no other source of sound nearby that can account for it. It is an annoying sound that may appear in one ear or both ears, be constant or intermittent, and be high-pitched or low-pitched. Most people think of and describe tinnitus as “ringing” in the ears, but the truth is that tinnitus can manifest in an array of sounds including “buzzing,” “roaring,” “clicking,” “rushing” and “hissing.” For some people, tinnitus causes distress and can wreak havoc on a person’s emotional and physical well-being.

While most people who experience tinnitus also experience a hearing loss, not everyone who experiences tinnitus will have hearing loss. Individuals may also notice that tinnitus appears suddenly or develops slowly over time. Regardless of when it shows up, how it is described or what it is attributed to, there are two main types of tinnitus: subjective tinnitus and objective tinnitus. These are very different and the type of tinnitus can help determine its etiology.

Subjective tinnitus is the most common type of tinnitus and sometimes it is referred to as “phantom” tinnitus. The reason for the term “phantom tinnitus” is that only the person experiencing it can hear it. Some of the common causes of subjective tinnitus include noise induced hearing loss, presbycusis, or hearing loss attributed to aging, middle ear infections and even impacted cerumen, or wax, in the ears.

Common risk factors for subjective tinnitus other than hearing loss include:

• Noise exposure
• Smoking
• Diabetes

Less common risk factors for subjective tinnitus that may be ear related include:

• Meniere’s disease
• Temporomandibular joint disease
• Acoustic neuroma
• Head injury

It is also common for people to experience subjective tinnitus from certain medications. While there are many medications that may list tinnitus as a side effect, it is important to note that not all people who take these medications will experience tinnitus.  The most common ones include:

• Non-steroidal anti-inflammatory drugs (NSAIDS) - Aspirin, ibuprofen and naproxen are over the counter medications often used for pain relief.
• Aminoglycoside antibiotics - Used to treat life-threatening illnesses
• Diuretics - Used in the treatment of hypertension (high blood pressure)
• Chemotherapeutic agents - Used to combat certain types of cancer
• Quinine - Used to treat malaria
• Anti-depressants

The other type of tinnitus is called objective tinnitus, often referred to as pulsatile tinnitus and less frequently as vascular tinnitus. Pulsatile tinnitus is less common that phantom tinnitus and is usually an indication of a medical condition involving blood flow disturbances, especially in the head and neck region. With this type of tinnitus, physicians and other individuals, as well as the individual can hear it and it usually sounds like a whooshing or throbbing.

Common medical conditions that can cause pulsatile tinnitus include:

• Hypertension (high blood pressure)
• Head and neck tumors
• Atherosclerosis (narrowing of the arteries)
• Twisted arteries in the head and neck area

Less common causes of pulsatile tinnitus include:

• Multiple sclerosis
• Hyperthyroidism
• Iron deficiency

In either case of tinnitus, subjective (phantom) and/or objective (pulsatile/vascular), it is important to report it to and investigate it with the appropriate medical professional, particularly if it is interfering with your daily life. Audiologists can help individuals suffering from subjective tinnitus to classify and quantify the type, while physicians can assist in finding medical conditions that may be causing objective tinnitus.

In the meantime, know that tinnitus is real but manageable, and not unique to any one person. While most people who experience tinnitus have hearing loss, if you do experience it suddenly, it does not mean you will “go deaf” or lose your hearing, or that it will get worse. So if you experience that irritating, annoying noise in your ears, whether it is “buzzing,” “roaring,” “clicking,” “rushing” and “hissing” don’t allow it to control your life. Seek help from the appropriate professional and get a handle on it before it gets a handle on you!

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How is tinnitus treated?

Rather than “treating” tinnitus, the goal is to help a patient manage their tinnitus. After the underlying causes of tinnitus have been identified, there are several therapies which have been found efficacious in reducing or eliminating the perceived tinnitus and its associated distress.

• Hearing Aids. Many patients who report tinnitus have underlying hearing loss. If the hearing loss is treated effectively with hearing instruments, the tinnitus is also reduced.
• Counseling. Counseling programs can educate patients on what causes the brain to create tinnitus sounds, and can help patients learn coping strategies including changing the way one thinks about tinnitus and relaxation techniques.
• Sound Generators. Many patients find soothing sounds such as wind, water, or birds to be a relaxing and help diminish the sound of the tinnitus they perceive. There are table top sound generators, smart phone apps, and many modern hearing instruments also include settings are essentially sound generators. These generators have been shown to help mask or minimize the perceived tinnitus sound.¹
• General Wellness. Patients with tinnitus may find that changes in diet, exercise, and relaxation affect their perception of tinnitus.
• Behavioral Therapy. There are several types of therapy that have been found to be helpful for patients suffering with severe tinnitus. These include cognitive behavioral therapy, mindfulness-based stress reduction, tinnitus activities treatment, and progressive tinnitus management.²
• TMJ and other Physical Treatments. In very few cases, tinnitus is caused by physical dysfunction in the temporomandibular joint, obstructions in the ear canal, or head and neck injuries. Treatment of these underlying physical symptoms can bring relief of tinnitus symptoms.³

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How do I relieve and cope with tinnitus?

If you are suffering from tinnitus, you may already know that it can be debilitating. Tinnitus is described as a perception of noise or ringing when no such external physical noise is present. In other words, you hear something that isn’t there, a notion that can be disturbing all on its own. Depending on how loud or often that noise is experienced though, it can also lead to fatigue, stress, sleep problems, depression, and other serious issues. The most important thing you can do to start alleviating and coping with tinnitus is to see a doctor, typically an ENT or an audiologist.

Because tinnitus is a symptom and not a condition, it is important for your doctor to determine the underlying cause for your having tinnitus. This will ultimately allow your doctor to choose the appropriate treatment methods for ameliorating the symptoms. In almost all cases the doctor will perform a comprehensive hearing exam. This is the main and most important step in determining what may be contributing to your tinnitus. Once this assessment has taken place, an appropriate treatment plan can then be recommended. The typical treatments include one or many the following techniques for alleviating and coping with tinnitus:

Audiological Solutions

• Hearing aids – hearing loss is the most common cause of tinnitus. This happens naturally as the brain attempts to replace the frequencies it can no longer hear naturally. Typical treatment is hearing aids. Most sufferers of tinnitus report amelioration and often complete recovery from tinnitus when the brain and ears are being stimulated with actual noise through the hearing aids.
• Masking devices – these devices are worn on the ear and work by generating low level noise to cover up the tinnitus. Typically an audiologist will work with you to determine the correct pitch and noise level that is needed. These devices can also be combined with hearing aids.
• Therapy – tinnitus retraining may be employed alone or in conjunction with the other solutions. The therapy combines the use of sound therapy devices and counseling over time to help cope with the effects of tinnitus.
• Medication – some medications, not limited to, but including anti-depressants, have been shown to alleviate tinnitus.

Lifestyle Solutions

• Diet changes – dietary changes can be recommended to any tinnitus sufferer. Foods that are high in sodium have been linked to increases in the frequency and strength of tinnitus. It is recommended for tinnitus sufferers to avoid eating foods that are high in sodium.
• Lifestyle changes – while it is shown that tinnitus can lead to stress, one of the best ways shown to reduce tinnitus is simply to reduce the amount of stress in your life from external factors. Not all stress can be eliminated, but making small changes can improve your tinnitus as well as your overall health.
• Support groups – Tinnitus is a very common symptom that many people suffer from. For that reason tinnitus support groups are available in or near most big cities. Having a group of people to meet with who are dealing with the same issues is often a big help in coping and generally reducing stress. This is often a good forum as well for people to share ideas for what is helping them to cope.

If you are suffering from tinnitus, there is help out there for you. It is usually just a matter of finding the right doctor. Don’t suffer in silence, get help today!

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How is tinnitus prevented?

Tinnitus is most commonly a symptom of untreated hearing loss.  Preventing hearing loss and preventing tinnitus follow the same strategies. 

• Avoid exposure to loud noises
• If exposure cannot be prevented, wear appropriate hearing protection
• Keep your blood pressure in a normal range
• Keep blood sugar in a normal range
• Exercise
• Eat a healthy diet, avoid substances known to aggravate tinnitus 
• Discuss medications with your physician, be aware of side effects and ask for alternatives if tinnitus is noted after beginning a new medication. 

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How do hearing aids work?

Hearing aids are small, electronic devices, that enable the user to hear better by collecting sound, amplifying it, and directing it into the user’s ear.  There are several different styles and shapes of hearing aids, but they all have essentially the same components.  Sound is collected by the microphone of the hearing aid, those sounds are made louder by the amplifier, and then are sent into the ear by a tiny receiver, or speaker.  All hearing aids also utilize a power source, or battery.  Hearing aids differ by their style or shape, by the technology used to amplify the sound (analog or digital), and by their special features.  Hearing aids can be custom made to fit inside the ear or ear canal, or they can fit behind the ear and have a piece, either a mold or a dome, that goes inside the ear to conduct the sound toward the eardrum and improve sound quality.¹

Analog hearing aids take sound waves and make them louder, without really distinguishing between different types of sound, like speech or noise.  Some analog hearing aids can be digitally programmable, meaning the audiologist can create settings for different environments that the user can access with the push of a button, such as a program for quiet environments, a program for noisy restaurants, and a program for a park or a theater.  Analog circuitry is less sophisticated than digital technology, and it is usually less expensive.  Although analog circuitry is available in all styles of hearing aids, it is becoming less and less common.

Digital hearing aids have all the same features of analog programmable aids, but they have a microchip to convert sound waves into digital codes, similar to the binary code of a computer.  The chip analyzes the sound to identify loudness, pitch, and whether the sound is speech or environmental noise, and allows for a much more sophisticated processing of the sound during the amplification stage.   This may improve the user’s listening performance in certain situations, like in background noise.  Digital technology also provides greater flexibility in programming the devices to match a wider variety of patterns of hearing loss.²

Hearing aids have some optional features that can be added in or selected to improve the user’s listening experience.  Here are some common ones:

• Telecoil (or t-coil).  These are tiny coils inside the hearing aid that allow the users to turn off the traditional microphone, and hear the sound coming from the telephone clearly.  This features is also helpful to use in many theaters or large rooms where an induction loop system is present.
• Directional microphones.  Directional microphones are designed to improve a user’s ability to communicate in noise, by amplifying to a greater degree sounds that occur from a specific direction over other directions.  Directionality is commonly used to improve the sounds occurring in front of the user, assuming the user is face-to-face with whomever they wish to communicate.  Directionality could also be used to improve the sounds from other directions in special cases, for example, a bus driver or a parent driving a carpool, who need to be able to hear sounds of passengers behind them.
• Feedback control.  Automatic feedback controls within the hearing device analyze and automatically reduce the annoying whistling sound hearing aids can sometimes make.
• Wireless connectivity.  Wireless connectivity can refer to the ability of the hearing aids to communicate with one another, improving sound localization and enabling the user to control both devices with the single touch to one device, or it can refer to the ability of the devices to communicate with Bluetooth enabled electronic devices.  Some hearing aids can even allow users to receive their phone calls from their smartphones in their hearing aids and stream audio for movies, music, or video.
• Rechargeability.  Some hearing aids utilize rechargeable batteries, allowing them to be placed on the charger nightly and instead of the nuisance of frequent, even weekly, battery changes.³    

These additional features can really help hearing aids meet the specific needs of an individual, but they can also add to the cost.  An audiologist is trained to help individuals select the style, technology type, and features of hearing aids that will best improve their hearing and communication.  

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What is unbundled hearing aid pricing?

Have you or someone you know come across the same exact hearing aids priced vastly different from multiple providers? Now, before you get discouraged and assume you’re getting taken to the cleaners, let me first reassure you there is likely a good reason, but to find out you may want to first ask your provider to see if their pricing model is bundled or unbundled. “What does that even mean,” you ask? That’s a great question; let me try to break it down for you... 

Bundling: “Think all Inclusive”

To begin the discussion of unbundling it is important to first explain bundling. To date, bundling is the most common or conventional method for the pricing structure of both the hearing aids and nearly all follow-up services rendered. Think of it as a “packaged” model where you pay for the whole package at once. With this the cost of a pair of hearing aids and typically three years of in-office service fees are put into one single charge and billed on the day of the hearing aid fitting. This bundled price can vary depending on the level of technology you desire or need and is based on your audiogram (hearing test) and listening needs. For example: the vast majority of those seeking the treatment of hearing aids have hearing loss in both ears. Therefore, they need a treatment plan for both ears as well. With the bundled model, the price of a pair of premium (top-of-the-line) hearing aids and all future office visits for the next three years typically ranges from $6,000-$7,000. This amount is then billed at the fitting appointment, and for the most part, you will not owe anything again until your 3 year warranty has expired. This pricing structure may give patients the perception that the hearing aids themselves cost that high amount and all of their follow-up services are “free,” but that is not the case. You have just paid for the hearing aids and ALL of your services up-front over the next 3 years, instead of paying as you go.

Unbundling: “Think a-la-carte, for your Hearing Care”

The bundled model may be the most common pricing structure to date, but this is rapidly changing. This is due in-part to audiologist’s push towards more transparency in the way they bill their patients for their care. Many want to charge in a similar manner to other healthcare providers (dentists, physical therapists, chiropractors, etc.) who charge for their professional services as they occur. Another reason for the change is outside competition listening to consumers and revamping the way hearing aids are billed to patients. 

This newer structure takes the “packaged” model and unpacks or “itemizes” services rendered. More specifically, Unbundling breaks apart the cost of the hearing aids from its accessories, batteries, and follow-up services. The provider bills the patient or insurance provider for the services as they occur versus billing for the services before they have been used (as in the bundled model). It allows for more transparency for the patient and helps you understand what you’re truly paying for through the course of your treatment. For example: say there is a patient who comes in that has never worn hearing aids before and may need more assistance in the beginning as they adjust to hearing aids. Let’s say they use 20 appointments over the course of three years. At the same time you have an experienced hearing aid user who only comes in for routine visits and uses around 10-12 visits over the course of three years. If both patients chose the same pair of hearing aids, does it make sense to charge them the same price? Not really! It makes more sense to charge the patient for the appointments as they are used rather than charge them for services they may never use.

Pros of Unbundling:

1. Less upfront cost to the consumer

As discussed above your upfront cost can be significantly less on the day of the hearing aid fitting, because you’re only paying now for the hearing aids themselves and the cost of the fitting appointment. After the fitting your audiologist will likely want to see you again in 1-2 weeks to ensure you’re adjusting well to them. After the 2 week follow-up, routine maintenance appointments for most offices are every three to six months. These appointments are important because you will have a professional look over your hearing aids, check your ears, and give your devices a good cleaning. This will help lengthen the life of your devices and in turn save you money in the long run.

2. Your treatment is tailored for you and your individual needs

As explained above you may be a patient that needs a lot of follow-up visits or you may use just the standard maintenance appointments. It can all depend on your needs as a patient. With the unbundled model care is custom built to you. It is understood if you need less appointments you will pay less than someone who needs more.

3. Ability to choose your professional

Now this is a big one. With the traditional bundled model, once you pay for your hearing aids it is in your best interest to continue to go to this provider because the services following will not be charged to you, seeing as you’ve already paid for them up-front. However, if you’re unhappy with their services or want a second opinion, it will, in most circumstances cost you money on top of what you’ve already paid in order to get that second opinion. This could cause you to feel “tethered” to your original provider rather than making you feel you have options. Thus, the unbundled model also holds providers to a higher standard of care for their patients.

Another scenario to consider are individuals who travel or reside in multiple locations. For example: What if you purchased your hearing aids in Michigan where you live during the summer months, but you spend your winters in Florida? Accidents happen and you may need another providers assistance. With the unbundled model you only pay for the services at the time they are rendered, allowing you to go to an office in Florida without paying extra feeling penalized.  

Cons of Unbundling:

1. Paying as you go can get expensive

For individuals with more severe difficulties understanding speech, it may be in their best interest to keep the bundled model. They may need aural rehabilitation or auditory training programs from their provider and more frequent visits for their therapy plan. Appointments may also be longer until the patient feels more confident and does not have the need to come in as frequently. Therefore, during this time of extra need, paying per-appointment may become costly over time.

2. You’re an experienced hearing aid user and have not paid per visit with your previous set

If you go to an office that has switched to being “unbundled only” it may be a big change for you. You’re used to being able to go in as many times as you needed without having to pay. The idea of paying for each appointment may take some time to adjust to. 

Do I Have a Choice?

Since this model is new, chances are most offices will give you the option to choose between unbundled or bundled plans. Take time to talk with your provider to decide which plan is best for you. Many offices also offer a sort of mini-bundle packaged plan you can add at any time throughout your treatment. Therefore, if you think the unbundled plan is a good choice at first, but you later change your mind, you can discuss your options with your provider and make an informed decision for a more pre-paid bundled model.

Closing Thoughts:

In conclusion, both pricing structures have their own pros and cons. It is important you talk with your provider about your goals with hearing aids and your budget as well. Remember that the hearing aid is only one piece to the puzzle and is only as good as the provider programming them to your hearing needs. Finding a good provider in your area may take some extra research, but it is well worth your time. Communication between the two of you is essential. Remember, every patient has different hearing needs and will require different levels of care. If you have made the decision to pursue hearing aids, think about what you want from your provider and which pricing structure works best for you.

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External Resources

Here is a list of useful hearing loss resources. If you are interested in having your resource listed, please contact us at info@hearingtracker.com, or sign in and use our contact form. Alternatively, you may wish to leave a comment, including your resource, at the bottom of this page.

Accessibility

AccessWireless - Learn about cell phone features for people who are deaf or hard of hearing. Find information about hearing aid compatibility ("HAC"), closed captioning, video and text communications, and visual displays.

Global Accessibility Reporting Initiative - Find phones, tablets, and mobile apps that are optimized for consumers with hearing impairment.

Audiology Best Practices

Guidelines for the Audiologic Management of Adult Hearing Impairment - Guide for audiologists who wish to adopt clinical best practices. Hearing Tracker's "service quality" award is based on the recommendations of this guide.

Blogs to Follow

AU Bankaitis's Audiology Blog - A.U. Bankaitis, PhD is a clinical Audiologist and Vice President of Oaktree Products, Inc., a multi-line distributor hearing healthcare products.

Hack and Hear - Helga Velroyen's blog covers everything related to hearing and hearing aids and the hacking of them.

Hear Better With Hearing Loss - Katherine Bouton is the author of "Shouting Won't Help" and "Living Better With Hearing Loss." She is a frequent speaker on hearing loss issues, and speaks to both professional groups and hearing loss groups.

Hearing Loss Help - Neil Bauman, Ph.D. covers topics related to hearing loss, hearing loss coping skills, assistive devices, looping and loop systems, tinnitus, ototoxic drugs, Meniere's disease, balance problems, etc

Helping Him Hear - A blog authored by an auditory researcher who's son was diagnosed with mild hearing loss at five weeks.

Living With Hearing Loss - Shari Eberts discovered that she had progressive hearing loss in her mid to late twenties. Her blog is an outlet for her experiences as well as a community for those dealing with similar issues.

Hearing Industry News

Audiology Worldnews - "...global website for hearing care dispensers and ENTs to find information and resources: Latest news and topics related to the profession, new implants and hearing aids on the market, last conferences, interviews."

Hearing Health Matters - "...created by and for people who share the belief that Hearing Health and Technology Matters! Our vision is to provide timely information and lively insights to anyone who cares about hearing loss."

Hearing Mojo - Provides information, research, news and a support forum for hard-of-hearing consumers and the industry that serves them.

The Hearing Blog - The blog of hearing expert and electrical engineer Dan Schwartz. Dan wears hearing aids himself and has a passion for finding the latest industry scoops.

Hearing Loops

What is a Hearing Loop - A hearing loop is a wire that circles a room and is connected to a sound system. The loop transmits the sound electromagnetically. The electromagnetic signal is then picked up by the telecoil in the hearing aid or cochlear implant.

Loop Finder - Find a hearing loop in your area using this website sponsored by the Hearing Loss Association of America and Otojoy.

Loop Wisconsin - Great general information about hearing loops for audiologists and hearing health professionals. The site also has good information for consumers wanting to learn more about hearing loops.

Information about Hearing Loss

Better Hearing Institute (BHI) - "Founded in 1973, the Better Hearing Institute conducts research and engages in hearing health education with the goal of helping people with hearing loss benefit from proper treatment."

Hearing Health Foundation (HHF) - HHF's mission is to prevent and cure hearing loss and Tinnitus through groundbreaking research, and promote hearing health. Hearing Health Foundation's envisions a world where people can enjoy life without hearing loss and Tinnitus.

Hearing Loss Association of America (HLAA) - "The Hearing Loss Association of America (HLAA) is the nation's leading organization representing people with hearing loss. According to the National Center for Health Statistics 48 million (20 percent) Americans have some degree of hearing loss making it a public health issue third in line after heart disease and arthritis."

National Institute on Deafness and Other Communication Disorders (NIDCD) - "The National Institute on Deafness and Other Communication Disorders (NIDCD), part of the National Institutes of Health (NIH), conducts and supports research in the normal and disordered processes of hearing, balance, taste, smell, voice, speech, and language."

The HearStrong Foundation - "The HearStrong Foundation aims to shatter social stigmas and radically challenge the general perception of hearing in our society. The foundation serves to celebrate individuals worldwide who have not only faced hearing loss, but conquered it with a determined spirit, a focused mind and an unwavering heart!"

Noise Induced Hearing Loss

National Institute on Deafness and Other Communication Disorders (NIDCD) - "The National Institute on Deafness and Other Communication Disorders (NIDCD), part of the National Institutes of Health (NIH), conducts and supports research in the normal and disordered processes of hearing, balance, taste, smell, voice, speech, and language."

Occupational Safety and Health Administration (OSHA) - "With the Occupational Safety and Health Act of 1970, Congress created the Occupational Safety and Health Administration (OSHA) to assure safe and healthful working conditions for working men and women by setting and enforcing standards and by providing training, outreach, education and assistance."

Noise Induced Hearing Loss Prevention

LimitEar - a UK-based company specialising in technologies that protect headphone and earpiece users from serious irreversible conditions, such as Noise-Induced Hearing Loss (NIHL).

Practice Building for Hearing Providers

AudiologyEngine - "We can support you in your practice by delivering ... solutions across all of the elements of your Practice. From your online presence and marketing to the everyday processes and procedures used to manage your practice."

AuDseo - "AuDseo is a premier digital marketing agency specializing in getting your hearing aid practice to the top of local search results. We take a well rounded approach to your online presence with mobile-friendly web design, search-engine optimization, PPC campaign management, and creative content creation. We highlight what makes your practice unique and help you get found!"

Professional Groups for Hearing Providers

American Academy of Audiology (AAA) - The American Academy of Audiology is the world's largest professional organization of, by, and for audiologists. The active membership of more than 12,000 is dedicated to providing quality hearing care services through professional development, education, research, and increased public awareness of hearing and balance disorders."

Academy of Doctors of Audiology (ADA) - "The Academy of Doctors of Audiology is dedicated to the advancement of practitioner excellence, high ethical standards, professional autonomy and sound business practices in the provision of quality audiologic care."

Academy of Rehabilitative Audiology (ARA) - "The primary purpose of ARA is to promote excellence in hearing care through the provision of comprehensive rehabilitative and habilitative services."

American Speech-Language-Hearing Association (ASHA) - "The American Speech-Language-Hearing Association (ASHA) is the national professional, scientific, and credentialing association for more than 173,070 audiologists, speech-language pathologists, speech, language, and hearing scientists, audiology and speech-language pathology support personnel, and students."

International Hearing Society (IHS) - "The International Hearing Society (IHS) is a membership association that represents hearing healthcare professionals worldwide. IHS members are engaged in the practice of testing human hearing and selecting, fitting and dispensing hearing instruments and counseling patients. Founded in 1951, the Society continues to recognize the need for promoting and maintaining the highest possible standards for its members in the best interests of the hearing impaired it serves."

Tinnitus Relief

MindfulTinnitusRelief.com - Eight week on-line program focusing on reframing your experience with tinnitus. There are elements of deep breathing, yoga, relaxation and meditation throughout the course. The skills you develop over these 8 weeks not only apply to tinnitus but to nearly every facet of modern living.