One Hearing Aid or Two? My Takeaways From a New Clinical Trial
A new clinical trial compares monaural and binaural hearing aid use—and highlights the role of individual benefits, costs, and preferences.)
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Hearing aids are one of the biggest purchases many people make, after a home or a car. So, it’s no surprise that one of the questions people with hearing loss in both ears ask most often is whether they really need two, or if one would be enough.
With advances in hearing aid technology, hearing science, and evolving consumer needs, this area seemed ripe for reexamination. A new randomized clinical trial published this year in JAMA Otolaryngology–Head & Neck Surgery tested it directly. I was proud to be a part of the study team as the lead patient advocate and co-lead of the stakeholder advisory team. I am also a co-author of the article.
The Short Answer: Two Helps More, But One Also Helps
The case for two hearing aids makes intuitive sense. Hearing with both ears helps the brain figure out where sounds are coming from, follow speech in noise, and enjoy a fuller, richer sound. Even so, in earlier studies, anywhere from 19% to 61% of people preferred or used just one hearing aid. But those studies were often small, mixed together many types and degrees of hearing loss, used older technology, and rarely focused on mild to moderate age-related hearing loss.
This new study provides more contemporary evidence. In short: two hearing aids provided greater benefit on average, but one hearing aid also helped.
Study’s Real-World Design Adds Credibility to Results
The trial enrolled 275 adults aged 50 and older with mild-to-moderate hearing loss, predominantly in the higher pitches, the classic pattern of age-related hearing loss. Most participants (89%) had mild hearing loss in their better ear, and all were new or nearly new to hearing aids.
Each person was randomly assigned to wear one hearing aid or two hearing aids for three months. After three months, each person chose whether to keep their assigned setup, switch, or stop wearing hearing aids.
Importantly, participants paid for their own hearing aids and audiology services, just as they would in any clinic, using insurance benefits if they had them. (Phonak, the study’s industry partner, offered the devices at a small discount and with an extended trial period.) In earlier studies, hearing aids were typically provided for free, which is not reality for most consumers. Because cost was part of the picture, we could see not just how much people benefited, but also which configuration they chose when their own money was on the line.
What the Study Found: Most People Chose Two
The study’s main questionnaire measured how often people had trouble communicating in everyday situations. On a 100-point scale, participants wearing one hearing aid improved by an average of 14.4 points from where they started, and participants wearing two improved by an average of 19.7 points, a difference of about 5 points. The difference between the groups was statistically significant, but it is not yet clear what a 5-point difference means in everyday life.
Several of the study’s other measures also favored two hearing aids. People wearing two reported less remaining difficulty with their hearing aids and were more likely to recommend their setup to a friend or family member. Other metrics, such as overall satisfaction and daily use, showed little or no difference.
At the end of the trial, about 29% of participants chose one hearing aid, about 71% chose two, and fewer than 1% chose none. About 6 in 10 people who started with one hearing aid decided to add a second, and almost no one gave up on hearing aids altogether.
My read: two hearing aids helped more on average, but one hearing aid helped, too. And an average cannot tell you what will work best for you. Everyone’s hearing loss, communication needs, and priorities are different. When it comes to one versus two, the devil really is in the details.
Patient Voices Helped Shape the Study
One of my favorite things about this trial was that the funder, the Patient-Centered Outcomes Research Institute (PCORI), requires patient involvement in every study it funds. PCORI treats patients not as mere subjects, but as important partners at every stage of the research.
Our stakeholder advisory group brought together people with hearing loss as well as their communication partners. This group helped inform the choice of outcome measures and shape the materials that the participants saw.
Dr. Sherri Smith, the study’s lead author, found the patient involvement so valuable that it changed how she does research. She now includes people with lived experience on every grant and study team, even if it isn’t required. For those of us with hearing loss, “nothing about us without us” is not a slogan—it is how research becomes useful in real life.
Previous Research
Researchers have studied one versus two hearing aids for decades, documenting the benefits of bilateral () amplification while recognizing individual differences (see Cy Libby’s historical overview and Alice Holmes’s review of older adults). A 2011 study by Robyn Cox and colleagues found that some adults with mild-to-moderate hearing loss in both ears preferred one hearing aid after trying both options.
Preference alone does not establish binaural interference—a condition in which speech understanding is poorer with both ears than with the better ear alone. But some people do experience this difficulty and may understand speech better with one hearing aid—which further emphasizes the importance of a comprehensive hearing exam from an audiologist.
The Bottom Line
This new study gives us stronger, more contemporary evidence on a question people ask every day. Two hearing aids helped more on average, and most participants chose two when the decision, and the cost, were theirs. But one hearing aid helped as well, and for some people it was the right choice. That makes this a decision to talk through with your provider, weighing your hearing, your communication goals, your budget, and your preferences, rather than a one-size-fits-all rule.
Whatever you decide, don’t let uncertainty or cost keep you from treating your hearing loss. The sooner you start, the better.
Read the study, “Unilateral and Bilateral Hearing Aids for Age-Related Hearing Loss: A Randomized Clinical Trial,” in JAMA Otolaryngology–Head & Neck Surgery.
Shari Eberts
Hearing health advocateShari Eberts is a passionate advocate, author, and speaker on hearing loss issues. She is the founder of Living with Hearing Loss, a popular blog and online community for people with hearing loss, and an executive producer of We Hear You, an award-winning documentary about the hearing loss experience. Her co-authored book, Hear & Beyond: Live Skillfully with Hearing Loss, is the ultimate survival guide to living well with hearing loss. Shari has an adult-onset genetic hearing loss and hopes that by sharing her story, she will help others to live more peacefully with their own hearing issues. Visit Shari at LivingWithHearingLoss.com.