Hearing Aids 101

Understanding the benefits and complexities of hearing aids

When I received my hearing aids, it changed everything. To hear so many new and beautiful sounds, like on a beautiful sunny morning hearing the birds. It was amazing all the sounds I heard and it made a big difference.

Ib Dabo
Journalist, Motivational Speaker
HLAA Board Member

What you need to know about hearing aids

It’s natural to want a simple answer to the question, “What are the best hearing aids to buy?” The truth is there is no simple answer. The best hearing aids you can buy will support your specific hearing loss and your interests, lifestyle, and budget. The good news is that advanced technology means even less expensive hearing aids offer features that can help you hear better and more clearly in different situations.

Today’s hearing aids are small wonders of technology that can greatly improve the quality of your life. But they can also be complicated and varied. We understand if you feel overwhelmed by the prospect of choosing the right ones. The information below will help.

Having the right expectations

Understanding how hearing aids work, how they can help, and where they fall short is essential to managing your hearing loss. Having the right expectations will help you get the most from your hearing aids and know when you need additional technologies. Moreover, you will have less frustration and greater satisfaction with using your hearing aids. For example:

Hearing aids are not like eyeglasses

Many people assume that hearing aids correct our hearing loss the way glasses correct our eyesight. But, where eyeglasses can give us 20/20 vision, wearing hearing aids does not give us normal hearing. Hearing aids simply amplify the sound you hear — things will be louder, but not always clearer. For example, in a noisy restaurant, you can read the menu with your eyeglasses, but your hearing aids may amplify the background noise which can make it difficult to understand your dinner companions.

If your friends and family assume that simply wearing your aids should give you normal hearing, share Shari Eberts’ post, Ten Reasons Hearing Aids Are NOT Like Glasses.

Hearing aids and audiogram

Proper fit matters

The particular size and shape of your ear canal and where the hearing aid’s speaker is placed within it can impact the quality of sound you hear. Additionally, if your hearing aid’s earmold does not fit properly, sound can leak back into the device’s microphone, causing a whistle sound. We recommend working with a skilled hearing health provider to ensure your devices match your specific needs and ears. This is particularly important if you have moderate to severe hearing loss.

When getting fitted for a hearing aid, ask your hearing health provider to run a real ear verification test. This simple test will measure and verify the performance of your hearing aids. With this information, your provider can make necessary adjustments to help your device live up to its full potential.

In-the-ear hearing aid

Learn more:
Real Ear Verification

Working with a Hearing Health Provider

Hearing aids require an adjustment period

Whether it is your first pair or a new, updated pair, it can take a few months to adjust to wearing hearing aids. Beyond getting used to wearing something in your ear, you have to adjust to hearing sounds you could not easily hear before — including your own voice. You may also need to adjust specific settings and learn how to use different listening programs. Also, different hearing aid brands tend to have a certain kind of sound which can take some getting used to.

It’s important to test new hearing aids is different settings

To take full advantage of your hearing aids, be patient, persevere, and work closely with your hearing health provider. Wear your devices everyday and in different situations, and play with the settings and listening programs. The goal is to fully test your hearing aids within the return window, just in case you need to exchange them for a different set.

Learn more
7 tips for getting used to your new hearing aids

Hearing aid benefits

The emotional, mental, and physical benefits of wearing hearing aids cannot be overstated. Being able to hear and communicate keeps us connected, engaged, and healthy.

Wearing hearing aids can help you:

  • feel more confident in conversations
  • hear speech over the telephone more clearly
  • enjoy music, TV, and movies with better audio
  • easily hear at venues, like live theaters, with assistive listening systems
  • combat isolation and therefore reduce the risks of depression, falls, and cognitive decline
  • stay safe by being able to hear warnings and determine where sounds are coming from
Conversations are easier when you can hear easily

Learn more:
Health benefits of hearing aids
Hearing aids for tinnitus

Hearing aid limitations

As beneficial as hearing aids are, they are not a cure for hearing loss — they are a treatment for a largely incurable medical condition. And while improvements in connectivity, programming, comfort, and fashion are welcome, limitations remain. Therefore, consider hearing aids as one of many tools in your hearing access toolbox.

Hearing aid limitations:

  • Hearing aids work best in quiet settings where you are within 6 feet of the speaker or sound source. This distance is known as the hearing aid bubble.
  • All sounds are amplified, meaning background noise becomes louder too.
  • Hearing aids amplify speech but not clarity, meaning it can be difficult to understand what you are hearing.
  • There are limitations to the amount of amplification a hearing aid can provide.
Hearing aids work best when you are within 6 feet of the speaker or sound source.
Hearing aids work best when you are within 6 feet of the speaker or sound source

The good news is that there are many tools you can use with your hearing aids to help you hear better in different situations. For example, a remote microphone or speech-to-text app may help you hear better in noising settings.

Learn more
Breaking the 2 Meter Hearing “Bubble”

Options for purchasing hearing aids

Hearing aids are regulated medical devices and until recently, consumers had to buy them from an audiologist or hearing aid specialist. In an effort to make hearing aids affordable and accessible for more people, President Biden directed the US Food and Drug Administration (FDA) to establish a new categories of hearing aids that can be purchased online or at retail locations without a prescription. These direct-to-consumer and over-the-counter hearing aids offer more options, but also make the process of choosing hearing aids more complicated. 

The critical thing to remember is that while hearing aids are becoming cheaper and more accessible, getting the right hearing aids for your specific hearing loss, ear anatomy, and lifestyle remains essential. Regardless of where you buy your hearing aids, we recommend working with a hearing health professional to get the best outcomes.

Purchasing from a hearing aid professional

Receiving guidance and customized programing from a qualified hearing healthcare professional will greatly improve your experience and the benefit you receive from the hearing aids. In Washington State, audiologists and hearing aid specialists are both trained and licensed to test hearing and to sell, fit and adjust hearing aids. Audiologists have medical degrees while hearing aid specialist are trained and certified by the state. You can find audiologists and hearing aid specialists in private practices, at retail locations, and wholesale clubs like Costco.

Hearing evluation

Bundled vs unbundled pricing
Traditionally, hearing health professionals bundle the cost of the hearing aid you purchase with services like evaluation, fitting, verification, and maintenance. This model provides an easy, holistic approach, but it can be more expensive and you might pay for services you don’t use.

An unbundled model gives you greater control over your costs, the level of service you choose, and potentially, where you purchase your hearing aids. For example, a hearing professional can evaluate your hearing loss and advise what type of hearing aid would best meet your needs. You can then try to purchase your hearing aids via the Internet or a discount retailer, and bring them back to your hearing professional for fitting, verification, and maintenance. Note: providing these services may be dependent on the type or brand of hearing aid you purchase, be sure to ask up front.

The Washington State Hearing, Speech and Deaf Center offers unbundled services at their Audiology Clinic in Seattle.

Over-the-counter (OTC)

Over-the-counter (OTC) hearing aids are designed to provide audio amplification for adults with mild or mild-to-moderate hearing loss. As the name suggests, OTC hearing aids will be available for purchase in stores and online without a prescription. On August 16, 2022, the FDA issued the final rule regulating how OTC hearing aids can be marketeed and sold to consumers; devices are expected to be available within the coming months. 


Benefits: It’s expected that the new OTC class of hearing aids will be significantly less expensive than those currently on the market which can average thousands of dollars a pair. Ideally, these options will inspire some to take a first step to treat their hearing loss sooner. Ultimately this can mean a better quality of life, and avoiding the increased risk of dementia, falls and isolation associated with untreated hearing loss.

Retail OTC hearing aids to be available late 2022


  • Most of these devices will provide general amplification with varying degrees of background noise reduction.
  • Some OTC hearing aids will offer phone apps that will allow you to adjust the aids, or allow for direct streaming to your phone.
  • We expect some OTC models to have telecoils which allow people to connect to assistive listening systems like hearing loops. Telecoils can be a valuable feature for hearing better in venues like places of worship, theaters, airports, etc. Learn more.
  • OTC hearing aids are considered ready to use out of the box; any product service is provided via phone or online by the manufacturer, or by mailing them back to the company. As of now, no local audiologist or hearing aid dispenser can maintain, repair, or adjust these devices.

Note: OTC hearing aids should not be confused with hearing amplifiers (PSAPs) or direct-to-consumer (DTC) hearing devices, which are already sold online and in stores. The difference between the three categories is the level of FDA regulations. OTC hearing aids are regulated as medical devices/aids for hearing loss; DTCs are regulated to lesser degree; and PSAPs are not regulated at all and are intended for specific uses like hunting or bird watching.

Learn more
F.D.A. Clears Path for Hearing Aids to Be Sold Over the Counter (New York Times)
Over-The-Counter Hearing Aids: Everything You Need To Know (Forbes)
Over-the-Counter Hearing Aids: Coming to a Store Near You (Katherine Bouton)

HLAA OTC Resources

Online Hearing Aids, Direct-to-consumer (DTC)

A direct-to-consumer hearing aid can be purchased directly from the manufacturer — typically online — without the need for a prescription from a hearing healthcare professional. DTC hearing aids are intended for those with mild-to-moderate hearing loss. If you have sudden or severe hearing loss seeing a hearing health professional is the best option.

When shopping for a DTC hearing aid, choose a company that provides the following:

  • An online hearing test or ability to upload an audiogram. This will help determine if a DTC hearing aid is a good right choice.  
  • A smartphone app for easy setup and personalized programming to ensure your hearing aid supports your unique hearing profile.
  • A sufficient risk-free trial period to ensure the device meets your needs.
  • Comprehensive customer support in a format that works for our needs. Some brands offer free consultations with hearing experts.
Phonak hearing aid set up app

Sometimes DTC and OTC hearing aids are referred to as the same category; the difference is the level of regulation. OTC hearing aids are regulated as medical devices/aids for hearing loss; DTCs are regulated to a lesser degree. The Direct-to-consumer (DTC) hearing device category includes many products that simply amplify sound, including products that are not hearing aids and cannot be marketed as such, these include hearables and personal amplifiers (PSAPs).

Learn more
Buying Hearing Aids Online: Everything You Need to Know

Buying hearing aids in Washington State — Consumer Protections

Telecoil and Bluetooth Information
Your hearing aid dispenser or audiologist is required by law to tell you about Bluetooth and telecoil options for your hearing aids before you buy. These technologies can greatly enhance the value of your hearing aids by providing more ways to help you hear.

Telecoils can connect your hearing aids to assistive listening systems, like hearing loops, and to your phone. A telecoil can also connect your hearing aid to a tablet, computer or music device, using an accessory neckloop. Bluetooth wirelessly connects your hearing aids to personal devices like smartphones, laptops, and tablets.

We encourage you to get hearing aids with both of these technologies if you can.

Trial Period
Washington State law requires that you receive a contract that includes the make and model of your hearing aids, full financial terms of sale, and a trial period of at least 30 days. Your purchase becomes final in Washington State only after the trial period. Some providers allow for more time, so be sure to ask.

Use the trial period to test your hearing aids in different environments and ask for help if you need it. If you return your hearing aids during the trial period, you’re due a refund within 30 days of the return date, less any agreed-upon charges and fees in the written contract.

Filing a complaint
If you’re still not happy with your hearing aids, or you and your provider are unable to reconcile your differences, you may file a complaint online with the Washington State Department of Health.


How hearing aids work

A hearing aid is a small, battery-powered electronic device designed to help you hear better. All hearing aids amplify sound through a three-part system:

  • A microphone picks up sound around you.
  • An amplifier makes the sound louder.
  • A receiver sends these amplified sounds into your ear.

Analog hearing aids are based on old technology and are becoming less common. Analog hearing aids convert sound waves into electrical signals and then make them louder. They’re usually less expensive and have simple volume controls.

Digital hearing aids leverage newer digital technologies to convert sound waves into digital signals and then amplify them. Further, computer chips in digital hearing aids analyze information like the direction of a sound and its pitch or volume. This makes it easier to adjust the sound to what you need in different environments and many programs can adjust automatically. Digital hearing aids also offer a greater degree of customization to your specific hearing loss needs. Digital hearing aids cost more than analog models, but the results are much better. They’re also smaller and more powerful.

Hearing aid types and styles

Hearing aid design has come a long way. Today’s hearing aids are small, comfortable and discreet, and they vary in size, color, features, and how they fit in your ears. There are two basic types of hearing aids:

In-the-ear (ITE) hearing aids are worn inside the ear, and sometimes completely inside the ear canal. If you choose an ITE option, your hearing health provider will need to take an impression or scan the inside of your ear, for a personalized fit. ITE hearing aids are the perfect solution for those who want a discreet hearing aid and have mild-to-moderate hearing loss.

Behind-the-ear (BTE) hearing aids are the most widely used types of hearing aids on the market today. As the name suggests, the main body of the hearing aid sits behind the ear. A clear, discreet tube connects to an ear mold or dome and is placed inside the ear canal. BTE hearing aids are suited for mild to profound hearing loss and are available in many sizes, shapes, and color options.

Learn more
What is the best hearing aid style for me (with advantages and disadvantages to each style)
Hearing aids: How to choose the right one (includes a “Before you buy” guide)

Important hearing aid features

To choose the best hearing aids for your lifestyle, it is necessary to understand the available features. All of the features below are optional but can significantly increase and improve the usefulness of your hearing aids. The important thing is to learn how and when to use the features you’ve chosen. Your hearing health provider can help.

Telecoil Connectivity

Telecoils, or T-coils, let you take full advantage of personal and public assistive listening systems (ALS) like hearing loops and FM and IR Systems. ALS and telecoils work together to deliver sound from an audio source directly to your hearing aid. Furthermore, the enhanced audio signal extends the listening range of the hearing aid.

Telecoils are not a flashy new technology, but they are an essential feature to that can help you get the most from hearing aids. Telecoils are optional in many hearing aids and we strongly recommend them.

Learn more:
Hearing Aid Telecoils and Hearing Loops: What are They?

Bluetooth Connectivity

Bluetooth technology enables direct streaming of sound from personal devices. In other words, you can stream audio from your Bluetooth-enabled smartphone, TV, music players, computers, and tablets directly to hearing aids.

While hearing aid Bluetooth technology is rapidly evolving, there are limitations. Pairing may require an additional streaming device. Certain hearing aids may only pair with Apple or Android devices. And Bluetooth connections generally have a range of around 30 feet. Be sure to do your research so can take full advantage of this great feature.

Learn more:
Hearing Aids with Bluetooth Technology Help You Stay Connected
Best Bluetooth Hearing Aids of 2023 for Android and iOS


Different Listening Programs

Listening programs are designed to help you hear in different situations. Beyond telecoils and Bluetooth programs, other options can reduce background noise, improve telephone clarity, or eliminate feedback, while others make speech patterns easier to identify. Programs may change automatically, or you can control the settings manually on the device or using a remote control.

Hearing Aid Programs: The What, How and Why

Directional Microphones

Most hearing aids have an omnidirectional microphone — meaning sound is picked up from all around. Therefore, this microphone works best in quiet settings with little background noise. Newer models can also include directional microphones which let you focus on sounds in front of you without the distraction of background noise. A hearing aid with a directional microphone, for example, can make it easier to hold a conversation at a party or at a crowded restaurant.

Directional and omnidirectional microphones are often paired to give you the best option in different settings. Further, microphones can be managed with a manual or automatic switch based on environment and noise level. 

Learn more:
What is a Directional Microphone

Smartphone Apps

Hearing aid smartphone apps can help you easily manage your hearing aid features. You can check your battery levels, adjust volume, connect to different listening programs, and much more — all with a few clicks on your phone.

Above all, these apps can help you feel more in control and give you a greater understanding of your hearing aids. Make sure your hearing aids and phone are Bluetooth compatible; some hearing aids and their app are designed for iOS or Android phones only.

Learn more:
Hearing aid apps: What you need to know
5 of the Best Hearing Aid Apps for Your Smartphone

Ever-evolving technology

Advances in both technology and our understanding of how people hear continue to revolutionize the hearing aid industry. Even less expensive hearing aids offer some personalization, sound and speech processing, digital noise and wind noise reduction, and less feedback — those annoying high-pitched screeches, squeals and whistles. This is good news for everyone with hearing loss, but it can be hard to know what is not just the latest but also the greatest. Or what is hype and what is real. Here are some key advancements we are keeping on eye on.

Stigma-busting designs

Hearing aids are smaller, more comfortable, and less noticeable than ever before. And hearing aid manufacturers are now offering a variety of colors to match hair and skin tones, as well as flashier designs for personalized flair. These new options, combined with the popularity of earbuds and headphones, will go a long way to minimizing the perceived stigma of wearing aids.


We live in an era defined by connectivity. Our devices — smartphones, tablets, music devices, computers, even cars and smart homes — all connect via Bluetooth and wi-fi to the Internet and to each other. Hearing aid connectivity is improving, but there are still limitations. Distance, pairing, and proprietary software all impact our ability to seamlessly connect our hearing aids to other devices we use everyday and all day. The good news is that the need to connect (pair) our hearing aids to multiple devices is driving the industry to develop new hearing aids that make this easier.

Microcomputers in our ears

As digital technologies advance, microchips used in digital hearing aids will be capable of doing more and more. It will be like having computer in your ear. These chips already recognize various sounds and improve audio quality before the signals even reach your inner ear for processing and translation by your brain. Some new models are also being used to track and report physical activity and brain health.

Artificial intelligence

In premium hearing aids, artificial intelligence (AI), is being used to access a deep neural network (DNN) to process sound. By logging volume control settings and program preferences for certain sound environments, the hearing aids can begin to make these changes automatically when the environment is detected. Essentially, a DNN allows hearing aids to begin to mimic how your brain would hear a sound if your hearing wasn’t impaired.  

Customizable tinnitus relief

This technology allows you and your hearing professional to customize a soothing sound stimulus designed to help manage your tinnitus.