Are you dealing with hearing loss, and considering whether you need hearing aids? It’s a topic that makes many people hesitant and anxious—and that explains why the average person with hearing loss waits 4-7 years before they seek help. Whether it’s hesitancy to admit your hearing is declining, self-consciousness about what others will think, worries about the cost or doubts that they’ll really make a difference, your concerns are understandable.
With all that in mind, we want to give you straightforward information that addresses your worries and questions, so that you can make a smart decision for your hearing health. That includes clarifications about realistic expectations of what hearing aids can do for you—and what they can’t. We chatted with our chief of audiology, Dr. Thomas Tedeschi, Au.D., to get the truth about hearing aids—including insights on how hearing works, what it means to experience hearing loss and the benefits of hearing aids. He also debunked some myths about hearing aids to help you understand the big picture of what you can expect from these devices.
To understand how hearing aids work, we need to start with the basics: How does hearing work?
When you hear a noise or a person’s voice, sound waves are channeled into the pinna (the cup-shaped exterior of your ear) and enter the ear canal. The waves then hit the eardrum, causing a vibration that sets the three small bones (the malleus, the incus and the stapes, collectively known as the ossicles) in the middle ear into motion. The energy of this vibration travels into the fluid-filled cochlea. This snail-shaped chamber is lined with tiny hair cells, which act as sensors that transform the vibrations into electrical energy. This electrical signal then goes up to the brain via the auditory nerve, and the brain interprets what we hear.
“So, we really hear with our brain as the interpretation center,” Dr. Tedeschi says. “The cochlea and all the other [elements] are just your transmission line to get to the brain.” All in all, it’s an amazingly complex process that takes place in a split second, but also happens continually as you go through your day.
So, where does hearing loss fit into the hearing process? Hearing loss is caused by a blockage or damage to the “transmission line,” resulting in sensorineural hearing loss, conductive hearing loss, or a combination of the two, also known as mixed hearing loss.
Still curious? Check out our video, which explores the science behind hearing loss.
Now that you know how hearing works and what causes hearing loss, let’s dig into how hearing aids can help with hearing loss and what their limitations are.
Hearing aids are a common treatment for hearing loss, since, when used correctly, they are one of the few things that can help improve a person’s ability to hear.
Dr. Tedeschi notes that hearing loss has two dimensions. “We have the hearing, which is the sound itself, and we have the understanding of speech. Speech understanding takes place in the brain and hearing takes place along the ‘transmission line’ to the brain.” If hearing loss goes untreated over a period of time, speech understanding can be affected as well. So, what hearing aids can do, when worn consistently, over time, is improve that understanding ability.
But how do hearing aids work to make that happen? They help deliver sound signals more effectively, magnifying sound vibrations entering the ear. Remaining hair cells in the cochlea can detect these more significant vibrations and send the signal to the brain.
While hearing aids can improve your ability to hear the world around you, they don’t cure hearing loss. That’s why, when a person removes their hearing aids at the end of the day, their hearing hasn’t actually gotten better.
“When we have damage to the ‘transmission line,’ we cannot replace or correct it,” Dr. Tedeschi says. “But what we can do is help that signal get to the brain.
“The brain is very plastic, and it can learn. We're not regenerating anything in the brain, but we're helping the brain to be able to [interpret] that signal [more clearly] and thus be able to help us hear better,” he says. “I always tell people, it's just what the name implies: We call it a hearing aid. It's a device to aid us in hearing.”
Dr. Tedeschi says he always reminds his patients that hearing aids will not give a person perfect hearing. “Don’t think that you’re going to become James Bond and that you’ll hear everything across the room or pick up 100% of what is said.” After all, even those without hearing loss don’t hear everything. However, hearing aids can make an enormous difference. “It’s going to change your life. But don’t expect it to be the panacea for everything,” he says.
It’s important to have clear expectations when using hearing aids for the first time. Know that adapting and adjusting to hearing aids and the new way things sound takes time—so don’t be discouraged if you don’t like how things sound at first. You’ll likely need your hearing care professional (HCP) to make adjustments to your hearing aids along the way.
“It’s a process,” Dr. Tedeschi says. “When you start to wear hearing aids, everything is loud. As you start to wear them all the time, the brain quickly adapts and … starts to hear, and then you start to understand more clearly. You start to understand what's going on and you have fewer requests for people to repeat things … It becomes very natural for you.”
When you wear your hearing aids all the time, your speech understanding improves and voices sound clearer. “It becomes a much more natural way of listening and hearing. But if you keep taking them on and off or only wearing them periodically, you never get used to that and the brain never has that opportunity to adapt,” Dr. Tedeschi adds.
Which brings us to our next point...
“Your brain never adapts to [hearing with hearing aids] if you don't wear them all the time,” Dr. Tedeschi says, noting how the brain has to undergo a learning curve to adjust to hearing aids. “Our brain is accustomed to hearing normally. We want to keep the brain as healthy as possible for hearing and understanding speech. What happens is, when we wear hearing aids only periodically, the brain does not adjust.”
Some people take their hearing aids out when they’re home, especially if they live alone, thinking they don’t need the hearing aids if they aren’t in a situation that demands conversation. However, Dr. Tedeschi notes that in doing this, you’re missing out on everyday noises (birds chirping, the phone or doorbell ringing, your car’s turn signal) and even cues that can alert you to danger (smoke alarms, tornado sirens, etc.).
If you live with a spouse or family member, it can cause a lot of frustration if you only wear hearing aids occasionally. You may even find yourself withdrawing socially, because you aren’t used to your hearing aids and still struggle to hear in social situations.
“When we only wear our hearing aids periodically … it becomes ‘When do I determine when I put those hearing aids in and when I don't?’” Dr. Tedeschi adds. “People start to avoid crowds, they avoid get-togethers with family, and they start to become more reclusive or they become more socially isolated. By wearing your hearing aids all the time, then you become used to hearing and you do not avoid those situations.”
The adjustment to hearing aids takes time, and wearing them all day, every day will speed up the process. If you’re concerned that your hearing aids aren’t effective in certain situations, talk with your HCP.
Hearing aids are designed to help many types of hearing loss, and their advanced technology can be adapted to the differences in each person’s hearing (e.g. high-frequency vs. low-frequency hearing loss, or sensorineural vs. mixed hearing loss).
Your HCP will conduct a hearing test to identify your specific hearing challenges. The resulting audiogram will visualize what ranges and tones you can hear well and which ones you struggle with. HCPs then specially program hearing aids to fill in the decibel ranges and pitches that you can’t hear on your own.
“Today's hearing aids are technological wonders,” Dr. Tedeschi says. “We can frequency-shape the output of the hearing aid to match your hearing loss.” This is called frequency-specific amplification. Additional signal-processing technologies allow more refinements, like making loud sounds softer and softer sounds louder, so that all sounds are within your unique “dynamic range” of hearing. But programming is not a “one-and-done” situation.
“As your hearing changes over years, your hearing aids can be reprogrammed to match,” Dr. Tedeschi adds. “They're completely flexible in matching your hearing loss not only today, but what your hearing may be in the future.”
While hearing aids and cochlear implants both help people with impaired hearing, they aren’t interchangeable. Hearing aids are generally for people who have mild to severe hearing loss, while cochlear implants are for individuals who have severe to severely profound hearing loss, including those who are deaf. These implantable devices bring hearing loss back to a mild-to-moderate hearing loss level.
Dr. Tedeschi notes that cochlear implant technology has greatly improved, even in the past decade. “We now have implants that can amplify more frequencies than in the past,” he says. Historically, cochlear implants were just for children, but today they’re a treatment option for any age.
A cochlear implant is a surgically implantable device with an external processor. The external microphone and speech processor is worn behind the ear—similar to a behind-the-ear hearing aid—along with a transmitter that sits above the ear, attached to the skull. The internal device involves a receiver and stimulator that’s implanted beneath the skin; together with the transmitter, this part of the device receives signals from the speech processor, transmitting them into electrical signals. These signals travel along an electrode that is threaded into the cochlea, where a number of nodes stimulate the auditory nerve and send signals to the brain.
Together, all the parts of this device bypass the damaged part of the ear—whether that’s the eardrum, ossicles and/or damaged hair cells in the cochlea—sending an electrical sound signal through the auditory nerve, directly to the brain.
A surgeon, typically an otologist, would implant the device, while an audiologist would tune the device to the individual’s hearing loss and work with them to get the best result. Like hearing aids, there is an adjustment period after getting a cochlear implant, and it typically requires working with a speech-language pathologist alongside your audiologist.
Today’s hearing aids have advanced features that help the wearer adapt to a wide variety of noise environments. Dr. Tedeschi highlights some of the most popular hearing aid technology that can be personalized to your lifestyle and hearing needs.
Hearing aids can be programmed to match your specific hearing loss frequency—meaning the hearing aids will automatically amplify the parts of the hearing range that you struggle with.
“As we have hearing loss at different frequencies, we can program the hearing aids so that each frequency gets a different amount of amplification, so that we can mirror with the hearing aids what you have lost,” Dr. Tedeschi says.
You need different hearing aid settings in different environments. That’s why Miracle-Ear hearing aids allow you to create up to four presets for your most-used environments.
Using a smartphone app, “I can program my hearing aids so that, whenever I go into this specific place … my hearing aid will change its configuration to help me hear the clearest in that situation,” Dr. Tedeschi says. “I can just pull my phone out and hit, say, the restaurant setting on my phone, and the app will change my hearing aid configuration to allow me to hear much better in a restaurant.”
Many hearing aids are now equipped with Bluetooth technology—which allows you to stream sound directly into your ears from your phone, TV, laptop or other Bluetooth-enabled devices. You can answer your cell phone with the sound coming directly into your ears rather than holding a phone to your ear and getting feedback or poor sound quality.
“It gives you a much clearer signal because now you're hearing the telephone with the proper amplification and signal processing for your hearing loss,” Dr. Tedeschi says.
It’s important to understand that hearing aids are different from sound amplifiers, or personal sound amplification products (PSAPs). A PSAP simply amplifies all sounds equally (for example, both the person you’re having dinner with at a restaurant and all the ambient noise at the restaurant).
“For a person with hearing loss, that becomes worse because they cannot separate the speech,” Dr. Tedeschi says. “A lot of times the noise is louder than the speech, so it gets drowned out.”
When comparing hearing aids vs. amplifiers, some people turn to PSAPs as a lower-cost alternative. But they simply aren’t designed to improve your hearing and speech understanding the way hearing aids are.
While a hearing aid’s main purpose is to help you hear more clearly, using these devices can have a positive effect on other aspects of your physiological and psychological health as well.
Hearing loss can have a surprising effect on your physical health and longevity. A study out of Johns Hopkins University found that people experiencing hearing loss who don’t use hearing aids, and who have other comorbidities such as heart disease, diabetes, etc., have an increased risk of dementia. However, by using hearing aids, the risk of dementia is reduced.
Another recent study published in January 2024 shows that people with hearing loss who choose not to wear hearing aids have a higher mortality rate than people with hearing loss who wear hearing aids.
Not only that, but ongoing research shows that untreated hearing loss can result in increased risk of physical frailty and falls.
Psychologically, untreated hearing loss is connected to increased risk of depression, social isolation and cognitive decline. Dr. Tedeschi notes how important it is for your mental health to be able to communicate with others. Hearing loss can take away social opportunities and confidence—but hearing aids can turn this around.
When using hearing aids, he says, “You become more personable, you become more in-tune to what’s going on in the world around you and you become more psychologically active.”
It can also affect your upward mobility at your job, if you’re still in the workforce. “One of the things we’re seeing is that people who have hearing loss in the workforce, who choose not to wear hearing aids, have lower promotion rates, lower income averages than those who wear hearing aids,” Dr. Tedeschi says.
Hearing aids are designed to improve your hearing when worn regularly—but they can’t reverse hearing loss or solve health issues. And, unfortunately, hearing aids aren’t a good fit for all types of hearing loss. For those with profound to severely profound hearing loss, hearing aids simply aren’t the right tool. In that situation, it’s best to talk with an audiologist to see if you’d be a good candidate for a cochlear implant.
If you’re ready to purchase your first pair of hearing aids or upgrade your current pair, head to your local Miracle-Ear hearing aid center.
Our certified hearing care professionals (HCPs) will conduct a hearing test to measure your level of hearing loss, then fit you with the hearing aids that are best suited to your hearing and lifestyle needs. They can also talk you through hearing aid cost and payment options. Ready to get started? Book your hearing appointment today.
And before you go, check out our tips for communicating with your HCP.
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