In a nutshell: Buy the over-the-counter or prescription hearing aids offering the most control and connectivity features you can afford.
By Stephen O. Frazier
Credit: @mark0polo/Unsplash
I’m not a hearing care professional but, at age nearly 90 and as a longtime hearing aid wearer, I have learned a bit about buying them. For one thing, cars and hearing aids have a lot in common. I’ve bought quite a few of each.
Hearing aids, like cars, come in many brands and models, and some will meet your needs much better than others. There are a lot of very conscientious hearing care providers out there ready to sell you those hearing aids, but another lesson I learned is that like car salesmen, a hearing aid seller’s primary concern is to make a sale. So, buyer beware.
For many years, to get hearing aids you had to see a trained, licensed professional to buy the devices. It could be an audiologist or hearing aid dispenser (also called a hearing instrument specialist, or HIS). You would undergo an ear exam and then a hearing test. If the test indicated you had a hearing loss, you could then buy a pair of hearing aids.
Nowadays—if you are an adult and you think you have a mild to moderate hearing loss—you can pick up a pair of over-the-counter (OTC) hearing aids that meet strict Food and Drug Administration standards at a nearby drugstore or other store like Staples. No appointment, no hearing test, no waiting.
So, which should you do? Audiologist? Hearing aid dispenser? Nearby store?
Audiologist or Dispenser?
Most audiologists today hold a doctoral degree, but some old-timers may have only a master's degree and years of experience. An HIS must have a high school diploma or its equivalent.
In my experience both audiologists and dispensers have the training to test hearing, fit and adjust hearing aids, and recognize common conditions such as wax buildup. But only audiologists have been trained and allowed to deal with more serious conditions. So, when something even more serious is suspected, dispensers know they need to refer clients to an audiologist or an ENT (ear, nose, and throat doctor, or otolaryngologist).
I've been treated by both groups of professionals. For me, some dispensers have fitted and adjusted my hearing aids better than some audiologists. I have found that skill varies by individual, not by title.
When choosing a provider, proximity is another factor. Choose an office that is reasonably easy for you to get to because there may be a series of follow-up visits to optimize your hearing aids for your specific hearing ability.
And to the layperson, it may seem like some offices specialize in only a few hearing aid brands, narrowing your choices. Truthfully, though, there are only five major prescription hearing aid manufacturers, who have diversified their brands by features and price points.
You Need a Hearing Test
While you can buy OTC hearing aids without a test, or use free online screening tools, I strongly recommend a comprehensive, in-person exam. A professional evaluation includes a physical inspection of your ears to catch hidden medical issues.
These exams are often covered by insurance, and many retail chains (like Costco or Miracle-Ear) even offer them for free. Plus, you are under no obligation to purchase devices from the person who tests you. You can always take your results and shop around for a provider you prefer.
Your test results will determine which pathway is right for your level of hearing loss:
Mild to moderate: You have a choice of either OTCs, whose prices range from under $100 to over $2,000 per pair, which is roughly where prescription pricing begins.
If you do qualify for OTC devices, keeping a budget in mind is important, but remember that cost directly correlates to capability. As OTC prices increase, so do their available features.
And even with mild to moderate loss, prescription models are often worth the investment. OTC aids are largely “one setting fits all” with very limited customization.
By contrast, prescription devices can be precisely programmed by an audiologist to match your specific hearing loss pattern and differing hearing environment needs. They also offer advanced features rarely found in OTC models, such as superior noise-filtering in crowded rooms and direct connectivity to assistive listening systems.
Moderately severe to severe: You will need prescription hearing aids. OTC devices simply lack the amplification power and advanced functionality required to meet severe hearing needs.
Your Provider Should Ask These Questions
Your first or second visit should include a review of your lifestyle and a clear explanation of the features available in modern hearing aids.
This would include a discussion of the various shapes and sizes of hearing aids, and which would best meet your needs.
And if telecoils and Auracast are not discussed, you are not being fully informed—consider seeing someone else.
A Reality Check About Hearing Aids
Hearing aids amplify sound, but they do not restore hearing the way glasses restore vision. Most hearing aid microphones are effective only within 8 to 10 feet. Sounds from farther away may be faint or inaudible for hearing aid wearers, while people with typical hearing will still hear and understand them.
Hearing aids come in many styles and technologies, and choosing the right one matters. Understanding your requirements, lifestyle, listening environments, hearing care options, and budget will help you make the best choice. Here, again, a trained hearing care provider can help you find the right device for your lifestyle.
With OTCs, you may let vanity cause you to buy tiny, in-the-canal aids where larger (and yes more visible) aids would better serve what you need.
The “Best” Hearing Aids
Again, like cars, hearing aids are made by many companies. Each company's devices can have features in common and features exclusive to them. There is no “best” hearing aid—the best is the one that has the most features you want and need at a price you can afford.
There are, however, some features that should be standard in all hearing aids, both prescription and OTC. Telecoils, Bluetooth, and Auracast capability are all on my “must have” list.
Over the past two decades thousands of performing arts venues, lecture and meeting rooms, places of worship, legislative chambers, etc. have installed assistive listening systems called hearing loops. Hearing aids with telecoils will connect to an audio signal broadcast by that loop.
Auracast provides the same sort of service to hearing aids enabled to receive its signal. Over the next few years, it's expected venues like sports stadiums, public transportation terminals, and public transportation itself (trains, planes, buses, subway cars) will all broadcast announcements via Auracast.
My Musts When Buying Hearing Aids
So to review, here are my musts when buying hearing aids:
See a hearing care professional for an ear exam and a hearing test, then buy OTC or prescription devices there or elsewhere.
Buy only devices with a guaranteed trial period and return policy.
Buy the OTC or prescription hearing aids offering the most control and connectivity features you can afford.
Insist on telecoils, Bluetooth, and Auracast-enabled or “-ready.”
Join a support group (a local chapter of the Hearing Loss Association of America, Association of Late-Deafened Adults, or the Say What Club) to learn about living with hearing loss from experienced hearing aid wearers.
Wear your hearing aids all day, every day. Not doing so will make you always uncomfortable when using the devices—and besides, the more your brain can access and process every sound, the better.
Some final thoughts: The Centers for Disease Control and Prevention/National Center for Health Statistics reports that at least 85 percent of Americans with measurable hearing loss are under the age of 65 and 35 percent of them also wear hearing aids. So, think about that if you’re thinking about age and stigma.
Speaking of which, according to a 2024 International Journal of Audiology paper, while hearing care providers seem to focus on hearing aid appearance for their patients, the patients seem to be more affected by the perceived stigma of hearing loss itself. This offers an opportunity for hearing care professionals to help patients navigate living with hearing loss more broadly versus focusing just on the hearing aids.
Hearing Health staff writer Stephen O. Frazier was trained as a hearing loss support specialist by the Hearing Loss Association of America. Having devoted the past 25 years to advocacy for people with hearing loss, he has facilitated the passage of numerous regulations in New Mexico, where he lives, that strengthen protection and services for people with hearing loss. Frazier has presented workshops on hearing loss and assistive technology at the local and national level and has also written extensively on various topics related to hearing loss and assistive technology. For more, see sofnabq.com and loopnm.com/Auracast.html, which covers the latest about Auracast technology.
The Latest Blog Posts
While you can buy OTC hearing aids without a test, or use free online screening tools, I strongly recommend a comprehensive, in-person exam. A professional evaluation includes a physical inspection of your ears to catch hidden medical issues.