Philadelphia University + Thomas Jefferson University

Hearing Loss & Hearing Aids

Did you know that in the United States alone there is an estimated 36 million people with hearing loss? If left untreated, hearing loss can result in communication difficulties, which research has shown can lead to isolation, depression, increased anxiety, and other physical and emotional health problems. Determining if you are ready for a hearing aid and which hearing aid you should purchase can be a very daunting task. Educating yourself about the products, the costs, and the process of obtaining hearing aids is the best first step.

How do I know if I need a hearing aid?

There are many signs that you or a loved one may notice that could indicate difficulty hearing.  The first step in determining whether you have a hearing loss and may need a hearing aid is to have a hearing evaluation.  State law requires that you have a hearing test within 6 months before purchasing hearing aids.  If it is determined that you have hearing loss and your physician has determined that your hearing loss cannot be treated by medical or surgical intervention, hearing aids may be an option for you.   

A hearing aid evaluation lasts approximately one hour and is an opportunity for you and your audiologist to work together to determine which hearing aid is right for you.  There are certain questions that you should be sure to ask your audiologist during the initial hearing aid evaluation visit.  During this visit, realistic expectations, styles of hearing aids, features of hearing aids, cost of hearing aids, and your listening needs will be discussed.

What are the different styles & special features of hearing aids?

There are many different styles of hearing aids to choose from.  Determining which style is best for you depends on multiple factors.  These include:  type and severity of hearing loss, visual and dexterity abilities, cosmetic concerns, what features and controls are needed, and size and shape of ear.

When traditional hearing aids are not an option, there are a few special hearing aids that may be a more appropriate fit.  CROS or Bi-CROS hearing aids are used for those with single sided-deafness.  BAHA is a surgically implanted device that may be an option for people with conductive hearing loss, mixed hearing loss or single sided deafness.

Hearing aid technology has advanced enough to offer many options to hearing aid users.  By understanding your daily communication problems and the typical environments you find yourself in, your audiologist can recommend an appropriate level of technology and optional features.  These special features can help to optimize hearing in your most adverse listening situations.

What is the cost of a hearing aid?

Hearing aids cost between $2000 – $6000 to $1800 – $5900 a pair.  Medicare does not cover any costs associated with hearing aids.  Most insurance companies follow Medicare guidelines.  Some insurance companies will reimburse you directly for part of the cost of the hearing aids.  You are encouraged to call the number on the back of your insurance card to find out if you have a hearing aid benefit. 

The Jefferson Balance and Hearing Center offers a 30-day trial period with new hearing aids.  If at the end of the trial period you are not satisfied, you may apply your down-payment to another pair of hearing aids or, if you would like, you may return the hearing aids and your money will be refunded to you, minus a small fitting fee.

Follow-up Care & Office Visits

At the Jefferson Balance and Hearing Center follow-up visits are covered in the cost of the hearing aids for the duration of your warranty period.  You will have a minimum of four visits with your audiologist.  The first visit, the hearing aid evaluation, will be to assess if you would benefit from hearing aids and allows you and your audiologist to decide what is best for your lifestyle.  At your second visit, you will be fit with your hearing aid selection and you will learn how to use and care for them.  During your 30-day trial period, you will visit with your audiologist twice to check your progress and make any necessary adjustments.

If you did not purchase your hearing aids through the Jefferson Balance and Hearing Center but would like to have your hearing aids serviced, please schedule an appointment with an audiologist by calling 1-800-JEFF-NOW to discuss your options for repair or reprogramming.


Feedback is the audible “whistling” or “squealing” sound sometimes emitted from a hearing aid.  Amplified sound from a hearing aid can leak out of the ear from the area between the ear and the hearing aid or through the vent.  This already amplified sound is picked up by the hearing aid microphones and the process begins again.  The already amplified sound is amplified again on its second time through the hearing aid and the cycle continues.  This is called the feedback loop and the process can result in a squealing or whistling sound. If you should have problems with feedback, please contact your audiologist.

Other Considerations

  • Hearing Aids are not a cure for hearing loss. They can be extremely helpful in many situations, but even the best technology does not equal perfect hearing.  Your audiologist may recommend an assistive listening device (ALD) in addition to hearing aids to help in situations where a hearing aid is not enough.
  • You will need to practice understanding sounds and speech.  It typically takes individuals with a hearing loss seven years to seek help, and during that time the pathways to the brain do not get full auditory (sound) stimulation.  Your audiologist may even assign you exercises to do at home to practice.
  • Hearing aids are an investment.  You will need to treat them like the expensive electronics that they are.  They should not be stored in a warm, damp place like the bathroom or be exposed to chemicals like hair spray.  Follow the cleaning routine that your audiologist sets out for you. 
  • You will need to replace your hearing aids after some time.  Currently, hearing aids function with minimal need for repair for three to seven years, depending on the type of hearing aid.  Even with careful cleaning, parts can wear out on a hearing aid.  Often when hearing aids reach the end of this time window, the cost of repairing them is no longer practical.
  • Remember that the audiologist is your partner in better hearing.  Bringing a spouse, family member or friend to your appointment is always encouraged.

Difficulty Hearing?

  • Do you hear, but not understand, what is being said?
  • Does it sound like people are mumbling?
  • Do you have trouble hearing the television or radio, or do family members complain that the TV or radio is too loud?
  • Do you often ask people to repeat what they've said?
  • Do you have difficulty understanding what is being said on television?
  • Do you find it difficult to hear people speak or follow conversation in a noisy environment, such as a restaurant or party?
  • Do you have difficulty understanding women or children?

If you answered yes to any or all of these questions, you should have a full hearing evaluation.

Styles of Hearing Aids

Behind-the-ear (BTE) aids consist of a small plastic case worn behind the ear. The circuitry of the hearing aid is housed in this plastic case, which is connected by a clear tube to an earmold. The earmold is a custom-fit piece that delivers sound into your ear. Some advantages to this style include increased power for more severe losses, decreased whistling (feedback) in some cases and less of hearing aid damage for those with excessive earwax or drainage from the ear.

Open-fit BTE aids are similar to the traditional BTE aids in that the plastic case rests behind the ear. The main difference with this style is that instead of a custom earmold, a thin tube connects to a small dome that fits in the ear. This type of hearing aid may be appropriate for those with normal hearing at some pitches, but hearing loss at other pitches. It may allow you to utilize some of your natural, normal hearing while amplifying only those pitches where you have hearing loss. This may reduce the perception of feeling 'plugged up'.

In-the-ear (ITE) hearing aids are custom made and fit entirely in your outer ear. All of the hearing aid circuitry is contained inside this one-piece, which fills the bowl of the outer ear. While these aids can be smaller than BTEs, they can usually fit many of the features, such as volume control, directional microphones, and telecoil, to name a few. The sizes of these aids however, can limit their power output and therefore are not appropriate for severe to profound hearing loss.

Canal hearing aids are the smallest custom-fit hearing aids. In-the-canal (ITC) aids fill the entire ear canal, while completely-in-the-canal (CIC) aids are even smaller and sit further down in the canal where they are almost hidden. This style has many cosmetic advantages due to their small size. However, they may be limited to how many special features can be added due to their small size.

Hearing Aid Styles

CROS & Bi-CROS Hearing Aids

CROS hearing aid system is appropriate for a specific group of people seeking hearing aids. You may be a candidate for a CROS hearing aid system if you have hearing loss on one side that is so severe it cannot be aided by a traditional hearing aid and have normal hearing, or at most a mild high-frequency hearing loss, in the other ear.  This is usually referred to as single-sided deafness.  A CROS aid system consists of two devices, one worn on each ear.  The device on the ear with hearing loss consists of a microphone to pick up sounds from that side and a transmitter.  The transmitter wirelessly sends the signal to the device on the better, normal hearing ear.  The sounds are not amplified, they are simply sent to the better hearing ear.  It should be noted that the device on the better, normal hearing ear is typically an open fit, so that this ear is not “plugged up.” 

BICROS system is similar to a CROS system, but is for people who have severe, unaidable hearing loss in one ear and aidable hearing loss in the other ear.  BICROS aid systems are similar to a CROS system in that a device is worn on both ears.  The poorer-hearing ear wears a device with a microphone and transmitter for sending sound to the better hearing ear.  The distinguishing feature of a BICROS system is that the better hearing ear not only receives signals from the poor side, but it also amplifies those signals along with amplifying signals on the side of the better-hearing ear.  It is essentially a hearing aid that also receives signals from the poorer-hearing side.


BAHA is a surgically placed device that can be beneficial to people for whom a traditional hearing aid may not be appropriate.  Someone with single-sided deafness, a mixed hearing loss, or a conductive hearing loss may be a candidate for this type of hearing aid. 

The BAHA works by sending sound directly through the bones of the skull.  A sound processor is attached to a titanium screw that is surgically implanted in the temporal bone.  Sound is picked up by the processor which in turn sends auditory vibrations to the screw.  The sound will travel through the bones of the skull and cause vibrations of the fluids in the inner ear.  These inner ear vibrations are then transmitted via neural impulses and are perceived as sound.  This process allows sound to bypass the outer ear and middle ear, which is why this device usually works well for those with conductive hearing loss.  In the case of those with single-sided deafness, the vibrations of the skull are picked up by both inner ears (cochleas) and therefore allow sound to bypass the poorly-functioning cochlea and be picked up by the functioning cochlea.  In the case of single-sided deafness, this does not return hearing on the deaf side, instead the screw and processor are placed on the poorer-hearing side and sound is sent through bone conduction to the better hearing cochlea.  This may allow the user to listen to conversation on their poor side without turning the head.  

More information on the BAHA can be found at:

Special Features

Directional Microphones are special microphone arrays that may be helpful to individuals that have difficulty hearing speech in noise. Directional microphones work by reducing background noise and may allow the user to communicate in the presence of noise.

Telecoil (T-coil) or Auto-phone features are special hearing aid programs that work to deliver a clearer signal to the hearing aid user when using landline telephones. A t-coil may also be used to listen through some assistive listening devices (ALDs), whether at home or in public areas.

Volume Controls are manually manipulated by the user to increase or decrease the level of amplification from the hearing aids as needed.

Environmental Programs/Memories are available in some hearing aid models. These programs/memories can be tailored specifically for use in a variety of listening environments. For example, if someone frequently finds themselves in a noisy situation, their audiologist may create a program designed for use in that particular environment. Some hearing aids will require the user to manually press a button to access multiple programs, but others can make some adjustments automatically.

Bluetooth compatibility is a feature that some newer models of hearing aids are offering. This feature is applicable to electronic devices that are compatible with Bluetooth technology. Mobile phones, televisions, or personal audio devices can be paired with hearing aids to provide the user with an improved and more convenient listening experience.

Hearing Aid Evaluation

A hearing aid evaluation is a no-charge, informational session with an audiologist.  The goal of this session is to determine what hearing aids may be appropriate for you and your hearing loss.  It is approximately an hour long session and will address most, if not all, of the following:

  • Educating you on your hearing loss and what that means for the use of hearing aids.
  • Discussing the situations in which you have difficulty hearing.  Do you have more difficulty with certain people? Certain environmental sounds?  Certain places? 
  • Styles of hearing aids and the pros and cons of each for your particular hearing loss.
  • Levels of technology and the features available on the hearing aids.  This goes hand-in-hand with talking about your lifestyle and how you typically spend your day.  By learning what sort of sound environments you encounter, the audiologist can make a better recommendation for hearing aid levels and features. 
  • Cost of hearing aids, what this cost includes, and the payment process.

There may be an opportunity to have a pair of hearing aids demonstrated on you in the office.  This excludes any custom hearing aids and is completely dependent on what hearing aids are in stock in the office.  If you choose to order a model that requires a custom fit, an impression of your ear will be taken on this visit.     

Hearing Aid Delivery

Approximately two weeks after you order your hearing aids, you will return for a hearing aid delivery.  This is approximately a one hour appointment where the following will occur:

  • The hearing aid is attached to the office computer and your audiologist will fine- tune the sound of the hearing aids based on your perception of how the aids sound.
  • You will learn how to insert the hearing aids and remove them from your ears.
  • You will learn how to change the battery, how often it should be changed, what kind of batteries you will need, and where to get them.
  • You will learn how to clean and care for the hearing aids. 
  • The audiologist will answer any of your questions and make sure that you are comfortable going home with the hearing aids for the first time.