Prescription hearing aids come in between two and five different technology levels, ranging from the top-tier premium offering to the bottom-tier basic offering. This classification has nothing to do with what a hearing aid looks like or what style it is. Instead, it's all about the technology inside the device.

Premium hearing aid levels come with all the newest and best features intended to optimise your hearing performance. However, they also come with a higher price tag. On the other hand, basic-level hearing aid offerings are limited when it comes to features and the ability to customise, but they are also typically less expensive.

The question that arises then is whether a higher level of hearing aid technology actually results in better hearing performance.

The late Dr. Robin Cox and her team set out to explore this question in their 2016 study titled "Impact of Hearing Aid Technology on Outcomes in Daily Life One: The Patient's Perspective". The objective of this study was to explore self-reported differences in hearing ability among adults comparing premium technology to basic technology.

While premium hearing aid technology is capable of outperforming basic technology in a laboratory setting, there is not a whole lot of research data out there that shows if premium is better than basic in a real-world situation. This single-blind study had 45 participants, all around the age of 70, with adult-onset mild to moderate hearing loss.

Each participant trialled two different brands of hearing aids, their premium option as well as their basic level option. The study was counterbalanced, so each participant trialled different devices at different intervals. In total, each participant actually trialled four different sets of devices.

Each participant trialled two different brands of hearing aids, their premium option as well as their basic level option. The study was counterbalanced, so each participant trialled different devices at different intervals. In total, each participant actually trialled four different sets of devices.

Link to the study

At Liverpool Hearing Centre, we offer a range of hearing aids from top brands like Phonak, Unitron, GN Resound, Signia, Widex, and Starkey. Each of these brands offers hearing aids at various technology levels, allowing you to choose the one that best suits your needs and budget.

The study followed foundational best practices when fitting and programming the hearing aids, including performing real-ear measurements, adjusting programming based on perception, providing counselling, and making follow-up adjustments. Participants were surveyed based on quality of life improvements, comparing each set of hearing aids to not using hearing aids at all. They were also asked to rate speech clarity, noise bother, wearing the devices when needed, listening fatigue, sound comfort, and localization ability on a scale of 1 to 10, with 10 being the highest.

At the completion of each of the brand trials, every participant was asked which pair of devices they felt were better. They did not know at the time which pair of devices were the premium devices and which ones were the basic devices. When all of the four one-month trials testing each of these sets of devices were completed, each participant was asked to rate each device on a scale between 1 and 10, with 10 being the best and 1 being the worst.

The study concluded that both premium and basic-level hearing aids provided a significant amount of benefit compared to not using hearing aids at all. However, they found no statistically significant differences in perceived improvement using premium versus basic technology. They also found that some participants preferred the premium-level technology and some participants preferred the basic-level technology. The biggest influence on this was which set of hearing aids they tried second, possibly meaning that the hearing aid experience that was most fresh in their minds was the main deciding factor.

This might seem surprising. How is it even possible that premium-level technology did not consistently beat out basic-level technology? There are at least three different theories that may explain this.

1. Premium features in a laboratory setting may not translate into real-world benefits: Just because premium hearing aid technology can consistently beat out basic technology in a laboratory setting does not mean that that improvement translates into the real world. The real world is chaotic, and no matter how well engineers try to recreate a real-world setting inside a laboratory, it is never going to be identical.

2. The tests may not have been sensitive enough: The tests used to evaluate perceived differences may not have been sensitive enough to identify statistically significant differences between premium and basic technology levels, or they may not have been appropriate to do a direct comparison of technology levels.

3. Possible flaws in the study: This study may have had some flaws that led to this outcome.

At Liverpool Hearing Centre, we understand that choosing a hearing aid can be a complex process. That's why we offer a range of services, from hearing tests to earwax removal, to ensure you get the hearing aid that best suits your needs. We personally believe that it takes a period of time for the brain to adapt to the ways that particular brands of hearing aids amplify sounds. This is why the second hearing aid may have more consistently performed better following the period of adjustment to the first trialled hearing aid.

Let's delve deeper into the theories that might explain why premium-level technology did not consistently beat out basic level technology in Dr. Cox's study.

Premium Features May Not Translate into Real-World Benefits: Just because premium hearing aid technology can consistently beat out basic technology in a laboratory setting does not mean that that improvement translates into the real world. The real world is chaotic, and no matter how well engineers try to recreate a real-world setting inside a laboratory, it is never going to be identical.

The Tests May Not Have Been Sensitive Enough: The tests used to evaluate perceived differences may not have been sensitive enough to identify statistically significant differences between premium and basic technology levels, or they may not have been appropriate to do a direct comparison of technology levels.

Possible Flaws in the Study: Every research study ever conducted has had some potential for flaws and bias. For instance, in this study, the researchers accidentally mixed up the manual program order for 16 of the 45 test subjects. While this doesn't seem like a big deal, who knows what other mistakes they could have made that went unidentified? Despite these potential flaws, the study was peer-reviewed and is considered valid. However, it would have been beneficial to see different age ranges and different severities of hearing loss included in the study to generalise the information to the rest of the population of individuals who have hearing loss.

My recommendation is the same for everyone: you should be going with the highest level of technology that you can reasonably afford. And if you cannot afford it, you should be dropping down to a technology level that you can afford. Then, it is the job of your hearing care professional to optimise the performance of those devices. If you're the type of person who wants to make sure that your hearing care professional has all the features and customisations they could ever want to optimise the performance of your hearing aids, then go with the highest level of technology. But even if you cannot afford premium-level hearing aid technology, you should still feel comfortable going with a lower level of technology, as long as your hearing care professional is going to spend the time to optimise those devices and give you the time to explain the differences.