Do Hearing Aids Cause Additional Hearing Loss or Protect It

Multiple times a month, a patient will ask me if wearing their hearing aids will cause additional hearing loss. It is actually a very logical question since hearing aids make sounds louder and loud sounds do cause hearing loss. So let’s take a deep look at this question.

So do hearing aids cause additional hearing loss? Professionally fit hearing aids do not cause additional hearing loss because there are settings on the hearing aids that prevent this. Hearing aids amplify soft sounds to make them audible but do not amplify already loud sounds. Thus, ensuring that everyday sounds will not be loud enough to cause additional hearing loss.

However, it is worth noting that although hearing aids do not cause additional hearing loss, they also do not protect your ears from loud noise exposure either. Let’s take a gunshot noise as an example. If you wore your hearing aids and fired a shot, the hearing aids would not amplify the gunshot but it also wouldn’t reduce the gunshot noise. Each hearing aid has a vent in it that would allow this noise to pass to your eardrum and not provide you any protection from the very loud noise.

To further dig a little deeper into this question, I will also state that wearing hearing aids does protect your word understanding ability which is the most important ability you have for understanding communication. Let me explain each of these topics in greater detail.

How Do Audiologists Ensure Hearing Aids Will Not Cause Additional Hearing Loss?

When you get fit with hearing aids the audiologist will typically do a series of specific tests on the hearing aids to ensure that they do not reach a level of discomfort and have proper amplification. 

Hearing aid settings are based on a prescription obtained from the hearing test. The testing of the hearing aids is called real ear measurements.

One of the sub-tests that are run is called maximum power output and is commonly referred to as M.P.O. This test is completed by placing a small, thin tube deep inside of your ear canal about 4-5 mm away from your eardrum and then placing the hearing aid in the ear canal as well. The probe tube acts as a microphone so the audiologist knows precisely the amount of sound hitting your eardrum.

hearing aid real ear measurement

The picture above is a typical result that the audiologist would be looking at. The * symbol at the top represents the threshold of pain and the light blue line represents a series of very loud beeps played at 85dB. Above this input level, the hearing aids will not amplify sound. The audiologist will run this test to make sure that the hearing aids will not acoustically hurt your ears.

Please note: you should still not wear hearing aids when you should be wearing hearing protection.

What About Hearing Aids Not Fit By An Audiologist

Having this test done is an advantage of using professionally fit hearing aids. Hearing aids sold online that are called over-the-counter hearing aids, do not get programmed by an audiologist, and therefore this testing is not completed. However, substantial research is done by hearing aid manufacturers on many people to ensure that the hearing aids will not get loud enough to cause additional hearing loss. 

The FDA actually regulates these over-the-counter hearing aids and they are designed specifically for mild-to-moderate hearing losses so that there will be no potential to cause damage to the human auditory system even if the hearing aid is at its loudest setting.

On the other hand, PSAPs, which are personal sound amplification products, are not considered medical devices and therefore not really regulated. Often, these devices look very similar to hearing aids but are sold very cheaply.

These devices may or may not have the same research done by the manufacturer to ensure they do not get loud enough to cause hearing loss. This website does a whole lot of reviews of these over-the-counter hearing aid products as well as less expensive PSAP products with the intention to help you give you the most complete information to help you pick out the best one for your situation. 

Hearing Aids Do Not Protect from Loud Noise Exposure

As I said before, hearing aids do NOT place additional amplification on the loud noise, but it also doesn’t stop noise from being loud enough to cause you additional hearing loss.

It is true that a hearing aid receiver maxes out at a certain volume and cannot physically get louder, however, the seal of the hearing aid in your ear is not great enough. The results are that sound goes around and through the hearing aid and can result in hearing loss. 

Hearing aids actually have a hole going straight through them called a vent that allows intense and loud sounds to travel through. It is not safe to believe that hearing aids are a form of hearing protection.

This often comes up when people want to wear their hearing aids hunting and believe they can because they see active noise reduction products advertised on the market, some of which actually include amplification.

But there is a lot more noise than just hunting.

Things like loud power tools, noisy farm equipment, or even a loud lawn mower can cause additional hearing loss. The solid rule to follow is: if you should wear hearing protection for any activity then do it by pulling out your hearing aids and putting in earplugs or wearing ear muffs. 

Hearing Aids Protect Word Understanding Ability

When you have hearing loss and you do not wear hearing aids, you lose your ability to understand words. This has been a very widely researched topic for the last 30 years and it is called auditory deprivation.

What the term/condition means is that a person who suffers from hearing loss and elects not to wear hearing aids, over time, will lose the ability or skills for speech understanding.

This disorder can affect you if do not wear properly fit hearing aids, wear old hearing aids that are not loud enough, or choose to only wear one hearing aid (called monoaural fit) when two aids are actually needed.

Even someone who has mild asymmetrical hearing loss can be affected.

Often patients have one good ear and one bad ear and choose to not spend the money on a hearing aid because they believe that they do sufficiently with just using their good ear. If hearing loss is not treated (i.e. you do not wear both hearing aids when needed), auditory deprivation can cause an irreversible permanent loss of functionality in relation to speech understanding.

The research does not suggest that the hearing level changes (meaning you will still hear the beeps at the same level) but it suggests that your brain will not be able to process the sounds and understand words from those sounds. This is a brain issue and not an inner ear issue.

Essentially, when your brain does not get stimulated by the auditory system, those brain cells get weak from not being used. The weaker they become, the less they understand a complex signal such as speech and become hopeless when that speech is in a background noise situation such as a restaurant. 

The bottom line of this point is to wear well-functioning hearing aids if you have any hearing loss. 

Related Questions

Do hearing aids prevent future hearing loss from occurring?

Hearing aids do not protect your inner ear from further damage. While hearing loss can be caused by various factors such as aging, genetics, loud noise exposure, ototoxic medications, insufficient blood supply, and others, hearing aids do not prevent future hearing loss.

Will my hearing loss continue to get worse over time?

It is impossible to predict if your sensorineural hearing loss, which is the most common type, will worsen over time. However, in general, hearing loss tends to increase with age. Therefore, it is safe to assume that your hearing loss will either remain stable or worsen over time, but it is highly unlikely to improve.

Can I wear both hearing protection ear muffs and hearing aids under the muffs at the same time?

It is not recommended to wear both hearing protection ear muffs and hearing aids simultaneously. Ear muffs are designed to reduce the amount of sound you hear, while hearing aids amplify sound. Wearing both can result in the hearing aids picking up the reduced sound and amplifying it again, potentially causing feedback and squealing. Therefore, it is advised not to attempt wearing hearing protection and hearing aids simultaneously.

Jonathan Javid Au.D.

Jonathan Javid Au.D., a seasoned audiologist with an extensive background in the field of audiology. With over 11 years of invaluable clinical experience, Jonathan has dedicated his career to helping individuals enhance their hearing and improve their quality of life.

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