Hearing Aids

We are able to evaluate and repair any make and model of hearing aid and can provide each patient with objective information about the performance of their hearing aids, regardless of where the hearing aids were purchased. We have access to the latest digital hearing aid technology from a variety of hearing aid manufacturers. If it is determined that you potentially could benefit from amplification, our audiologist will discuss hearing aid options during a hearing aid consultation.

We understand every hearing loss is different and that your listening needs are unique , so we ensure that our hearing aids come in a variety of levels of technology, sizes, colors and styles, and features according to your preference and needs. During the course of your consultation, our specialists will assist you in selecting the best quality hearing aid for your particular listening needs and lifestyle requirements.

Hearing aids can be expensive and may be difficult to afford for many individuals. With this reason, it’s important that we deliver the most helpful health care options to enable equal opportunities for each and every patient. Prior to the hearing aid fitting, our medical support assistants will verify any hearing aid benefits offered by your health insurance provider(s). In addition, we offer zero-interest payment plans on all hearing aids. 

Hearing Impairment

There are three categories of hearing loss:

  • Conductive
  • Sensorineural
  • A combination of conductive and sensorineural, which is known as a mixed hearing loss.

Normally, sounds are collected by the external ear and directed into the ear canal. These sound waves travel through the ear canal and vibrate the tympanic membrane or eardrum.  The vibrations of sound are then passed along the 3 bones in the middle ear:

  • Hammer (malleus)
  • Anvil (incus)
  • Stirrup (stapes)

A conductive hearing loss results when something blocks the passage of sounds through the ear canal, when the tympanic membrane is perforated or does not vibrate correctly, or when there is a problem with the way the three bones in the middle ear vibrate.

Conductive Hearing Loss

Common causes of conductive hearing loss include:

  • Excessive build-up of wax in the ear canal
  • Foreign objects lodged in the ear canal
  • Infection or fluid in the middle ear space
  • Head trauma resulting in a disarticulation of the bones in the middle ear
  • Otosclerosis or abnormal growth of bone in the middle ear
  • Cholesteatoma or tumor in the middle ear

Sensorineural Hearing Loss

The inner ear or cochlea is a tiny, fluid-filled structure hidden deep in the mastoid bone of the skull. The cochlea's function is to change the vibrations of sound into a neural impulse that can then travel up the acoustic nerve to the brain. Damage to the structures of the inner ear, such as the hair cells or nerve fibers that connect to these hair cells can result in sensorineural hearing loss. The most common type of sensorineural hearing loss is known as presbycusis and is due to the effects of the aging process.

Other potential causes of sensorineural hearing loss include:

  • Exposure to loud sounds such as firearms, machinery, and loud music
  • Meniere's disease
  • Drugs or medications that are ototoxic (or harmful to hearing)
  • Viral inner ear infection
  • Disruption of blood flow to the cochlea
  • Viral infections
  • Head trauma
  • Acoustic neuroma or a tumor growing on the auditory and vestibular nerves
  • Congenital hearing loss

Mixed Hearing Loss

A combination of a sensorineural hearing loss and a conductive loss is called a mixed hearing loss.  For example, an individual with a long-standing sensorineural hearing loss may acquire an ear infection resulting in a mixed hearing loss. In this example, the conductive component may be improved with medication or surgery, but the sensorineural hearing loss will remain.

Do I need to see an Ear, Nose and Throat (ENT) physician before purchasing a hearing aid?

For our adult patients, it is strongly recommended that you see an ENT physician as part of the evaluation of hearing loss, and before being fitted for hearing aids.  If your hearing evaluation reveals the need to see an ENT physician, our audiologists will refer you to the appropriate physician with the Department of Otolaryngology-Head and Neck Surgery. Every child fitted with hearing aids at the UNC Medical Center will first be evaluated by a physician within the Department of Otolaryngology-Head and Neck Surgery.

Are hearing aids covered by my health insurance plan?
Some insurance plans do help pay for hearing aids. 

Because every health insurance plan is different, it is necessary to check with your individual provider. Our business associate will contact your health insurance provider to check for hearing aid benefits prior to the hearing aid fitting appointment.  For our patients who do not have coverage for hearing aids through their health insurance, UNC Hospitals offers a zero-interest payment plan.  UNC Hospitals also participates in The Starkey Hearing Foundation's "Hear Now" program.  Hear Now is a non-profit program for individuals with hearing loss who could benefit from amplification but have limited financial resources.  The North Carolina Department of Health and Human Services may also be an option for those who meet the income requirements to receive one hearing aid.                                                                  

Does Medicare or Medicaid pay for hearing aids?

Unfortunately, Medicare does not provide coverage for hearing aids at this time.  Medicaid does cover amplification for patients from birth to age 21.  For more information about programs for children with hearing impairment offered by the North Carolina Department of Health and Human Services, please visit the Early Hearing Detection and Intervention Program (EDHI) website.  If you have further questions about these programs, please contact one of our pediatric audiologists at 919-843-4479.

Hearing Aid Styles

Hearing aids are available in a variety of styles from behind-the-ear to invisible-in-the-canal. The style of hearing aid recommended depends on many factors including, the results of the hearing evaluation, the size and shape of your ear canal, your manual dexterity and visual acuity, the situations in which you are having the most difficulty hearing, your interest in using accessory devices such as remote controls, phone streamers, hearing loops, and your personal preferences.

Behind-the-ear (BTE)

The traditional behind-the-ear (BTE) hearing aid requires two separate pieces – the hearing aid which sits behind the ear, and the custom ear mold.  The hearing aid houses the electronic components (microphone, amplifier, circuitry, and the receiver or loudspeaker). The hearing aid is coupled by tubing to the ear mold, which helps to hold the hearing aid in place and also directs the sounds into the ear canal.  BTE hearing aids are just as technologically advanced as smaller hearing aids, and may be appropriate for almost any degree and configuration of hearing loss.

  • Advantages

o   An appropriate choice for infants through adults, particularly children and those those with reduced manual dexterity or visual impairment. 

o   BTE hearing aids can be fitted to any degree and configuration of hearing loss. 

o   This style is also durable, FM compatible, and less susceptible to wax and moisture problems compared with in-the-ear styles.

o   As a child's ear grows, the ear mold can be replaced at a much more reasonable cost than replacing the entire hearing aid. 

  • Disadvantages

o   The BTE may be slightly more visible when compared to other styles and is more susceptible to wind noise compared to in-the-ear hearing aids where the microphone is more protected by the external ear from the wind.

o   The portion over the ear can cause discomfort for those wearing glasses or receiving oxygen via a nasal cannula.

Open Fit BTE

The Open Fit BTE is a thin tube & receiver-in-canal (RIC)/ receiver-in-the-ear (RITE). Many individuals with high-frequency hearing loss report feeling "plugged" when wearing traditional hearing aids. Open fit hearing aids have revolutionized the treatment of high-frequency hearing loss by leaving the ear canal much more open to reduce or even eliminate the "plugged" or "head-in-barrel" (occluded) sensation experienced by many hearing aid wearers. An open fit BTE is a small behind-the-ear hearing aid connected to a thin tube that directs the sound into the ear canal without the use of a traditional ear mold. A RIC/RITE has a portion behind-the-ear and a wire leading to the receiver (speaker) which produces the sound in the ear canal.

  • Advantages

o   Great flexibility in programming hearing losses ranging from mild to severe. 

o   Does not require ear mold impressions and the delay of getting pieces custom made to fit your ear.

  • Disadvantages

o   The BTE may be slightly more visible when compared to other styles and is more susceptible to wind noise compared to in-the-ear hearing aids where the microphone is more protected by the external ear from the wind.

o   The portion over the ear can cause discomfort for those wearing glasses or receiving oxygen via a nasal cannula.

In-the-ear (ITE)

In-the-ear (ITE) hearing aids are custom shaped to fit the bowl-shaped area of the outer ear and ear canal and include all of the electronic components in the plastic shell.  ITE hearing aids are appropriate for mild to severe hearing loss.  In-the-ear styles are not typically recommended for young children due to rapid changes in the size and shape of the external ear as they grow. 

  • Advantages

o   This style is more powerful than the other smaller styles that are fitted into the ear canal. 

o   Typically, a larger battery is used which provides better battery life and which makes changing the battery easier than with smaller styles.

o   This style can accommodate important features such as a volume control wheel, push-button for changing listening programs, and directional microphones for better hearing in a background of noise.

  • Disadvantages

o    ITE hearing aids are more susceptible to wax and moisture problems when compared to BTE hearing aids. 

o   Some individuals experience more occlusion or a feeling of being "plugged up" than with the BTE style.

o   It is more expensive to recase an ITE hearing aid than to make a new ear mold for a BTE.

In-the-canal (ITC)

This style of hearing aid is custom-fit to the canal portion of the ear, and is smaller and less visible than the full-shell ITE.  ITC hearing aids can accommodate mild to severe hearing loss, and are not recommended for children.

  • Advantages

o   Many patients find the ITC to be more cosmetically appealing than larger styles of hearing aids. 

o   This style can accommodate important features such as a volume control wheel, push-button for changing listening programs, and directional microphones for better hearing in a background of noise.

  • Disadvantages

o   Due to their small size, ITC hearing aids can be difficult for some patients to handle and to insert into the ear. 

o   This style uses a smaller battery, which results in more frequent battery changes. 

o   Like the ITE, wax and moisture can be problematic.

Completely-In-The-Canal (CIC)

The CIC is a very small hearing aid made to fit deep inside the ear canal.  This style usually requires a thin, clear filament line for a handle so that the wearer can remove the aid from the canal.  Its small size and ability to hide mostly inside the ear canal make this a cosmetically appealing style.  The CIC is most appropriate for mild to moderate hearing loss and is not recommended for children.

  • Advantages

o   Many hearing aid wearers like that this is the least visible style of hearing aid. 

o   With the microphone placement deep inside the ear canal, the hearing aid is able to capitalize on the natural acoustic resonance of the external ear, and is less susceptible to wind noise.

  • Disadvantages

o   Due to small size and power limitations, the CIC is not an appropriate choice for severe to profound hearing loss. 

o   This style uses the smallest hearing aid battery, and therefore may have reduced battery life compared to other styles. 

o   Due to the size limitations, options such as volume control wheels, push-buttons for multiple listening programs and directional microphones are not available. 

o   Patients with limited manual dexterity may have difficulty inserting and removing the hearing aid from the ear, and may have difficulty changing the battery.  

o   Wax and moisture can be problematic, and some individuals report feeling "plugged up" while wearing CIC hearing aids.

Invisible-in-the-canal (IIC)

The IIC is now the smallest hearing aid available placing the entire aid as deep into the ear canal as possible. This device is for a small population of adult patients with the appropriate anatomy to fit a custom device into the shadow of the ear canal and adequate dexterity and vision. These hearing aids are generally fully automatic or may have volume and program flexibility when using a telephone or a small "wand" as a remote control.

  • Advantages

o   No one will know you are wearing a hearing aid. No piece hanging on the top of the ear.

  • Disadvantages

o   Tiny batteries require good dexterity and vision, as well as regular replacing due to shorter battery life.

o   Ear mold impression can cause discomfort and even harm when not performed by an experienced audiologist.

Hearing Aid Features

In addition to selecting the most appropriate style of hearing aid, it is also important to consider the following special features that are designed to improve your ability to hear in challenging listening situations and to enhance the functionality of your hearing aid.

Directional Microphones

Do you have difficulty hearing in a background of noise? This is a common problem, particularly among individuals with hearing loss. The standard hearing aid is equipped with at least one microphone.  This omni-directional microphone picks up sounds in all directions: the front, the back, and to the side of the individual wearing the hearing aid.  In a background of noise, it is assumed that the listener will face the sound source they would most like to hear. Therefore, a directional microphone system is designed to help the listener hear sounds better from the front, and reduce the background noise coming from the sides and from behind.

FM Systems

Integrated FM systems are another solution for better hearing in a background of noise.  FM systems are also helpful in meetings, classrooms, or lectures where the person speaking is some distance away from the listener. This wireless system includes a transmitter that is placed near or even worn by the person who is speaking, and a receiver that connects to the hearing aid.


The telecoil is designed to receive electromagnetic signals. These signals are produced from a variety of sources but telephones and loops are the two most useful reasons to get a hearing aid with a telecoil. 

  • Phone: The loudspeaker in the handsets of many telephones generally provides enough electromagnetic energy for a telecoil to interpret and pass on the signal to the hearing aid user. This allows the hearing aid wearer to use the telephone without feedback (whistling) if the telephone has a "T rating" of T3 or T4. Telecoils are built into behind-the-ear and many in-the-ear hearings aids and can be activated by the hearing aid user by pushing a button. Some hearing aids have an automatic telecoil which activates when the user places the telephone handset up to the hearing aid.
  • Loop: A listening (aka induction) loop can come in many shapes and sizes. Personal loops can be used in a chair, at the front desk, or even in your living room. Larger loops are being installed as popularity increases in public areas of the U.S like airports, auditoriums, and places of worship. An active website of current Assistive Listening Device locations can be found at aldlocator.com 

Volume Control Wheel

Although most modern hearing aids have the ability to make automatic volume adjustments, some individuals prefer to have the option to increase or decrease the loudness in certain listening situations.  A volume control allows the user to more precisely adjust the sound level from the hearing aid and may improve audibility and comfort.

Program Switch

Some hearing aids have a program switch or button that allows the wearer to manually select a customized listening program for specific listening situations. Although many hearing aids have the capability to automatically adjust to different acoustic environments, some individuals prefer to manually select from two or more listening programs.

Remote Controls

Most hearing aid manufacturers offer remote controls that allow the user to stream from Bluetooth devices, increase or decrease the hearing aid volume, change listening programs, or activate telecoils and FM systems.  Remote controls come in a variety of sizes and styles.  Some remote controls can transmit sounds wirelessly from the television into the hearing aids allowing for a personal "surround sound" system.