Many people become hard of hearing as they get older due to the loss of specialised cells that are needed for the cochlea to work properly. The cochlea is the innermost part of your ear and it processes sounds for your brain to interpret. As you grow older, the specialised cells begin to die and you will eventually notice that sounds are not as clear as they used to be.

Signs of hearing loss

All about hearing aids


Two ladies talkingSigns of hearing loss

If you have difficulty understanding what people say to you, this may be the first sign that your hearing is not as good as it was. You may hear people talking but think they are mumbling or not speaking clearly. Most people with age related hearing loss notice the 'high frequency' sounds disappearing first. Speech sounds with the highest frequencies are the consonant sounds such as 's', 'sh', 't', 'k', 'p' and 'f'. These sounds help us to make sense of speech.

Some people find it embarrassing or difficult to accept that they are becoming hard of hearing. In fact, it is a natural part of getting older. One in five of all adults, and more than half of people over 60 have a hearing loss.

If you are under 60 and you think you have developed a problem with your hearing, it is very important to see your GP (family doctor) about this as the doctor can arrange for you to have a hearing test.

Are any of these situations familiar?

  • Do other people seem to mumble rather than speak clearly to you?
  • Do people often have to repeat things for you before you understand what they say?
  • Do you have difficulty understanding what is being said in noisy places, such as pubs or restaurants, although other people manage to have conversations?
  • When you are talking to people in a group, is it hard to keep up with the conversation?
  • Do you find it tiring to listen to conversations because you have to concentrate hard?
  • Do other people think your television or music is too loud but you cannot hear it properly if they turn it down?
  • Do you often have difficulty hearing on the telephone?

If so, it is possible that you have a hearing loss.

The thought of losing your hearing can be worrying. You might not want to think about it at all, but the sooner you do something, the better.

Your first step should be to visit your GP to have your ears checked. Before you go, make a note of your reasons for thinking you have a hearing loss. Use the checklist we have given to help you think of times when you have had difficulty hearing. Describe your hearing loss to your GP and explain how you feel it affects your day-to-day life. You should also explain that you would like to know if something could be done to help you.

Your GP will look in your ears to check for obvious problems and you may be able to have your hearing tested in their surgery. Usually, they will refer you to the audiology clinic to have hearing tests.

A Consultant Audiological Physician heads the local audiology service and direct referrals are received for anyone with a hearing impairment requiring a hearing aid. Direct referrals are referrals received directly from Primary Care by the audiology clinic. What this means in essence is that the elderly can be referred directly by their GP to the Audiology Department at Whipps Cross without having to be referred to the ENT consultant first. This is a considerable advantage, because it means that they only have to wait on one waiting list i.e. the audiology waiting list and they don't have to climb to the top of the ENT waiting list, and then have to be referred to audiology and sit on another list.

If someone is referred for a hearing aid but following assessment the audiologist thinks that it is necessary for the person to see an ENT doctor, then this will be arranged by the Audiology Service. It is much more efficient for the person with an age related hearing loss to be referred directly to the Audiology Service. If they are initially referred to an ENT specialist, then they can end up waiting on two waiting lists before being issued with a hearing aid.

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All about hearing aids

The following information is for people who think they may need a hearing aid or if you have just got your first hearing aid and want to know more about it.

The RNID Information Line can give you more information about hearing aids (see contact details below).

What is a hearing aid?

A hearing aid makes sounds louder so that you are able to hear them. It is battery-operated and you usually put it in or around your ear. Hearing aids are available in different shapes, sizes and types. However, all hearing aids work in a similar way. Very simply, they all have a built-in microphone that picks up sound. This sound is then processed electronically, either by analogue circuits, or digitally. The resulting 'signals' are then passed to a receiver, or earphone, in the hearing aid where they are converted back into sounds for you to hear.

A hearing aid also has an ear mould - the part that goes in your ear - tubing and batteries.

The type of hearing aid you get will depend, for example, on your hearing loss and what you find comfortable.

A hearing aid won't give you perfect hearing. It will make sounds louder and may help you to hear on the telephone, make conversations easier and, as a result, increase your confidence when talking to other people.

However, it won't necessarily make sounds perfectly clear.

A hearing aid will not make your hearing worse. If you have tinnitus - hissing, buzzing or other noises in your ears or head - you may hear it less when you use a hearing aid.

It takes time to get used to a hearing aid. However, keep trying it out until you are happy with it. Until you get used to using it in a lot of different situations, you won't know if it suits you. When you get your hearing aid, you should be given advice on how to get the best from it. You should also be shown how to use it and look after it. You can always ask for more help.

How to get a hearing aid

The first thing you need to do is get your ears and hearing checked to confirm you have a hearing loss and to see if a hearing aid will help. Your hearing difficulty may need medical investigation and treatment so it is a good idea to see your GP (family doctor) first, even if you are thinking of buying a hearing aid privately.

In the UK you can get a hearing aid free of charge on the NHS or buy it privately.

Getting a hearing aid on the NHS

To get a hearing aid on the NHS, you first need to visit your GP. They will refer you to an ear, nose and throat (ENT) consultant or an audiologist at a local hospital. At the hospital they will examine your ears and ask about your medical history, including any family deafness.

You will be seen by an audiologist who will test your hearing using an 'audiometer', which produces sounds with differing frequencies (pitch) and levels of loudness. You will be asked to tell the audiologist which sounds you can hear. The results are shown on a chart called an audiogram. The audiologist will use this to see if a hearing aid will help you.

Buying your own hearing aid

If you want to buy your own hearing aid, you will need to find a private hearing aid dispenser. Ask your GP or a friend if they can recommend one. By law, all hearing aid dispensers must be qualified - or in supervised training - and registered with the Hearing Aid Council. This regulates dispensers' training and conduct, and handles complaints. The RNID Information Line can give you a list of hearing aid dispensers in your area, but cannot recommend one.

In some ways, getting your hearing aid privately is similar to getting one from the NHS. Your hearing will be tested and your hearing aid dispenser will show you how to use and look after your aid. You will, however, have to sign a contract agreeing to buy your hearing aid. Make sure you read the terms and conditions of this contract and find out about any money-back guarantee before you have your hearing test. Ideally, you should get at least 28 days to try out the hearing aid and be able to return it during this time if you are not satisfied with it.

How much do aids cost?

Hearing aids cost between £300 and £2,500 each. Medical insurance may cover part of the cost of a hearing aid, but check with your insurer first. When the guarantee runs out, you will also have to pay for repairs and the costs of this can mount up. You will also have to buy your own batteries. Hearing aids last about five years on average so remember that you will have to pay for new ones in the future. You should also insure your hearing aid against loss, theft or damage if you buy it privately.

Different types of hearing aid

Hearing aids are described as analogue or digital, depending on the technology they use to process sound. Digital hearing aids are the newest kind of hearing aid. The following types of aid are available as digital or analogue - except for body worn and bone conduction aids. Your audiologist or hearing aid dispenser will advise you on the most suitable type for you. If you find it difficult to manage small or fiddly controls or equipment, you may find that you prefer to use the larger type of aids. However, some people find it easier to put an in-the-ear type of aid into their ear.

Behind-the-ear (BTE) hearing aids have an ear mould, which sits inside your ear. The hearing aid rests behind your ear and a plastic tube connects it to the ear mould. They are the most common types of hearing aid and most people who get NHS hearing aids have one of these.

In-the-ear (ITE) and in-the-canal (ITC) aids have their working parts in the ear mould so the whole aid fits into your ear. They tend to need repairing more often than BTE aids. Some ITE aids can be seen from the side. The smallest in-the-canal aids fit right inside your ear canal, where they cannot be seen. If you have severe hearing loss, or very small ear canals, these aids will probably not suit you.

Body-worn hearing aids have a small box that you clip to your clothes or put in your pocket. This is connected by a lead to an earphone and ear mould. Body-worn hearing aids are the most powerful hearing aids available and are more suitable for people with sight problems and/or problems using their hands.

Bone conduction hearing aids are for people with conductive hearing loss or people who cannot wear a conventional hearing aid. They deliver sound through the skull by vibrations. One type involves a small operation behind the ear.

CROS/BiCROS hearing aids are for people with hearing in one ear only. CROS hearing aids pick up sound from the side with no hearing and feed it to the better ear. BiCROS aids amplify sound from both sides and feed it into the ear that has some hearing.

Disposable hearing aids are only suitable for people with mild to moderate hearing loss. They can be thrown away and replaced with a new one when the battery runs out, usually after ten weeks. You can buy them from some branches of Boots, the high street chemist. They cost from £26 a month for one aid.

Waterproof and water resistant hearing aids have a thin membrane to help stop water getting into them. Waterproof aids are suitable for swimming and water-resistant aids can be used for other watersports.

What are Digital Hearing Aids?

Digital Hearing Aids look just like modern analogue hearing aids but they are different because they process sound digitally using a tiny computer inside the aid. This makes it possible to process and customise sounds very precisely to suit your hearing loss and you can then listen to sound comfortably, whatever the pattern of your hearing loss. Many digital aids can be programmed with different settings for different sound environments that you can select at the touch of a button. Some adjust themselves automatically.

Getting a Digital Hearing Aid on the NHS

Digital Hearing Aids have been issued locally over the last few years. We only now issue analogue hearing aids under exceptional circumstances or to replace existing aids.

The standard digital hearing aid issue by the local audiology service is a post-aural hearing aid, and other types of aid such as In the ear aids are only issued if there is a health indication that they are necessary.

Because of the very high demand for digital hearing aids there is a waiting list for NHS digital aids. Such waiting lists are being experienced throughout the country. It is therefore important that people who may require a hearing aid are referred early rather than late. In very exceptional circumstances the person can "jump" the waiting list. If the person believes that they have a very exceptional need then this should be discussed with the local audiology service.

If someone is housebound, in Waltham Forest a domiciliary service is available.

Getting a Digital Hearing Aid privately

You can also buy Digital Hearing Aids from a private hearing aid dispenser. They cost up to £2,500 each. Advice on commercial hearing aids is available through the local NHS audiology clinic.


You will have to change the batteries in your hearing aid regularly. If you have an NHS hearing aid, you can get free batteries from any hospital audiology or ENT department that has a battery service. Sometimes you can also get them from your local health centre. You can also buy batteries from any pharmacy.

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RNID Information Line

For a range of information on deafness and hearing loss


RNID Information Line

19-23 Featherstone Street



Phone: 0808 808 0123

Textphone: 0808 808 9000

Fax: 020 7296 8199



RNID Tinnitus Helpline

For information and advice about tinnitus

Phone: 0808 808 6666

Textphone: 0808 808 0007

Fax: 020 7296 8199



Thanks for Peter Watkin's help in compiling the information.