Hearing aids for profound hearing loss

More than two million Americans live with hearing loss that is severe or profound, as defined by the World Health Organization (WHO). People with this kind of hearing loss generally wear higher-powered hearing aids or receive cochlear implants. 

What is severe or profound hearing loss?

According to WHO, if the quietest sound you can hear with your better ear is between 60 and 80 decibels, your loss is severe. It will be at least 80 decibels if your loss is profound. In the United States, a stricter definition is often used, so that someone who can’t hear a sound less than 90 decibels would be considered to have a profound loss.    

With either definition, if you have profound hearing loss, you won’t hear most everyday sounds without amplification, just loud sounds. You might catch a 100-decibel ambulance siren if your car window is open—but not someone calling you from behind. 

People with profound hearing loss can't hear sounds quieter than about 90 decibels. Ordinary conversation tends to be about 60 decibels.

Profound hearing loss usually stems from a birth defect or an illness or injury, not from age. However, it's not uncommon for people with age-related hearing loss to have profound hearing loss in the high frequencies (meaning high pitches are very difficult if not impossible to hear). 

Many people with profound hearing loss learn to read lips or use sign language as they cannot typically hear speech. Both sign language and lip reading are excellent ways to help boost your communication abilities.

However, people with severe or profound hearing loss can still benefit from hearing aids, or in some cases, cochlear implants. Let's take a look at how power hearing aids work and what to consider: 

Power hearing aids

What are power aids? Hearing aids for profound or severe hearing loss are known as "power hearing aids," "super power hearing aids," or "ultra power." They require more powerful batteries, hence the name. 

Who sells them? All the major hearing aid manufacturers offer them for both adults and children. They are generally prescribed and sold via your ENT doctor's audiology office, or a hearing aid clinic. 

What are some top power hearing aid brands? 

Here are some of the more well-known power aids for profound hearing loss:

• Oticon: Xceed, Super Power and Ultra Power
• ReSound: Enzo IA
• Starkey: Evolv AI Power Plus BTE 13
• Phonak: Naída

How are these hearing aids different?

Size: Power aids are slightly bigger than others because they contain more circuitry. But they can be worn by all age groups, even babies. 

Style: Behind-the-ear (BTE), with a full earmold fitting inside the ear for a snug fit (see photo). Unless one ear has normal hearing, you will need hearing aids for both ears. Small hearing aids that nestle invisible inside the ear (known as ITE) won’t do the job, notes audiologist Catherine Palmer, former president of the American Academy of Audiology. Nor will over-the-counter hearing aids, which are not approved for severe or profound hearing loss.

Batteries: The hearing aids are either replaceable "button" batteries or rechargeable. For button batteries, they typically run on a 675 battery or the smaller 13 battery. See a breakdown of hearing aid battery types here.

Hearing aid fitting

When it's time to get hearing aids, Palmer suggests describing in detail—from morning to night—a weekday and your weekends. Identify any situations in which you now find it hard to hear and your current solutions. Your audiologist can vary your aid’s programming and teach you how to use features to make your hearing aid work best for you.  

Amplification adjustments: If your hearing test determines you have severe hearing loss, your audiologist’s most important task will be to make sure the sound is loud enough so you can hear but not so loud it damages your natural hearing. The test shouldn’t be uncomfortable or damage your hearing. Your audiologist also may be able to move higher pitches, which tend to be harder to hear, into a more audible range for you, a process called “frequency lowering.”

Real ear verification:  While you’re wearing a hearing aid, your audiologist will put a microphone in your ear canal and measure the aid’s actual output. This is known as real ear measurement.

“A person could be tolerant of a decibel level that could be damaging,” Palmer says. “That is why we measure rather than asking someone how things sound.” 

Ear mold fitting: The next most important task is to get ear mold measurements for a snug fit. The point of ear molds is to minimize feedback, which is a whistling sound that occurs when amplified sound leaks out of the ear, reaches the hearing aid microphone, and is re-amplified. To get a precise measurement of your ear canal, your audiologist will use silicone to create an exact mold of your ear. Children will need new earmolds as their ears grow.

Features to consider

When choosing an aid, you and your audiologist will consider how much power it offers, how well it controls feedback, and its circuitry. Also:

Directional sound: Some hearing aids include two or three microphones that help you distinguish sound coming from different directions.

Telecoil: A telecoil inside the hearing aid links it to a hearing loop system, which are found in many theaters, churches, airports and major venues. Another option for newer hearing aids is Auracast™, an emerging Bluetooth® technology. 

Other factors you might consider include how moisture or dust resistant it is, the length of the warranty and the track record on repairs.

Assistive technology and other tools

Even with hearing aids, people with severe hearing loss often need assistive technology to hear, especially in noisy settings or in environments where it's important to hear well (like school or an office meeting). Palmer suggests using an remote microphones near the sound you wish to hear that will send signals to your hearing aid or cochlear implant.

Phone considerations: Hearing aids can wirelessly connect to smartphones, but people with severe-to-profound hearing loss may need a phone (or app) with automatic captioning. State programs may allow you to get one for free. Video applications like FaceTime, Facebook Messenger and Skype allow you to see facial expressions and read lips.

Safety considerations: Many new apps can turn your smartphone into a customized alarm system or provide other assistance. Tunity scans a television screen and runs the amplified sound through your headphones. Ava provides subtitles for conversations in the room. Your phone can give you text messages, vibrate, flash a light or make a low sound to pick up noise from a smoke detector, doorbell, phone or alarm clock. There are also plenty of other assistive listening devices to augment your hearing aids, including FM systems and vibrating bed shaker alarms.

Cochlear implants and other options

For some people, power hearing aids might not be the best option. A speech understanding below 50% (even with hearing aids) is often the guiding indicator that it's time to consider surgically implanted options. These include bone-anchored hearing systems and cochlear implants. 

Contrary to common perception, cochlear implants can be used in older adults. If you're finding a hearing aid is no longer providing the hearing experience you need, you may want to see an ENT to ask about cochlear implantation options.

If you have conductive hearing loss or chronic ear irritation, a bone-anchored hearing aid may be a better option.

Getting help

For any type of hearing loss, regular hearing care is key. If you have severe to profound hearing loss, you will want to schedule periodic hearing tests as recommended by your provider, as hearing loss often gets worse over time. 

If you need a new provider, our large online directory of hearing care professionals is a good place to start your journey to better hearing. You can read reviews from real patients, and book an appointment.