Which patients with permanent sensorineural or mixed hearing loss (approximately 25–70 dB HL) who experience communication difficulty, have adequate cognition and manual dexterity, no active ear infection or untreated otologic disease, and realistic expectations are good candidates for hearing aids?

Good Candidates for Hearing Aids

Patients with moderate hearing loss (40-70 dB HL) who experience difficulty with conversations, especially in noisy environments, are ideal hearing aid candidates and should be fitted with amplification. 1

Primary Candidacy Criteria

Hearing Loss Severity

• Mild to moderate sensorineural or mixed hearing loss (approximately 25-70 dB HL) represents the optimal range for hearing aid candidacy. 1
• Patients with moderate hearing loss (40-70 dB HL) have difficulty maintaining conversations without amplification and derive substantial benefit from hearing aids. 1
• Mild hearing loss (20-40 dB HL) patients who struggle with conversations in noisy surroundings are also appropriate candidates. 1
• Severe hearing loss (70-95 dB HL) patients may benefit from powerful hearing aids but often require additional support such as lip reading. 1

Functional Communication Difficulty

• Self-reported or family-observed communication difficulties (difficulty understanding conversations, increasing television volume) are critical indicators for hearing aid candidacy. 2
• Patients experiencing hearing disability that affects quality of life should be considered for amplification. 3
• Greater initial self-reported hearing disability predicts more successful hearing aid outcomes. 3

Essential Prerequisites

Medical Clearance

• No active ear infection or untreated otologic disease must be confirmed before hearing aid fitting. 2
• Cerumen impaction should be treated first, as removal may be curative and is necessary for accurate assessment. 2
• Sudden sensorineural hearing loss (≥30 dB loss within 72 hours) requires prompt otolaryngology referral before considering hearing aids. 2

Cognitive and Physical Capacity

• Adequate cognition to understand device operation and maintenance is essential. 1
• Sufficient manual dexterity to handle hearing aids, change batteries, and perform basic troubleshooting is required. 1
• Consider the patient's comfort with mobile technologies if Bluetooth-enabled devices are being considered. 1
• Availability of family/caregiver support should be assessed when cognitive or physical limitations exist. 1

Realistic Expectations

• Patients must understand that hearing aids improve but do not restore normal hearing. 3
• Greater action stage of change (readiness to use amplification) predicts better outcomes. 3
• Lower precontemplation stage (not denying hearing loss) correlates with successful outcomes. 3

Special Populations

Pediatric Candidates

• Children with moderate hearing loss (40-70 dB HL) who cannot maintain conversations without amplification require hearing aids. 1
• Any parental concern about hearing loss should trigger objective screening and potential hearing aid evaluation. 1
• Children with risk factors (family history, NICU stay >5 days, ototoxic medication exposure, craniofacial anomalies) need ongoing assessment. 1

Tinnitus Patients

• Patients with hearing loss and persistent, bothersome tinnitus should receive hearing aid evaluation, even if they might otherwise be marginal candidates. 1
• Hearing aids can provide substantial tinnitus relief in addition to improving hearing function. 1

Age-Related Hearing Loss

• Older adults with age-related hearing loss benefit from appropriately fitted amplification, which can reduce cognitive decline in at-risk populations. 1
• The ACHIEVE trial demonstrated that hearing aids with auditory rehabilitation reduce cognitive loss within 3 years for those at risk of cognitive decline. 1

When to Consider Alternatives

Cochlear Implant Referral

• Patients with appropriately fitted hearing aids who continue to have poor speech understanding (≤60% word recognition at 60 dB) should be referred for cochlear implant evaluation. 1, 4
• Severe to profound hearing loss (>70 dB HL) with limited hearing aid benefit warrants cochlear implant assessment. 1, 4
• The "60/60" guideline (60 dB presentation with ≤60% word recognition) has 96% sensitivity for identifying cochlear implant candidates. 4

Other Amplification Options

• CROS/BiCROS hearing aids should be considered for single-sided deafness when conventional amplification fails. 1
• Bone-anchored devices may benefit patients with severe unilateral loss and normal contralateral hearing who refuse devices on the better ear. 1

Common Pitfalls to Avoid

• Do not delay hearing aid fitting while waiting for hearing loss to worsen—the average delay between recognizing impairment and seeking help is nearly 10 years, which negatively impacts outcomes. 5
• Verify proper hearing aid fitting through real-ear measurements before concluding that amplification has failed. 1, 6
• Do not assume premium-level hearing aids always produce better outcomes than basic-level devices—comprehensive best-practice fitting protocols are more important than technology level. 7
• Address socioeconomic barriers, as higher socioeconomic status predicts better intervention uptake and outcomes. 3
• Assess and address low communication self-efficacy, which reduces likelihood of hearing aid uptake. 3