What if I told you that everything you've been led to believe about hearing aid technology levels has been a lie? By far the most searched question on YouTube when it comes to hearing aids is which hearing aid is the best. In the results, you'll see countless videos from a variety of professionals and influencers, myself included, telling you in our opinion, which hearing aids we think are among the best on the market. Often in these videos, the hearing aids being highlighted are a manufacturer's flagship premium technology offering. Now, in case you are unaware, prescription hearing aids come in between two and five different technology levels ranging anywhere from the top tier premium offering to the bottom tier basic offering. Just so we're clear, this has nothing to do with what a hearing aid looks like or what style it is. It has everything to do with what technology is inside of the device.

Premium hearing aid levels get all of the newest and best features intended to optimize your hearing performance, but in turn, they will cost you more money. And on the other hand, the basic level hearing aid offerings are limited when it comes to features and ability to customize, but they'll also typically cost you less money. But does a higher level of hearing aid technology actually result in better hearing performance? Well, that is exactly what the late Dr. Robyn Cox and her team set out to find back in 2016 with their study titled "Impact of Hearing Aid Technology on Outcomes in Daily Life One: the Patient's Perspective," which I will link in the description below. Now, bear with me as I quickly go over some of the key parts of this study and tell you what they found. And trust me, you are not gonna wanna miss this.

The objective of this study was to explore self-reported differences in hearing ability of adults comparing premium technology to basic technology. While premium hearing aid technology is capable of outperforming basic technology in a laboratory setting, there is not a whole lot of research data out there that shows if premium is better than basic in a real world situation. This single blind study had 45 participants all around the age of 70 years old with an adult onset mild to moderate hearing loss. Each participant trialed two different brands of hearing aids, but they trialed their premium option as well as their basic level option. And this study was counterbalanced, so each participant trialed different devices at different intervals. In total, each participant actually trialed four different sets of devices. Several foundational best practices were followed when fitting and programming these devices, including performing real ear measurement, adjusting programming based on perception, providing counseling and follow-up adjustments.

Participants were surveyed based on quality of life improvements, comparing each set of hearing aids to not using hearing aids at all, as well as a six item questionnaire rating, speech clarity, noise bother, wearing the devices when needed, listening fatigue, sound comfort, and localization ability on a scale of one to 10, 10 being the highest. At the completion of each of the brand trials, every participant was asked which pair of devices they felt were better and they did not know at the time which pair of devices were the premium devices and which ones were the basic devices. And when all of the four one month trials testing each of these sets of devices were completed, each participant was asked to rate each device on a scale between one and 10, of course, 10 being the best, one being the worst. Wanna know the results? Well, I'll get to that here in a second, but first, if you could do me a huge favor, click that like button, really helps out my channel, and if you have not yet subscribed to the channel with notifications turned on, go ahead and do that as well because that ensures you never miss one of my newly released videos and I release multiple new videos every single week.

That being said, I really appreciate it. Now let's go ahead and get to those results. The study concluded that both premium and basic level hearing aids provided a significant amount of benefit compared to not using hearing aids at all. Now, quite frankly, that should not surprise you, but what might surprise you is that they found no statistically significant differences in perceived improvement using premium versus basic technology. They also found that some participants preferred the premium level technology and some participants preferred the basic level technology, but the biggest influence on this was which set of hearing aids they tried second, possibly meaning that the hearing aid experience that was most fresh on their mind was the main deciding factor. But this is crazy, right? I mean, how is it even possible that premium level technology did not consistently beat out basic level technology? Well, there are at least three different theories that may explain this.

And the first one is like I mentioned before, that just because premium hearing aid technology can consistently beat out basic technology in a laboratory setting, it does not mean that that improvement translates into the real world. The second theory is that these tests that were used to evaluate perceived differences may have not been sensitive enough to identify statistically significant differences between premium and basic technology levels, or they may have not been appropriate to do a direct comparison of technology levels. And the third theory is that this study may have had some flaws that led to this outcome. Let's talk about the first theory, which is premium features in a laboratory setting may not translate into real world benefit. This is totally possible. I mean, just because you can create something inside of a lab does not mean that you can create that same effect in the real world.

This makes me think of my time in the Marine Corps. If a Marine is an expert at shooting the rifle at the range, this does not mean that they would be able to shoot well in a high-res combat situation. The real world is chaotic and no matter how well engineers try to recreate a real world setting inside of a laboratory, it is never going to be identical. On top of that, just because you have access to additional features inside of a premium hearing aid, there is no guarantee that your hearing care professional will know what to do to optimize those features to give you better improvement in the real world. Sometimes it takes me weeks or even months to get a digital feature dialed in exactly the right way to give someone perceived improvements, and sometimes those features we don't even need to use for years down the road when their listening situations change.

All right, let's talk about the second theory, which is these tests may have not been sensitive enough to identify a statistically significant perceived difference between premium and basic level technology, or they may not have been appropriate to do a direct comparison at all. This is what I found when I tried to replicate a study similar to this inside of my clinic with my patients. All of the subjective outcome measures that I used also showed no statistically significant difference between premium technology and advanced technology. The only thing that I identified, and keep in mind that this is not peer reviewed research, is that all of the participants inside of my clinic chose the premium level technology blindly, even though they did not identify any statistically significant differences on all of the questionnaires that they filled out. Now, if you would like to check out my case studies, I will link this video down in the description below.

Okay, let's talk about the third theory, which is this study may have had some flaws. To be fair, literally every research study ever conducted in the history of mankind has had some potential for flaws and bias. For instance, in this study, the researchers did accidentally mix up the manual program order for 16 of the 45 test subjects. And while this doesn't seem like a big deal, who knows what other mistakes they could have made that went unidentified. Personally, I felt like this study was done very well. Yes, I would've loved to see them do different age ranges as well as different severities of hearing loss. So we could actually take this information and generalize it to the rest of the population of individuals who have hearing loss. But overall, I believe the study was valid and it was peer reviewed. With all of that said, what are my biggest takeaways from this study?

Personally, my biggest takeaway is that treating your hearing loss with hearing aids is significantly more important than whether or not you go with premium level technology or basic level technology, as long as best practices are followed. I mean, just look at the quality of life results. While there were some outliers who indicated that hearing aids made their hearing worse, the vast majority of both premium and basic hearing aid users had a significant improvement in their quality of life. If this is not a compelling reason to take action on treating your hearing loss using any hearing aid with a hearing care professional who follows best practices, then I don't know what is. The key here is that all of the hearing aids that were set up by these researchers were probably set up very well considering that best practices were followed. Now, if this is the first time that you're hearing me talk about hearing aid best practices and you would like to learn why they're so critical to your success with hearing aids, then I highly recommend that you also check out my video that I'll link in the description.

And if you would like an easy way to find a hearing care professional who follows these best practices, check out my website HearingUp.com to find a local HearingUp network member near you. HearingUp members are committed to following comprehensive best practices to ensure you receive the maximum amount of benefit from whatever hearing aid tech level you use. All right. Now for my second key takeaway of this study, which is I do not necessarily agree with the author's statement of it could be reasonably asserted that the patient's perspective is the gold standard for hearing aid effectiveness. While I do agree that a patient's subjective perception of improvement is extremely important, I do not believe that it is the gold standard. I believe the gold standard is objectively better hearing. For instance, if we could objectively measure that you receive a 20% improvement in speech intelligibility using a premium level hearing aid versus a basic level hearing aid, but you did not actually perceive the improvement, does that mean that the premium provided you no additional benefit than the basic device?

Let me use an analogy. I'm a triathlete and I feel like I'm in the exact same shape whether I train 15 hours a week on average or 10 hours a week on average. However, on race day for some reason, I'm always consistently faster when I've trained for 15 hours a week on average versus 10 hours a week on average. The point I'm making is that perception is not always reality. Reality is reality and relying on subjective questionnaires to determine overall performance improvement may not be the best idea, especially when these comparisons of different technology levels are separated by months. Of course, we have to be careful here because we still do not know if there is an objective improvement in speech intelligibility using premium versus basic level technology or vice versa. Okay, so where does this leave us other than maybe entirely confused by this whole discussion when it comes to how to choose which technology level to go with?

I mean, if you go with premium hearing aid technology, you are risking paying more money and not getting additional benefit. On the other hand, if you go with a lower level of technology to save some money, you may have been one of those people who actually got more benefit with a premium level hearing aid. We also have to consider that this study was conducted back in 2016 and the technology that they used was from back in 2011. And since technology has been advancing substantially over the course of the past 10 years, we may actually have technology now that shows a significant difference between premium and basic levels. So using this research study as your only deciding factor may be risky. Honestly, I do not believe that there is one person on this planet who can guarantee which technology level is most appropriate for you, myself included.

So how do you logically decide which technology level to go with when there's no definitive answer for everyone? And what technology level would a hearing care professional be able to recommend that would not violate their code of ethics? Right or wrong? After having thought of this particular research study for the past seven years, this is what I tell all of my patients: when it comes to hearing aid technology levels, you have top tier, second tier, third tier, and sometimes even fourth and fifth tier devices. Each time that you go down in technology level, it takes features and customizations away from me when I'm trying to optimize those devices. But it does not guarantee that when you drop down in technology level that you lose performance. There's just the potential that you'd be leaving benefit on the table. So my recommendation is the same to everyone. You should be going with the highest level of technology that you can reasonably afford, and if you cannot afford it, you should be dropping down to a technology level that you can

afford. And then it is the job of your hearing care professional to optimize the performance of those devices. If you're the type of person who wants to make sure that your hearing care professional has all of the features and customizations they could ever want to optimize the performance of your hearing aids, then go at the highest level of technology. But even if you cannot afford premium level hearing aid technology, you should still feel comfortable going with a lower level of technology as long as your hearing care professional is gonna spend the time to optimize those devices and follow best practices. Now, I do realize that my recommendation could present some form of a bias towards a profit motive because the higher technology levels typically cost more money. So one thing that I also do inside of my clinic is I ensure that the higher levels of technology do not have a higher profit margin than the lower levels of technology.

So this prevents myself and my providers from having some form of unconscious financial bias. Overall, I really enjoyed this study, but honestly, I still don't feel like it makes it very clear cut what you should be doing as someone with hearing loss, trying to decide which technology level to go with. Ultimately, I only really care about one thing, and that is that you can hear your absolute best and if premium hearing aid technology even slightly improves the possibility that you could hear your best, I think it's worth considering, especially if you have a hearing care professional who's willing to take considerable time to optimize your features inside of those devices. Although I would have absolutely no issues if you decided to go with a basic level hearing aid, because as long as you're going to a hearing care professional who follows best practices, chances are you're gonna love those devices as well.