Premium vs. Basic Hearing Aid Technology Levels - Which is Better in 2023?

Premium vs. Basic Hearing Aid Technology Levels - Which is Better in 2023?

The top hearing aid manufacturers all offer a variety of technology levels to cater to different needs and budgets. Often, the discussion revolves around premium devices that boast the latest features with the promise of superior hearing performance. But do these high-end hearing aids genuinely offer a meaningful advantage in real-life situations over their basic counterparts?

In our quest to understand the true impact of hearing aid technology on our daily lives, we embarked on a journey through research studies and real-world experiences. Our objective is to examine self-reported hearing ability and quality of life improvements across different technology levels of hearing aids, scrutinizing the validity of common perceptions and marketed claims.

Key Takeaways

  • Higher technology levels in hearing aids do not always translate to better real-world performance.
  • Personal preference plays a significant role in perceived hearing aid effectiveness.
  • Real-world experiences may differ from controlled laboratory outcomes in hearing aid evaluations.

Misconceptions About Hearing Aid Technology Levels

Despite common beliefs, higher technology levels in hearing aids do not always equate to significantly better real-world hearing performance. As hearing care professionals, we often shine a spotlight on manufacturers' premium, flagship technology offerings. It's important to understand that prescription hearing aids come in various technology levels, typically ranging from basic to premium. Premium levels include the newest features and are designed to optimize hearing performance but come at a higher cost. Conversely, basic level aids offer fewer features and customization but are more affordable.

However, a groundbreaking study led by the late Dr. Robin Cox sought to determine if premium technology truly results in better hearing in everyday life, beyond the controlled environment of a lab. The study involved 45 participants with mild to moderate hearing loss, who trialed premium and basic hearing aids from two brands in a counterbalanced design. Each participant experienced four different sets of devices.

We adhered to foundational best practices for fitting and programming, including real-ear measurement, personalized adjustments, and comprehensive follow-ups. Participants then rated the hearing aids based on perceived improvements in quality of life and specific aspects such as speech clarity, noise annoyance, and listening effort, on a scale of 1 to 10.

Interestingly, the results revealed no statistically significant difference in the perceived improvement when using premium versus basic technology. Some participants favored basic models while others preferred premium. The most recent experience seemed to hold the most weight in their preferences.

Three potential theories might explain these findings:

  1. Laboratory vs. Real World: The benefits observed with premium technology in a lab may not translate directly to real-life settings, which are more complex and variable.
  2. Sensitivity of Evaluation: The tests used might not have been sensitive enough to capture the nuances between different levels of technology, or simply might not have been appropriate benchmarks to evaluate and differentiate between them.
  3. Potential Study Flaws: Every study has limitations. In this specific research, some programming sequences were mixed up for some participants, which could have influenced their experiences and opinions.

A personal anecdote supports these findings. When replicating a similar study in my clinic, even though my patients chose premium technology when given a blind test, they didn’t report statistically significant differences on the questionnaires when compared to basic technology.

It's vital for us to recognize that these insights call into question the assumption that more expensive, higher-level technology will always provide a better hearing experience. Individual preferences, the fitting process, and real-world application play significant roles in determining the best solution for each person’s unique hearing needs.

The Study by Dr. Robin Cox

Objective and Background

Our purpose was to examine self-reported variances in hearing ability in adults, evaluating the efficacy of premium versus basic hearing aid technology in real-life situations. We aimed to verify if the laboratory superiority of premium technology also translates to everyday life improvements.


In our counterbalanced, single-blind study, 45 participants around 70 years old with adult-onset mild to moderate hearing loss were involved. Each tested four different sets of hearing aids – two premium and two basic models, each from different brands. We maintained several best practices, such as real ear measurements and personalized adjustments through counseling. Participants' quality of life was measured against the baseline of not using hearing aids, and their experiences were recorded using a six-item questionnaire. This questionnaire included speech clarity, noise annoyance, ease of wear, listening fatigue, sound comfort, and the ability to localize sounds, rating them on a scale from 1 to 10.

Questionnaire Criteria Scale

Speech Clarity 1–10

Noise Bother 1–10

Wearing Convenience 1–10

Listening Fatigue 1–10

Sound Comfort 1–10

Localization Ability 1–10

Key Findings

At the end of the study, it was clear that both premium and basic hearing aids significantly benefit users compared to no devices. Interestingly, no substantial differences in perceived improvement between premium and basic technologies were found. Preferences amongst participants varied, with no consistent dominance of premium technology. We speculate that recent experiences with the equipment could have swayed decisions, implying that recency might play a role in perceived performance.

Our study proposes that premium features, although adept in controlled environments, may not offer the same advantages in the unpredictability of the real world. Furthermore, we question the sensitivity of the tests in identifying distinct differences between technology levels and consider that they may lack the nuance for direct technology level comparisons. Despite these findings, we acknowledge the potential for flaws and biases inherent in any research study.

Survey Results Analysis

In our exploration of self-reported differences in hearing ability among adults, we initiated a rigorous study with the objective to compare premium technology to basic technology in daily life scenarios. To achieve this, we enlisted 45 participants around the age of 70, all experiencing mild to moderate, adult-onset hearing loss. These individuals were instrumental in assisting us to understand the real-world performance of different hearing aid technology levels.

Trial Design & Structure:

  • Participants: 45 individuals, ~70 years old
  • Hearing Loss: Mild to moderate, adult-onset
  • Hearing Aids Tested: Two different brands, premium and basic options
  • Study Format: Single-blind, counterbalanced

Participants trialed four different sets of devices, two from each brand, encompassing both the premium and basic models. It was crucial that they did not know which was which to prevent any biases from influencing their feedback.

Best Practices Employed:

  • Performing real ear measurement
  • Adjusting programming based on participant perception
  • Providing necessary counseling and follow-up adjustments

Survey Methodology:

  • Quality of life improvements were gauged comparing hearing aids usage to non-usage.
  • A six-item questionnaire evaluated:
  • Speech clarity
  • Noise bother
  • Wearing compliance
  • Listening fatigue
  • Sound comfort
  • Localization ability
  • All ratings were on a scale of 1 to 10, with 10 indicating the highest satisfaction.

Upon concluding each brand trial, we requested participants to identify which set they felt performed superiorly, maintaining anonymity regarding the technology level of the devices they assessed.

Study Findings:

  • Both premium and basic hearing aids provided substantial benefit over non-use.
  • There was no statistically significant difference in perceived improvement between premium and basic technologies.
  • Participant preferences were split between premium and basic levels. Intriguingly, preference often seemed influenced by which device was tested second, suggesting recency effect as a possible determinant.
  • Feedback gathered did not always align with the order of technology levels, indicating real-world application could differ from controlled settings.

Our analysis also brought forth several theories addressing why premium technology did not uniformly surpass basic levels:

  1. Translation of Lab Benefits to Real-World: Laboratory advantages of premium features may not directly correlate with real-world improvements.
  2. Sensitivity of Tests: The tests might lack the sensitivity to discern statistically significant differences between the two levels, or they might not be appropriate for a direct technology comparison.
  3. Possible Study Flaws: No study is impervious to flaws, and some weaknesses, like the accidental programming order mix-up in 16 out of 45 test subjects, can influence the outcome.

In summary, despite the theoretical superiority of premium technology in lab conditions, our real-world data revealed a much more nuanced picture of hearing aid performance as experienced by the users themselves.

Likely Explanations for the Findings

Real-World Application of Premium Features

Our investigations suggest that premium hearing aid features, while advanced in laboratory settings, may not always provide noticeable real-world benefits to all users. The complexity of real-life situations can't be perfectly emulated in a lab. In our experience, even with access to numerous premium features, it's not guaranteed that such features will be effectively utilized by hearing care professionals to yield perceivable improvements. It's possible for a feature to remain underused until a user's listening needs evolve over time.

Feature Ratings

Lab Efficacy:

Noise Reduction

Lab Efficacy: High

Real-World Usefulness: Variable

Sound Quality

Lab Efficacy:High

Real-World Usefulness: Variable

Speech Clarity

Lab Efficacy:High

Real-World Usefulness: Variable

  • Optimization: Often takes weeks or months to fine-tune features for noticeable improvement.
  • Environment: Real-world settings are dynamic and unpredictable compared to the lab.

Sensitivity of Tests

The tests administered to assess perceived differences between premium and basic hearing aids may lack the sensitivity required to detect significant distinctions or may not be appropriate for a direct comparison. In our own attempts to replicate similar studies, subjective outcomes indicated no meaningful distinction, even though all participants chose the premium option without prior knowledge.

  • Subjective Measures: Did not show a significant difference between technology levels.
  • Blind Selection: Participants gravitated towards premium technology regardless of questionnaire results.

Potential Study Flaws

All research, by nature, harbors potential flaws, and it's our duty to recognize these in order to understand outcomes fully. In the study we refer to, there was an accidental swapping of manual program order for some participants.

  • Manual Program Order: Mix-up affected 16 out of 45 participants.
  • Quality Control: Such flaws can impact the validity of findings.

Every piece of research, including ours, must account for these variations that could influence the final conclusions drawn from the data. It's essential to consider these factors when extrapolating results to broader populations.

Conclusion and Final Thoughts

Our Study's Objective

We sought to explore the self-reported differences in hearing ability among adults, comparing the perceived benefits of premium versus basic hearing aid technology.

Study Design and Methodology

  • Participants: 45 adults with adult-onset mild to moderate hearing loss
  • Age: Approximately 70 years old
  • Protocol: Trial of two brands, both their premium and basic options
  • Method: Counterbalanced study, totaling four sets of devices per participant
  • Best Practices Applied: Real ear measurement, personalized programming, counseling, follow-up adjustments.

Data Collection

Participants completed surveys on:

  • Quality of life improvements without hearing aids as a baseline
  • A six-item questionnaire assessing:
  • Speech clarity
  • Noise disturbance
  • Frequency of device usage
  • Listening fatigue
  • Sound comfort
  • Localization skills

Data Rating System

Each device set was rated on a scale from 1 to 10 post-trial, with 10 indicating the highest satisfaction.


  • Both premium and basic hearing aid technologies provided marked benefit over no aids.
  • No statistically significant differences in perceived improvement between premium and basic technologies.
  • Preferences for premium or basic technology varied among participants.
  • The recency of the experience influenced preferences, suggesting the most recent trial could impact choice.

Theories Explored

  1. Lab vs. Real World: Premium features may not transfer to tangible real-world benefits.
  2. Test Sensitivity: Current tests might not be finely tuned enough to discern differences between technology levels.
  3. Research Validity: Potential flaws in study execution, which is a common challenge in research.

In Practice

In our clinical experience, despite the lack of significant differences reported in questionnaires, patients will often choose premium hearing aids when given a blind test - indicating that they are perceived differences not captured in some of these studies.

Personalized Care

Our commitment remains to personalized care, optimizing features to meet specific real-world needs over time. HearingUp Audiologists are committed to following evidence-based Best Practices and can help you choose the appropriate hearing aid technology for you.

Video transcript

Video transcript

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 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.

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