Hearing loss and hearing aids

Hearing loss and hearing aids

Sound travels through the ear canal and vibrates the eardrum and middle-ear ossicles. The cochlea converts these movements into nerve signals that reach the brain through the auditory nerve. A problem at any stage can reduce hearing.

Effects of hearing loss

Hearing loss is more than reduced volume. Sound may be muffled or distorted, speech can be difficult in background noise and some people become unusually sensitive to loud sound. Reduced localisation can affect confidence and safety. The effort of listening can cause fatigue and social withdrawal. In children, untreated loss can affect speech, language and learning, so timely assessment is important.

Types

• Conductive loss: sound is reduced in the outer or middle ear, for example by wax, an eardrum perforation, middle-ear fluid or ossicular disease.
• Sensorineural loss: the cochlea or auditory nerve is affected, reducing both loudness and clarity.
• Mixed loss: conductive and sensorineural components occur together.

Severity and the frequencies affected are measured with audiometry and recorded in decibels hearing level (dB HL). Labels such as mild, moderate, severe and profound are useful summaries, but communication ability also depends on speech recognition, listening environment and the hearing in each ear.

Hearing-aid options

A digital hearing aid contains microphones, a processor and a receiver. It is programmed for the individual hearing loss and can emphasise speech, manage feedback and reduce some background noise. It improves access to sound but cannot fully restore normal hearing.

Common styles include:

• Behind-the-ear and receiver-in-canal devices: suitable for a wide range of losses and the most commonly used styles.
• In-the-ear devices: custom-made instruments that sit in the outer ear or canal and require suitable ear anatomy and dexterity.
• Body-worn devices: now less common, but useful in selected situations.
• Bone-conduction devices: transmit vibration through the skull and can help when a conventional aid cannot be worn or with selected conductive or single-sided losses.

Remote microphones, television streamers, alerting devices and phone connectivity can provide additional help. When both ears have aidable loss, two aids often support localisation and speech understanding better than one.

Fitting and trial

An audiologist or hearing-aid dispenser uses the hearing test, communication needs and ear examination to select and program the device. An earmould may be required. A trial and follow-up adjustments are important because the brain needs time to adapt and real-life experience shows which settings need refinement. ENT review is needed for medical red flags, asymmetry, sudden loss, pain, discharge or other ear disease.

Reimbursement in the Netherlands

At the time this page was reviewed in 2026, adults aged 18 and over paid a statutory contribution of 25% of the cost of eligible hearing aids, earmoulds and tinnitus maskers covered under the basic insurance. The remaining covered amount can also fall under the compulsory deductible. Contracting, device category, referral requirements and additional insurance can affect the final amount. Children and special devices may be subject to different rules. Check your current policy and insurer before purchase. See Zorginstituut Nederland’s information on auditory aids.

Further options

For severe or profound hearing loss with limited benefit from well-fitted aids, specialist assessment may consider a cochlear implant or other implantable device. Good rehabilitation combines technology with communication strategies, realistic expectations and support for the people around the user.