Two hearing aids gave more benefit than one, by a margin that may not matter to patients

Design

Single-blinded, parallel-group randomised trial, 2 US centres

Population

275 adults aged 50+ with age-related hearing loss, new to hearing aids

Primary outcome

APHAB global benefit at 3 months

Effect

19.7 vs 14.4 points; difference 5.3 (95% CI 1.8-8.8) favouring bilateral

This single-blinded randomised trial at two US university audiology services allocated 275 adults aged 50 or older with age-related hearing loss and little prior hearing aid use to bilateral or unilateral receiver-in-the-canal aids.

At three months, self-reported benefit on the Abbreviated Profile of Hearing Aid Benefit (APHAB) was 14.4 points with one aid and 19.7 with two, a difference of 5.3 points (95% CI 1.8-8.8). Both groups improved meaningfully.

Bilateral fitting is routine but has had little randomised support, and the second aid roughly doubles cost. The trial confirms a small extra benefit.

The authors themselves say it is unclear whether the difference is clinically meaningful. For a patient who can afford or tolerate only one aid, a single aid still delivers most of the benefit.

• Offer bilateral aids as the default for symmetrical age-related hearing loss where affordable.
• Where cost is a barrier, tell patients one aid still gives substantial benefit.
• Start with one aid rather than none if that is what the patient will accept.
• Review at three months; the benefit measured here was early.

Why it matters

Cost is the main barrier to hearing aid uptake, and most of the benefit comes from the first aid.

Don't overread it

The extra benefit was self-reported at three months and may fall below the threshold patients notice.

The statistics, in plain English

A 5.3-point difference is statistically clear because the confidence interval excludes zero, but clinical meaningfulness depends on whether individuals notice it. Both groups improved by far more than the gap between them.

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