Evidence Trace, complete trial record
In plain terms
In plain terms: Hearing aids for age-related hearing loss has some human trial evidence supporting it, but the evidence is not yet strong enough for EBL to call it established. It is worth knowing about and worth discussing with your clinician.
Hearing aids for age-related hearing loss
B
Supported: a good trial, backed by more
The endpoint this grade is based on: self_report
The evidence as the record states it
Ferguson et al. (Cochrane Database Syst Rev, 2026; PMID 42644645): 16 randomized trials, 2,261 adults with mild to moderate hearing loss; hearing-specific quality of life SMD -1.25 (8 trials, 1,683 participants, moderate certainty); listening ability SMD -1.28 (5 trials, 622 participants, moderate certainty); general health-related quality of life SMD -0.27 (low certainty); little to no difference in loneliness (low certainty); working memory very uncertain; pain reported twice in one trial (very low certainty). Humes et al. (Am J Audiol, 2017; PMID 28252160): double-blind trial, same hearing aids with best-practice or placebo settings, 154 adults aged 55 to 79; Connected Speech Test benefit 21.3 versus 8.7 rationalized arcsine units (d 0.62); self-rated benefit d 1.25. Mulrow et al. (Ann Intern Med, 1990; PMID 2197909): 194 older veterans, hearing aid or waiting list, 4 months; social and emotional function and communication function improved. Sanchez et al. (J Am Geriatr Soc, 2024; PMID 39266468): ACHIEVE, 977 adults aged 70 to 84, hearing intervention versus health education; self-rated communicative function 8.9 points better at 6 months and 9.5 at 3 years. Ye et al. (BMC Med, 2022; PMID 35436911): 385 adults aged 45 and over in rural China, free hearing aids versus no intervention, 20 months; hearing handicap scores improved. Funding and conflicts: the Cochrane review had no dedicated funding, and three authors' institutions have received payments from hearing aid makers (WSAudiology, Sonova, Cochlear), stated in the review; ACHIEVE investigators report industry relationships, stated in the paper.
PMID 42644645 PMID 28252160 PMID 2197909 PMID 39266468 PMID 35436911
Evidence by specific use
Speech understanding measured in a listening test, adults aged 55 to 79 with mild to moderate hearing loss
Grade C
Humes et al. (Am J Audiol, 2017; PMID 28252160) ran a double-blind trial in which every participant received the same hearing aids and only the settings differed: best-practice amplification or placebo settings. On the Connected Speech Test (sentences at 65 dB SPL against competing babble), the gain in words understood was 21.3 rationalized arcsine units with real settings against 8.7 with placebo settings (Cohen's d 0.62). WHY NOT B: under Rule 06 a single positive trial without independent replication is a C. No second independent trial has measured speech understanding by test against placebo or no hearing aid; the listening ability pooled in the 2026 Cochrane review is scored on questionnaires and is graded with the self-rated use.
PMID 28252160
Self-rated hearing-related quality of life and everyday communication, adults with mild to moderate hearing loss
Grade B
The 2026 Cochrane review pooled 8 trials and 1,683 participants: a large difference in hearing-specific quality of life favoring hearing aids (standardized mean difference -1.25), moderate certainty, downgraded because participants could not be blinded (Ferguson et al., Cochrane Database Syst Rev, 2026; PMID 42644645). Single trials agree: 194 older veterans at 4 months (Mulrow et al., Ann Intern Med, 1990; PMID 2197909), 977 adults aged 70 to 84 through 3 years in ACHIEVE (Sanchez et al., J Am Geriatr Soc, 2024; PMID 39266468), 385 adults in rural China at 20 months (Ye et al., BMC Med, 2022; PMID 35436911), and the double-blind placebo trial (Humes et al., 2017; PMID 28252160). Self-rated, so the letter stops at B.
PMID 42644645 PMID 2197909 PMID 39266468 PMID 35436911 PMID 28252160
Why Grade B and not Grade A
Grade B reflects moderate human evidence -- typically a single strong trial, multiple smaller trials, or surrogate endpoint data without hard clinical outcome replication. To reach Grade A, Hearing aids for age-related hearing loss would require at least one additional independent randomized trial demonstrating a hard clinical endpoint or objectively measured functional outcome in a comparable population.
What this grade covers and what it does not
Grade B on self-rated hearing-related quality of life and communication: replicated across randomized trials and pooled at moderate certainty in the 2026 Cochrane review (PMIDs 42644645, 2197909, 39266468, 35436911), capped at B because it is self-rated. Grade C on speech understanding measured in a listening test: one double-blind trial against placebo hearing aids (Humes et al., 2017; PMID 28252160), which no second independent trial has repeated, so Rule 06 holds it at C. WHAT THIS GRADE DOES NOT COVER: severe or profound hearing loss and cochlear implants, which the trials did not test; loneliness, where the review found little to no difference; and memory and thinking, graded on its own record (hearing aids for cognitive decline).
What would move this grade
An independent randomized trial demonstrating a hard clinical endpoint -- mortality, major adverse event, or objectively confirmed functional improvement -- in an adequately powered sample, with results independently replicated, would support Grade A.
How to track whether this is working
Measured in the graded trials: word recognition on a speech-in-babble test with and without the hearing aids, and the Hearing Handicap Inventory for the Elderly. A hearing test (audiogram) defines mild to moderate loss.