Hearing Aids: Less Noticeable Than Hearing Loss
For: Wellness Made Easy, October 2003
Nobody is thrilled to be diagnosed with presbycusis: that’s the medical term for age-related hearing loss. And shopping for a hearing aid is not much fun either. But if you suspect your hearing is fading, keep the following in mind:
• While hearing aids were once associated with advanced age, many people in their forties and fifties wear them.
• The technology and appearance of the aids are much better than they used to be. Some models are almost invisible. In any case, a hearing aid is always less noticeable than hearing loss.
• A hearing aid can help you stay active and responsive—effective in your job, as well as in your social and personal life. Few handicaps are as isolating as loss of hearing.
• Hearing aids are especially effective for those with mild to moderate hearing loss. Yet only 20% of those who need them actually have them.
How hearing loss happens
Inevitably, as people get older, they suffer some hearing loss. By age 65 nearly a third of us have measurable hearing loss. Those born in the 1940s and later have been exposed to more loud noise than earlier generations—jet planes, jackhammers, rock concerts, stereo headphones, boomboxes—and thus hearing loss at younger ages is becoming more common: a government study found that presbycusis is 36% more common among men aged 45 to 65 today, compared to that age group in 1970.
Here are some signs of hearing loss:
• You often must ask people to repeat themselves. ("Why don’t they speak up?" you may find yourself wondering.)
• People complain that you play the TV too loud.
• You can carry on a conversation face to face in your living room, but you strain to hear in a noisy restaurant. Indeed, you’re reading lips. Or you just give up and sit silently.
• You’ve stopped going to the movies—the sound track always seems lousy. But your companion seems to hear quite well, which is even more annoying.
Protecting your pocketbook
Your first step is to get professional evaluation. Your primary-care physician can talk things over with you and do some preliminary tests, and then will probably refer you to an otolaryngologist (ear, nose, and throat specialist) or audiologist (not a physician, but a specialist in hearing testing and the fitting of hearing aids).
Having your hearing checked is not painful, but a complete test can cost up to $200. It’s important that these tests be conducted in a soundproof room, not in your home, which is one reason not to buy a hearing aid from a door-to-door salesman.
Make sure any audiologist you see is licensed. The American Speech-Language-Hearing Association (800-638-8255) will send you a list of licensed audiologists in your area. Most audiologists also sell hearing aids, but beware of those who offer only one type or one brand. Ask if you can have a copy of your audiogram (test results). Federal law says hearing aids can be sold only after the buyer has gotten an evaluation from a licensed physician; but if you are over 18, you can sign a form waiving the evaluation.
Hearing aids—wide choices
All aids contain four basic miniature parts: batteries, a microphone, an amplifier, and a loudspeaker to transmit sound into the ear. They come in four basic types: over- or behind-the-ear; in-the-outer-ear; in-the-ear-canal but still visible; and deep-in-the-canal and not visible. (There’s also the classic body-worn style, for those with profound hearing loss.)
The type of aid you need will partly depend on the kind of hearing loss you have. Each type has advantages and disadvantages: the tiny in-the-canal models hardly show, but are hard to adjust, and the batteries don’t last long. (Batteries may or may not cost a lot, but physically replacing them can be difficult.) In-the-outer-ear models have similar disadvantages. Many people dislike behind-the-ear models because they are so visible.
Generally speaking, the larger and more visible the aid, the better the amplification and the clearer the sound. But aesthetic considerations, understandably, often determine the choice.
Hearing aids vary not only in appearance and design, but also in their circuitry, which can be conventional (analog) or digital. Aids can also be programmable or disposable.
• Conventional aids have the most basic technology and cost the least ($600 to $1,200 per ear).
• Newer digital designs, which contain a microchip, can ad-just to different ambient sound levels—a great convenience for people on the move a lot ($1,400 to $2,500 per ear, or more).
• Progammable aids can be programmed by computer ($1,000 to $2,000 per ear).
• Disposable in-the-ear hearing aids are now available—you wear them for about two months and then change them. A year’s supply of the disposables costs about $400 a year per ear. That will add up over the years.
The audiologist you consult should be able to help you pick a model that suits your needs. Depending on your type and degree of hearing loss, you may be as well off with the less expensive models. There’s no "best" hearing aid. It’s a very personal decision: consider ease of use, comfort, looks, and performance.
A few pointers
• No hearing aid will capture sound as well as your own ears. Don’t expect perfection.
• Make sure you get at least a 30-day trial period with a money-back guarantee. If you return an aid, you may have to pay a small service charge and, perhaps, the cost of testing. Look for full refunds, if possible.
• It will take you a month, at least, to get comfortable with an aid, though you should notice improvement in a week or two.
• Find out what kind of training, assistance, and repair service will be provided. The hearing aid should be under warranty.
• If you need binaural aids (one for each ear), the audiologist may simply double the cost—or may offer a deal. It pays to shop around.
• Buying by mail order is not recommended. You need some-body to talk with.
• Tell the audiologist about yourself. Do you listen to music a lot? Maybe you need an aid with an extended frequency range to pick up treble as well as bass. If you often find yourself in meetings or large groups, you might want an instrument that limits background noise or frequency ranges.
• Try the aid in an ideal setting first—a quiet room, maybe.
• Consider an Assistive Listening Device (ALD) as an adjunct to a hearing aid. It is a small amplifier with earphones; when using one, you’ll look as if you are listening to a portable cassette player, so you may have to explain it to people. It transmits sound directly to your hearing aid via a switch in the aid. If you find that your hearing aid is less effective in certain situations—a noisy restaurant, for example—an ALD may help. They start at $50 and go up to $500. Try an inexpensive model first. No fitting or professional advice is needed.
What if you can’t afford it?
Many people do without hearing aids because of the cost. Most insurance plans, including Medicare, don’t pay for hearing aids. Some dispensers do have financing programs, but check the long-term interest charges. Local organizations sometimes can help, if your income level qualifies you.
The Better Hearing Institute (800-EAR-WELL) does not offer financial aid, but will send you a list of possible sources for help in your area. HEAR NOW (800-648-HEAR), another organization, supplies hearing aids to those who qualify for assistance. They also take donations of money or used aids if you want to dispose of one. The old aids are recycled: that is, some parts can be sold for reconditioning, and this money partially finances HEAR NOW. The hearing aids they provide are entirely new—not refurbished old ones.
UC Berkeley Wellness Letter, April 2002
