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Need a Hearing Aid? Get the Best Advice and Fit for You

What to do once you've recognized that you're experiencing hearing loss

By Bonnie Goldstein | June 29, 2012

To me, perfect hearing is achieved when my Bose headphones deliver rock music directly to my ears from my iPod. In less controlled environments, disappointingly, my reception is much less reliable.

For years, I’ve been asking people to repeat themselves, with the apology, "I’m hard of hearing." But recently I noticed I was saying it more often. I didn’t always understand them the second time around either, so I developed myriad ways to ask "Please say that again" — again and again.

(MORE: The Link Between Hearing Loss and Dementia)

This spring, my daughter, who is 40 and accustomed to my avoidance and procrastination, conducted an intervention. "Mom, I have to tell you something and you aren’t going to like it," she said. "You have to get hearing aids. You are mishearing what people say, then replying to what you think they said." She was right: My conversations had become a mix of random subject changes and odd tangents. "It makes you sound ridiculous," she said. I’d become Emily Litella.

Hearing loss is the third-most prevalent chronic health problem in older adults, after high blood pressure and arthritis. The U.S. Preventive Task Force recommends that everyone age 50 and older get a hearing test — and if the test indicates an impairment, getting it treated without delay. The most common type of age-related hearing loss, like mine, is caused by progressive damage to the hair cells of the inner ear and can be exacerbated by genetics, continued exposure to loud noise or smoking. There is no cure.

Problem is, I'd always had a deep aversion to hearing aids. My objections touched on self-image and appearance; the dread of another gadget forever requiring update and repair; and a bone-deep denial of aging and mortality. But I promised my daughter that, finally, I’d look into it. First, I needed to find an audiologist.

Seeking, and Paying for, Hearing Aids

An otolaryngologist, or ear, nose and throat doctor, can test and treat hearing loss and provide medical or surgical treatment. An audiologist, a specialist who typically has a doctorate in audiology, can assess hearing loss and its cause as well. If the hearing loss can be alleviated with hearing aids, an audiologist is equipped to prescribe and fit the appliances, or to arrange for cochlear implants or other therapies. (The difference between otolaryngology and audiology is similar to the distinction between ophthalmology and optometry.)

(MORE: Newest Hearing Aids: Better Sound, More Discreet)

A search of my insurance PPO plan yielded 21 audiologists in my area. I visited the closest, a Ph.D. who had been practicing 30 years. His office building screamed 1970s. My initial appointment took nearly two hours. The first thing the audiologist did was to remove wax from my ears, and I heard better immediately. The core of the exam was diagnostic audiometry testing, which involved a series of beeps in each ear. I then repeated one-syllable words after a recording of a man’s voice. The result confirmed my suspected loss, especially of more sibilant sounds like th and fff. And white noise had completely fallen away. My decline was equally steep on both sides. The prognosis: My auditory performance would be measurably improved by hearing aids.

The U.S. Food and Drug Administration regulates these instruments. The agency and many state health departments require that they be sold and fit by qualified health professionals, effectively prohibiting their sale over the Internet, though many marketers ignore this ban. More than 100 manufacturers make or import FDA-approved devices. Brands and styles vary, as do the quality, durability and accessories, but essentially, the gadgets are tiny digital microphones and transmitters housed in a plastic shell that fits inside the ear canal or gets hooked behind the ear. You can buy a standard model from specialists at in-store clinics inside retailers like Costco or Sears.

One can purchase a pair of hearing aids for as little as $2,000, but the retail price of the highest-end appliances can be closer to $5,000. Accessories are extra, as are batteries. (Considering the technological advances of the past decade, I’m surprised the modern version of an ear trumpet still runs on non-rechargeable batteries that may last only a few weeks.) Health insurance rarely reimburses the cost, unless you are a veteran or enrolled in the Blue Cross and Blue Shield plan for federal employees. Medicare classified hearing aids as a “luxury” item when the plan became law in 1965. Nearly 50 years later, basic Medicare still excludes hearing aids. (Some private Medicare D prescription plans have an allowance for certain house brands). My health plan includes "the purchase, examination or fitting of hearing aids" on its list of "exclusions and limitations."

I purchased a pair of Phonak Cassia M H20 devices in mocha taupe, made in Switzerland. They cost $1,850 each, plus a $450 fee to have them adjusted to offset my particular impairment. They are the "open ear" style, and include a small rubber tip on a thin plastic tube that inserts deeply into my aural passage and feels as if it is touching the edge of my brain.

Americans purchased $5.7 billion worth of hearing aids and audiology devices in 2011. The market is expected to reach $8 billion annually within six years. According to Consumer Reports, the typical markup on hearing aids from wholesale to retail is more than 100 percent. I asked my audiologist if the price was negotiable. "Not from me, it's not," he answered. (Historical note: My first new car, a 1972 Plymouth Duster, cost roughly the same as just one of my new auricle accessories. On the bright side, the hearing aids are easier to store.)

Adjusting to Life With a Hearing Aid

I used to be a television producer and the sound I hear when my aids are transmitting reminds me of the headphones worn in a control booth. Paper shuffling, birds tweeting and pens scratching add up to a constant racket. I can even hear my hair moving. Unfortunately, my aids do not have a volume adjustment feature. For that, I would need to purchase a small remote control for several hundred dollars, or trade up to a slightly larger model.

(MORE: How to Manage Hearing Loss)

My family encourages me to persevere with the new devices. They insist my brain will soon adjust and filter out low repetitive noises. For his part, my son said he was glad I got the aids because "now I know you hear me when I talk to you," though he added, with a grin, "listening is still a problem."

In one of my first outings with my tiny electronic trumpets, I had lunch at the neighborhood pancake house with my husband and son. The cacophony of clattering silverware, humming air conditioners and kitchen chatter came in so loudly I wanted to rip the little speakers out of my ears. Then I noticed, at the next table, a young dad in a Marine haircut, wearing a streamlined, multicolored, prosthetic leg, feeding his little boy in a highchair. When our meal was served, the toddler was under the table patting his father’s state-of-the-art artificial limb. I stopped noticing my discomfort and began to appreciate the small graces of an appliance-assisted life.