Your guide to options and financial help

Last updated 01/13/2017

Is there any way I can avoid age-related hearing loss?

You can do things to minimize hearing loss, but so far there’s no way to avoid age-related hearing loss if you’re genetically predisposed to it.

About one-third of people over the age of 65 have hearing loss. By the age of 75, it rises to about half.

 

Co-produced with the Commission of Deaf, DeafBlind & Hard of Hearing Minnesotans.


Know what’s happening as your ears age.

 

The-Human-Ear_474729752Credit: Getty Images
Age-related loss is called presbycusis. It’s caused by deterioration in the functioning of the inner ear. That’s where the cochlea, a snail shell–shaped passageway, turns sound waves into electrical impulses. Those impulses travel up the auditory nerve, also called the cochlear nerve, to the brain, which is where hearing really happens. Sensory hair cells in the cochlea can atrophy with age. A core membrane inside the cochlea called the organ of Corti can also stiffen and become less sensitive.

However, it’s hard to say in most people whether age is the only cause of their hearing loss. The cochlea’s hair cells can also be damaged by exposure to noise. A lifetime of being around anything from lawn mowers to loud music can destroy the cells, which the body does not regenerate. In most middle-aged and older people, hearing loss is probably due to both noise exposure and age.

 

 


Cut back on noise to keep the hearing you have.

Repeated or prolonged exposure to anything over 85 decibels will harm your inner ear. Even city traffic can generate that level of noise.

Your hair dryer or lawn mower might register at about 90 decibels. A power drill can put out 100 decibels and start to do damage after only 15 minutes. Music turned up and played through earphones can easily reach 105 decibels.

Turn down the volume or move away from loud sounds like sirens when you can. Cover your ears with your hands temporarily or wear ear protection.

Sudden loud noises at close range can cause hearing loss that’s immediate, but most damage caused by noise happens gradually. You won’t notice the effects until they’ve accumulated over time and hearing loss starts to interfere with your conversations and your ability to enjoy the things you want to do.


Choose ear protection that works for you.

The best kind of protection is the kind you’ll use.

Most types of hearing protection are not very expensive. A set of earmuffs might cost you $15 to $20. Earplugs cost $1 to $2 a pair or much less if you buy disposable foam plugs in a bulk package. You can find protection for your ears at home improvement, sporting goods, discount and drug stores or online. Find more about the pros and cons of different types of protection in the list below.

Follow the instructions for whatever protection you choose. When people don’t get good protection from earplugs or earmuffs, it’s often because they don’t insert or wear the devices correctly. There are tips for making even simple foam earplugs work their best:

Hearing protection devices are labeled with a number that represents the level of protection they’ll give. It’s called a noise reduction rating, or NRR, and it can be as high as 33 decibels. NRRs are required by law and they’re determined through laboratory testing by the American National Standards Institute.

But you should know that the usefulness of noise reduction ratings is limited. For one thing, the numbers are a composite of test results, so they can never accurately reflect what will happen with your unique ear anatomy and circumstances. Also, the results are achieved under ideal conditions, where a professional made sure that test subjects were perfectly fitted with the earplugs or other devices being tested and the sounds were consistent from test to test. In actual usage, the variables are much less controlled. As a result, the NRR is only an indicator of potential protection levels, not a measure of actual protection.

In fact, industrial safety professionals use formulas that dramatically discount NRRs to estimate how much real protection their workers are getting. Using one common formula, an NRR of 27 decibels on the package becomes an estimated 10 decibels of real protection in a worker’s ear. That’s still significant protection, but it shows that you can’t take the ratings at face value.

Here are common types of ear protection and advantages and disadvantages for you to consider:

Expandable Foam Earplugs
Made of memory-type foam. You roll them into a narrow cylinder, insert into your ear canal and wait 20 to 30 seconds for the foam to expand and fit itself to your ear.
++ Inexpensive and widely available in bulk for around 10 cents a pair. Corded versions that you keep around your neck run about 20 cents a pair.
–– In an environment where your hands are dirty, it’s hard to remove and reinsert the plugs as needed.

Non-Custom Molded Earplugs
Firmer plugs of silicone or similar material pre-molded to small, medium and large sizes or to a more generic one-size-fits-most.
++ Still inexpensive, around $1 per pair and up. Washable and reusable.
–– You might need a different size for each ear and will need to experiment to find that out. Getting a good, effective fit can be difficult.

Custom-Molded Earplugs
Also made from silicone or similar material, but custom fitted to your ear. The earplugs are made using a plastic mold that is cast from your ear. You can order custom earplugs online or buy them from an audiologist.
++ Good for people with hard-to-fit ears.
–– If you get professionally made custom plugs, you’ll need an audiologist to make a cast of your ears. The cost ranges widely, but can be $50 or more per ear. Custom earplugs themselves generally cost $100 or more for a pair. If you decide to make your own do-it-yourself custom earplugs from a kit, you can get by for under $50 total but your results might not be as good as what a professional can achieve.

Canal Caps
These cover the opening of the ear canal, but aren’t inserted into the canal. They’re on a metal or plastic band that you wear as you would headphones.
++ Easy to use and to put on and take off repeatedly. You can keep the band handy around your neck. Relatively inexpensive at roughly $5 and up.
–– You might find the pressure from the headband uncomfortable.

Earmuffs
Because they enclose the whole ear, earmuffs can be some of the best protection if they fit you well. Prices range widely, starting at $15 to $20. Many good options exist at that low end of the range.
++ Easy to put on and take off. Some have features to help you hear speech, listen to music, etc.
–– People sometimes find them too heavy, too warm or don’t like the feeling of pressure on their head. If you have a beard or wear glasses, it can be hard to get a good snug fit and you’ll lose some protection.


Use medications with caution; some can harm your ears.

Some prescription and over-the-counter drugs are ototoxic, meaning they have the potential to damage the inner ear. They can cause hearing loss, tinnitus (commonly known as ringing in the ears) and balance problems.

For many people, the risk of hearing loss from medications is low, but there are situations where the risk is elevated:
• you have a personal or family history of hearing loss, tinnitus or dizziness
• your kidney function is diminished (most ototoxic drugs are cleared from the body by the kidneys)
• you take more than the recommended or prescribed dosage
• you take more than one ototoxic medication
• you take a medication that is especially ototoxic, such as certain chemotherapy agents and antibiotics

There are about 130 drugs recognized as ototoxic, including some that are obsolete or rarely prescribed anymore. Here are a few of the more commonly used medications that are linked to hearing loss.

AspirinCredit: Thinkstock
Salicylates
Includes aspirin and the ingredient methyl salicylate, which is found in many creams and ointments used for sore muscles and back pain or joint pain

Aminoglycoside Antibiotics
Examples are streptomycin, gentamicin and neomycin

Atineoplastics
A family of drugs used for chemotherapy, including cisplatin and carboplatin

Loop Diuretics
These include furosemide, which goes by the brand name Lasix

One sign that medication is affecting your inner ear is the onset of tinnitus, or ringing sounds. If you suddenly have this problem or you had it earlier but now it’s worse, let your doctor know. Another sign you might experience is a feeling of pressure or fullness in your ears. If you do suffer drug-induced hearing loss, in most cases it will reverse itself when you stop taking the drug.

Don’t stop taking a prescribed medication on your own, however. Even if a treatment carries risks for your ears, it might be vital to your health in other ways. Instead, talk with your doctor about protecting your ears and about any effects that you’ve noticed.

Not everyone winds up with inner ear damage from an ototoxic medication. The effects of a drug will vary from person to person, and with the dosage and length of use.

To be proactive about your hearing, ask about potential side effects when anyone prescribes medication for you, including effects on your ears. Do the same for the over-the-counter remedies you use; a pharmacist can answer your questions about OTC products. Be sure that when you ask questions you also give accurate information about all of the medications you currently use and how much you take, including OTC items.

Using alternative treatments, taking lower doses, or avoiding taking multiple ototoxic medications at once can reduce the chance that your ears will be harmed.

If you need to take a medication that carries a significant risk of hearing loss, ask for a baseline hearing test before you start treatment so you and your doctor can monitor the effects.


Shed extra pounds and stay fit.

weightThis advice might surprise you when it comes to hearing loss, but your overall health does make a difference. Research shows a correlation between diabetes and hearing loss. Studies have also found a link between hearing loss and high blood pressure. Being overweight increases your risk for both of those chronic diseases.

More research is needed to understand exactly how diabetes and high blood pressure are a factor in hearing loss. What is known is that both conditions damage the vascular system. So one possible explanation researchers are looking at is that these diseases damage the tiny blood vessels that nourish and sustain the inner ear.

Another tip: Stop smoking, if you do, and avoid exposure to secondhand smoke. Both have been linked to a higher likelihood of hearing loss as you age.


I think I’m already losing my hearing, how can I tell for sure?

If you’ve noticed that you have trouble hearing or if people close to you say you do, that’s a good indicator that you have a problem. But it doesn’t tell you anything about the cause or the extent of your hearing loss, and it doesn’t move you closer to a solution.

The only way to really know what’s going on with your hearing is to be examined and tested.

Medical doctors are the only ones qualified to do a medical exam. Sometimes they’ll do a preliminary hearing assessment, too, but usually they’ll refer you to an audiologist for a more thorough assessment. Audiologists have extensive training and professional certification but no medical degree.

Hearing loss is caused by more than just age or exposure to noise. A few other causes are infections, medications, head injuries, strokes and tumors. Even a buildup of earwax (the medical term is cerumen) can cause significant loss. To get the right treatment, you need to know the reason for your hearing loss.

If you think you might have hearing loss, it’s a mistake to ignore it or dismiss it as a normal part of aging. Left untreated, it can lead to social isolation and strained relationships. Research is also finding an association between hearing loss and dementia, hearing loss and depression and hearing loss and reduced income.

Co-produced with the Commission of Deaf, DeafBlind & Hard of Hearing Minnesotans.


Watch for these signs.

Many people with age-related loss start to notice it in their 50s. High frequencies are typically the first to drop out. So the high-pitched voices of children might be harder to hear. The same is true for the small differences in sound that help us hear consonants, distinguishing an “f” from a “v” or an “s” from a “th.”

You might also notice that it’s harder to catch someone’s words when you have to do it against a backdrop of other noise, as in a restaurant.

Maybe you fake your way through conversations because you don’t want to keep asking people to repeat themselves. Or you feel stressed from always straining to hear. Or you find that misunderstandings are making you irritable and causing quarrels at home.


You can take online quizzes that help you gauge whether you have hearing loss. There are also online hearing tests you can take on your own. One of the best is the National Hearing Test developed by the National Institutes of Health. Do-it-yourself online tools can raise your awareness and get you moving toward a medical exam and professional hearing assessment, but they’re not a substitute for professional help.


Don’t wait for your doctor to bring up the subject, you’ll need to do that.

You might expect your primary care doctor to notice if you have hearing loss and talk with you about it. That’s unlikely. Your contact with your doctor is fairly brief, and under current best practices in health care infants are routinely screened for hearing loss, but adults are not.

So you need to bring up the subject. Your primary care doctor can screen you to identify likely hearing loss. Screening means asking you questions and maybe doing preliminary tests of your hearing. A primary care doctor can also treat some of the health problems that cause hearing loss.

But to know the extent and type of hearing loss that you have and to get treatment for certain causes of hearing loss, you’ll need to see specialists, usually an ear, nose and throat doctor and an audiologist.


Be aware there are serious risks with hearing loss.

Get treatment. If you’ve been putting it off, you’re not alone. Most people with hearing loss wait seven to 10 years before they get help, typically in the form of hearing aids.

But waiting comes with a cost. Age-related hearing loss is progressive, so it will get worse over time. You’ll have an increasing risk of social isolation and other physical, emotional, and financial problems associated with hearing loss.

Risks to Your Health
Hearing loss is associated with other serious health problems: depression, cognitive impairment and risk of falling. Whether and how hearing loss directly causes these problems is still being investigated, but they go hand in hand with hearing loss for many people.

Risks to Your Relationships
There’s a strain on your quality of life and your relationships when poor hearing creates misunderstandings. If you avoid social situations because you can’t hear, it can lead to resentment from others. Opting not to get treatment also sends a hurtful signal to the people close to you, namely that you don’t care enough to want to hear them.

Risks to Your Finances
A 2013 study looked at data on more than 900,000 people who had been diagnosed with hearing loss and found that they were more likely to be unemployed or underemployed and that they earned, on average, 25 percent less than people without hearing loss. So far, research only shows an association between these things, not a causal relationship. But it’s not hard to imagine the ways that unrecognized, untreated hearing loss could affect your relationships and performance at work.

Risks to Your Safety
Think of all the warning sounds you rely on: smoke and carbon monoxide detectors, weather alerts, noises around the house, an oncoming car when you’re on foot or a bike. If you’re driving, you need to hear approaching sirens, horns, and other cues. And you cause confusion for other drivers when you forget to turn off a turn signal that you can’t hear.


Take steps on your own until you can get professional help.

Notice the situations that are the most challenging for you and make adjustments to help yourself succeed in those settings. This will be easier if you let people know about your hearing difficulties. (By the way, these same tips can help if you’re a new user of hearing aids.)

• Ask coworkers, friends and family to get your attention before they start talking. They can do this by stepping into your field of vision and making eye contact or with a gentle tap on the shoulder.

• Position yourself where you can see the person talking to you. Avoid conversing with someone when they’re standing behind you, have their back to you, or have their face in darkness. Ask family members not to start a conversation with you when they’re in another room. In meetings at work, try to sit directly across from the person who’s making a presentation.

• Focus on the conversation at hand. Looking at your phone or working on another task makes it impossible to have a good conversation, even when you can hear perfectly.

• Ask people not to raise their voices and to rephrase instead of repeat. Shouting tends to distort sounds. If a particular combination of words is giving you trouble, different wording might be easier.

• Tell people specifically what you need help with. Summarize back to them what you did hear and ask them to fill in just the piece of information you missed. Ask them to move their hands away from their mouths or to slow down if that’s what would help.

• Mirror back to people what you think you heard. If you’re not sure you understood, repeat what you think you heard and ask for confirmation.

• Remove background noise when you can. Turn the TV or radio down or off when you want to talk with someone. Step over to a less noisy spot at a party. Choose quieter restaurants or go at less busy times.

• Use the induction loop or FM assistive listening systems provided at public events. Some theaters, concert halls, meeting rooms and places of worship have listening systems available for you to use. They transmit the speaker or performer’s voice directly to a small receiver and set of headphones or earbuds that you wear.


Use personal tech devices for now.

You can get hearing help from tech devices without getting hearing aids. Start by looking into the ways you can use your smart phone.

There are phone apps that amplify sound. You can use them alone, relying on your phone’s built-in microphone to pick up sound and using a set of earbuds to deliver it to your ears. Or you can pair an app with a plug-in directional microphone, which might do a better job of pulling in sound from a person seated across the table from you. That kind of set-up could be enough to help you in situations like restaurants or meetings until the day when you’re ready and able to get hearing aids.

The array of apps available is always changing along with the hardware they run on, and this guide doesn’t attempt to list apps or review them. But you can easily start learning about them with a search such as “apps for hearing loss” or “apps that amplify sound” on Google or another search engine, or by searching for “hearing loss” within an app store.

Other apps can help in other ways, for example letting you stream sound from a Bluetooth enabled device, like your smart TV, directly into your earbuds.

Aside from apps for your phone, another worthwhile search is for “assistive devices” or “assistive technology” for hearing loss. That can include devices such as pocket-sized amplifiers that you wear with a set of earbuds or headphones, but also things like smoke detectors, weather radios and doorbells equipped with flashing lights for those who don’t hear well.

Finally, a rapidly growing category of devices in recent years are small amplifiers that look like hearing aids. They’re called PSAPs, for personal sound amplification products. Because they are not required to meet Food and Drug Administration standards like hearing aids are, they can’t be called hearing aids. And because they’re unregulated, their quality and performance is all over the map.

However, PSAPs are gaining credibility and some perform nearly as well as hearing aids for a much lower price—hundreds instead of thousands of dollars. If you decide to shop for PSAPs, try to learn about the companies that make them and what kind of expertise has gone into the product. Soundhawk, for example, is a brand that has received favorable attention from audiologists for its performance, and that’s probably because the products are developed by engineers who formerly designed FDA-approved hearing aids.

As with other hearing questions, your doctor or audiologist can be a good resource when it comes to finding helpful non-hearing aid devices and technology.

Co-produced with the Commission of Deaf, DeafBlind & Hard of Hearing Minnesotans.


Where do I go for help with my hearing loss?

Hearing loss is a health issue. It has a number of possible medical causes and significant health consequences. So at least initially, the kind of help you should get is health care from your family physician or an ear nose and throat doctor.

It’s possible to buy hearing aids — often at substantial savings — by ordering online or shopping at big-box discount retailers. So for cost reasons, you might ultimately choose to take a detour from the traditional path of getting hearing aids from a doctor’s or audiologist’s office and go to these alternative suppliers instead. But to start with, give yourself the best possible opportunity to uncover health issues and deal with them safely by seeing a doctor.

Cost is one of the biggest reasons people put off getting help with their hearing loss. A pair of hearing aids — which is what most people need — can easily cost several thousand dollars. But when you think about cost, be aware that factoring it into your decisions isn’t as simple as comparing the price of one hearing aid to another. Here are a couple of examples to illustrate why that’s true:

• If you buy hearing aids from a discounter, you could be choosing to stick with that provider for the life of the hearing aids, whether you’re satisfied with their service or not. Some sellers program their hearing aids using proprietary software — ask about this when you’re shopping. You could decide later that you want to work with a different audiologist to adjust your hearing aids and find that it isn’t possible. In other words, the discount price might come with an offsetting cost in terms of your satisfaction and your freedom to get the help you want.

• The traditional path to hearing aids — physicians and audiologists — isn’t always cost prohibitive. Many are sympathetic to the cost challenges their patients face and  try to help by offering basic low-cost hearing aids in their mix of options for patients or helping patients choose less-expensive non-hearing aid devices. Some audiologists will negotiate prices if asked and will occasionally work with manufacturers to get price breaks or free hearing aids for patients in need.


Know the difference between a doctor, an audiologist and a hearing aid dispenser.

Even though they overlap in the services they provide, there are big differences in the training they have and what they’re qualified to do.

Physicians
They have medical degrees and years of clinical training and experience. They are the best qualified to diagnose health problems, including problems with hearing. In particular, ENTs (ear, nose and throat doctors) have extensive knowledge of how to medically and surgically treat disorders of the head and neck, including the ears.

ENTs are also called otolaryngologists and some are called otologists. Otologists have the highest level of specialized training related to the ears—the same training as other ENTs, plus an additional two years of residency focused on ear health and disorders.

Audiologists
They do not have a medical degree and are not physicians. Instead, audiologists have a doctoral degree in the science of hearing and balance. They’ve had training in a clinical setting on the prevention, diagnosis and treatment of hearing and balance disorders, and they are licensed by their states. Audiologists can’t prescribe medication or do medical procedures to treat the ear, but they can do a thorough hearing assessment and provide hearing aids or other devices that are an effective match for your specific pattern of hearing loss.

A physician might refer you to an audiologist. Audiologists are sometimes located in the same medical office as a physician, others have a standalone practice or work in a retail setting. You can also skip seeing a doctor and go directly to an audiologist.

Hearing Aid Dispensers or Hearing Instrument Specialists
Under varying titles, dispensers are licensed by their states to do hearing assessments, but only for the purpose of fitting someone with hearing aids. They have no medical training and cannot do a medical or audiological exam.

Requirements vary from state to state, but the training for hearing aid dispensers is always far less rigorous than it is for audiologists. A dispenser might need, for example, a two-year college degree in any field and six months of job-specific training, then a passing score on the licensing exam.


Find out what your health insurance or Medicare will cover.

Conventional wisdom says you’re on your own when it comes to paying for hearing exams and hearing aids, but that’s not entirely true. While some health plans, including Medicare, give no coverage, some private insurance plans give at least limited help.

Medicare
It’s a surprise to many people to learn that Medicare — Part A and Part B, the original parts of the program — does not cover hearing aids. Likewise, the Medicare supplemental coverage known as Medigap insurance doesn’t cover hearing aids. Also not covered are hearing exams, unless they’re for diagnostic purposes beyond getting hearing aids.

However, if you have a Medicare Advantage plan (that’s Medicare Part C, an alternative to buying Part A, Part B and a Medigap supplement) you might be eligible for some coverage of your hearing aids and exam.

Private Insurance
This includes Medicare Advantage plans, plans offered by employers, and plans you buy on your own from insurance companies. The only way to know what a private insurance plan covers is to call your insurer and ask.

Some private insurers provide an allowance — it could be $500 or $1,500 or another amount — toward hearing aids. Often, it’s a dollar amount that you’re eligible to claim at a specified interval—every three years, say, or every five years. Get specific answers from your insurer by asking detailed questions:
• Does my plan cover a hearing exam for purposes of getting a hearing aid?
• Do I have to have a certain kind or degree of hearing loss to get coverage of my hearing aid?
• Do I have to buy a specific brand or type of hearing aid?
• Do I need to choose from a certain set of providers to qualify?
• Can my provider bill the insurance company, or will I need to pay the full cost up front and apply for reimbursement from the insurance company?

State regulations that apply to insurers often mandate coverage of hearing aids for children, but not nearly as often for adults. But a few states do require insurers to give at least partial coverage to adults. New Hampshire requires coverage of at least $1,500 per hearing aid every five years. In Rhode Island, it’s $700 per hearing aid every three years.

To comply with the age discrimination protections of the Affordable Care Act, Connecticut told insurers they must provide the same coverage to adults as to children for all insurance policies issued or renewed starting January 1, 2016. The minimum coverage required is $1,000 every two years.

Arkansas requires insurers to offer hearing aid coverage to the state’s employers, who can decide to decline it. But if a company includes the coverage in its employee health plan, the minimum the insurer must provide is $1,400 per hearing aid every three years.

FSAs, HSAs and HRAs
Hearing aids and batteries are qualifying expenses, so you can use your FSA (Flexible Spending Account) and HSA (Health Savings Account) dollars to cover them, if you have such accounts.

The rules for HRAs (Health Reimbursement Accounts) are different, and they’re set by individual employers. If an HRA is the type of health fund your company provides, ask your human resources department whether hearing aids are a qualifying expense.

If you’re eligible for veterans’ benefits or medical assistance, those are other ways to get coverage of your costs.


Come ready for your hearing exam.

Hearing-Loss-Guide_Pure-Tone-Test_185232658Credit: Getty Images
Come to your appointment ready to tell about any changes you’ve noticed in your hearing and your health. Bring along a list of all the medications you take and the dosages. Include over-the-counter items, vitamins and other supplements.

Be ready to tell about your work history, and especially any jobs or other experiences where you were exposed to prolonged noise or sudden loud noise, even if it was many years ago.

A doctor or audiologist will do a physical examination of your ears. Then you might have several types of tests, particularly if you’re visiting an audiologist. Here are two of the most common.

• Pure-Tone Test: You wear earphones and use verbal or hand signals to indicate when you’re able to hear the tone being played. It shows the lowest volume at which you can hear sounds of varying frequencies.

• Speech Tests: You’re asked to repeat or recognize words, sometimes against a backdrop of other sounds. This shows the lowest volume at which you’re able to decipher speech.

An in-depth hearing assessment takes as much as an hour and results in a chart called an audiogram that maps our your specific hearing ability and hearing loss.


Learn what “mild” or “severe” hearing loss means.

The degree of hearing loss someone has is defined by the decibel range of the loss. If very soft sounds, in the range of 16 to 25 decibels, are the ones you can’t hear, that’s defined as a slight loss. If much louder sounds, in the range of 71 to 90 decibels, are what you can’t hear, that’s called a severe loss.

What really matters for you, though, is not a number or a label but how much the loss impacts your life. Depending on what you do for a living or in your free time, even a slight loss can be a big detriment.

Here’s the full range of hearing loss, defined in decibel terms:
Normal   -10 to 15
Slight   16 to 25
Mild   26 to 40
Moderate   41 to 55
Moderately Severe   56 to 70
Severe   71 to 90
Profound   91 and above

You might have a different degree of hearing loss with high-pitched sounds than with low-pitched sounds. That’s a common attribute of age-related hearing loss.

The specific ability that you have across different frequencies of sound is called the configuration or pattern of your hearing loss. By mapping it on an audiogram and understanding your specific pattern, an audiologist or other professional can program and adjust your hearing aids to work best for your unique needs.


Don’t feel pressured to buy anything.

Being tested does not obligate you to buy hearing aids at the same place or to buy hearing aids at all.


What’s the smartest way to shop for hearing aids?

There is no single best way to go about it, but there are some key ideas to keep in mind:

Your needs are unique.
The hearing aid that someone else thinks is perfect could be a bad pick for you. Because your pattern of hearing loss, the way you spend your work and leisure time, your preferences and what you find comfortable all make up a unique set of needs, you should take published hearing aid reviews and the recommendations of family and friends with a big grain of salt.

For similar reasons, “more expensive” and “more features” don’t necessarily equal “better” for you.

Anyone selling you a hearing aid should be intensely interested in how you spend your days.
If a provider is just talking about products and features and not trying to get a picture of how you live and what you need, walk away. You’ll do better buying from someone who wants to make a good match between you and the technology.

Ask lots of questions.
The Hearing Loss Association of America, a nonprofit made up primarily of people with hearing loss, offers a checklist that you can take with you to audiology appointments and on hearing aid shopping trips.

In particular, be sure you understand and get in writing the purchase terms and return policy for any hearing aids you’re considering. There is generally a trial period of at least 30 days, but you’ll want your provider to put on paper the dates when the trial period starts and ends, and whether the clock stops if you bring the hearing aids in for an adjustment or repair during the trial period.

different-kinds-of-hearing-aids_185245829Credit: Getty Images

Know what to expect cost-wise.

The average retail price of a hearing aid is $2,363, according to an October 2015 report from the President’s Council of Advisors on Science and Technology, which has advocated ways to bring costs down. Most people need two hearing aids, so that doubles the expense, to an average of $4,726.

Those are averages, so prices range much lower and much higher. Your actual cost will depend on the specific hearing aids you buy and the features you want.


Reduce your cost.

If you’re starting to shop for hearing aids, you’re coming to the project at an interesting time. There’s already some downward pressure on prices as manufacturers and providers feel competitive pressure from personal electronics.

Adding to that, the Food and Drug Administration is showing new openness to the idea of over-the-counter hearing aids. Over-the-counter devices called personal sound amplification products (PSAPs) are completely unregulated. As a result, some work well while others are junk, not worth buying even at a bargain price. Official recognition and oversight of the category could make PSAPs a more reliable low-cost option for consumers.

Meanwhile, there are things you can do on your own to try to reduce the cost of your hearing aids:

Negotiate
Consumer Reports found an average markup of 117 percent from the wholesale to the retail price of hearing aids, which leaves room to negotiate. Most people aren’t used to bargaining back and forth on the price of medical devices, but in a survey of 1,100 hearing aid owners, Consumer Reports found that 15 percent of them had negotiated and among those, 40 percent had succeeded in getting a lower price.

Compare
If a provider carries only one brand of hearing aid, talk with at least one other provider who carries several brands. You want a chance to compare capabilities and prices.

Unbundle
Ask your provider to show you a list of itemized, or “unbundled,” costs. You want to see separate charges for the hearing aid and each of the support services your provider is proposing to you. Then you can make a clear comparison between hearing aids and providers, and decide which services you do and don’t want. Be aware that unbundling is relatively new and not all providers are willing to share itemized prices, so this could take some extra shopping around.

Buy from a Discounter or Directly from a Manufacturer
You could think of this as a variation on unbundling. You can often get a more attractive price on hearing aids themselves by ordering from a manufacturer online or going to a big-box retailer. It’s another way to separate the cost of the devices from the bundle of support services that come from an audiologist.

One caution, however: Sometimes the hearing aids that you buy this way cannot be adjusted by anyone other than the company you bought them from, so you could be closing off the option of working with the audiologist you’re interested in. Ask about this before you buy.

Typically, an audiologist’s services include things like follow-up visits to adjust your hearing aids based on your experience using them; coaching on how to use your aids effectively, and auditory rehab. Those can be valuable supports, since it often takes time, adjustments to the devices and practice to get the full benefit from hearing aids.


Understand the basics about hearing aids.

Compensation, Not Restoration
No hearing aid, no matter how advanced, can restore your hearing. Hearing aids will help you compensate for what you’ve lost by amplifying the sounds you want to hear; many also have technology to dampen background noises that interfere with hearing. But hearing aids can’t “correct” your hearing the way eyeglasses correct your vision. For most people, it takes a period of adjustment — to the devices and to their own habits — to use hearing aids effectively.

Technology
Almost all hearing aids are digital now, meaning they have digital processors that can enhance the sound picked up by the microphones before delivering it to your ear. Digital hearing aids are customizable and programmable in ways that old analog hearing aids were not. You might want different settings at the gym, in a coffee shop, at home, and at work, for example. Many features are now standard, including feedback management systems that quash the old problem of whistling.

Configuration
When shopping for hearing aids, it’s easy to feel overwhelmed by the huge array of features and different brand-related names for them. But there are still just a few basic types of hearing aids. They’re often referred to by their initials: completely in the canal (CIC), in the canal (ITC), in the ear (ITE), and behind the ear (BTE). Here’s a description of each of those configurations along with a few of the pluses and minuses you might experience:

Completely in the Canal (CIC)
++ Very small and the least visible type of aid. Because it sits deep in the ear, it doesn’t pick up wind noise.
–– Not much space to house features or increased amplification capacity, which you might need over time. Small battery size generally equates to shorter battery life. If you have dexterity problems, tiny CIC hearing aids and batteries can be difficult to handle. CICs, like all types of hearing aids that sit in the ear canal or outer ear, are vulnerable to wax plugging up the speaker.

In the Canal (ITC)
++ Similar to the benefits of a CIC, plus ITCs have a little more room for features and amplification capacity.
–– Again, similar to CIC hearing aids.

In the Ear (ITE)
++ Enough room for many features and strong amplification. Longer battery life and easier handling than with smaller types of hearing aids.
–– Easily visible, if that’s a concern. Like other types of hearing aids that sit in the ear or ear canal, ITEs can give you a “plugged up” feeling, especially if they don’t have good venting. The plugged sensation produces something called the occlusion effect, in which sounds that you produce—your own voice or chewing sounds—seem overly loud and have a strangely booming and interior quality, as if you were under water.

Behind the Ear (BTE) with Receiver in the Aid (RITA)
++ Easy to handle, clean, and change batteries. A housing that sits behind the ear contains all the essential parts of the hearing aid: microphone, processor, and receiver (speaker). Tubing that runs over the top of the ear connects the housing to an earpiece that sits in the ear canal and delivers the sound. BTE RITA aids have enough amplification capacity for anything from mild to severe hearing loss across a full range of frequencies. Earpieces can be non-custom open-fit pieces or custom-molded. The open fit is comfortable for many people and creates a more natural hearing experience if you have high-frequency hearing loss (very common in age-related hearing loss), because the partially open ear canal can keep processing low-frequency sounds on its own.
–– Traditional BTE RITA hearing aids are fairly visible, though some now come with smaller housings, tubing, and earpieces. BTE aids are susceptible to picking up wind noise because the microphone is outside the ear, which might be bothersome if you like outdoor activities.

Behind the Ear (BTE) with Receiver in the Canal (RITC); also called Receiver in the Ear (RITE) and Canal Receiver Technology (CRT)
++ Smaller than traditional BTE hearing aids because the receiver sits in the ear and doesn’t have to fit into the behind-the-ear housing. (As noted, however, even traditional BTE RITA hearing aids now come in smaller sizes.) A thin wire connects to the earpiece and is less visible than standard tubing. As with other BTE aids, the earpiece can be custom-molded or a non-custom open-fit piece.
–– In-the-canal receivers are susceptible to damage from sweat, wax and oil and might need to be replaced.


Focus on just the features you’ll use.

Some of the most universally helpful features have become fairly standard and are built into most hearing aids. They include:
• a telecoil (Tcoil) to help you hear better on the phone and take advantage of induction loop, FM, and other hearing systems built into public places
• directional microphones that pick up more of the sound you want to focus on and help minimize background noise
• binaural processing, which means your two hearing aids will work together, more closely mimicking the way your ears work together
• direct audio input, which lets you send sound from your television or an MP3 player directly to your hearing aid, without the interference of ambient noise.

Increasingly, hearing aids have Bluetooth capabilities and connect wirelessly to your smart phone and other devices. Some have data logging and self-learning features so they learn and automatically adjust themselves to your preferences in different situations.

Expect challenges if you’re trying to do an apples to apples comparison of hearing aid features. There are many brand-specific names and variations. Ask providers to help you by giving you more generic names for these capabilities when they describe them to you.

Your own interests and preferences will help you recognize that some features aren’t useful to you. Save money by skipping them. Another savings opportunity is less obvious, and that is not to buy into the highest number of sound-processing channels available. Multiple channels allow for higher-definition sound. It’s akin to having a high-definition image on your TV screen. But beyond 10 or so channels, your ears can’t really perceive the difference in resolution. So paying more for a hearing aid because it boasts two dozen channels doesn’t make sense.

If you have a wish list of features, be aware that not every type of hearing aid can house every kind of feature. The smaller the hearing aid, the less room there is there is to build in extras. Audiologists and manufacturers will work with you to suggest alternatives—either a different feature set or a slightly larger hearing aid—if what you ask for doesn’t fit. Sometimes the issue is your unique ear anatomy, if you’re getting a hearing aid that has custom-molded parts.


What if I can’t afford hearing aids?

You’re not alone. In fact, trouble affording hearing aids is such a common problem that a large network of support resources exists for you to tap into, from the hearing industry itself to nonprofits to local and federal programs.

It takes time to find help you qualify for, but there are a couple of shortcuts open to you. One is to use the links in the next few sections of this guide. Another is to ask your doctor or audiologist to recommend resources to you. Over time, they’ve probably helped other people who had cost questions and might be able to recommend programs that could work for you.


Use your veteran’s benefits.

Military salute memorial day1Credit: Civil Beat
If you’re a veteran who receives or is eligible to receive health care in the Department of Veterans Affairs system, your benefits include coverage of a hearing exam and hearing aids (scroll down here to the section on “Sensory and Prosthetic Aids”). Coverage even extends to repairs and the ongoing supply of batteries you’ll need.

Contact a VA office or health facility in your area with questions. The VA also offers online enrollment for health benefits and online instructions to start the process of getting hearing aids or getting supplies and repairs.

 

 


Find out if your state’s Medicaid program will help.

Medicaid is the federally funded and state-run health insurance program for people with low incomes, and it sometimes covers hearing aids. Because each state runs its own Medicaid program, the coverage and requirements differ from place to place.

Check on details of coverage by contacting your state’s Medicaid office. Benefits.gov includes a roster of state programs where you can look up your state and link to contact information.


Ask about help from the hearing industry.

Most manufacturers say they are willing to help people who need hearing aids but can’t afford them. Some do this on a case-by-case basis through referrals from physicians and audiologists.

Others have set up corporate foundations to do this work, such as the Starkey Hearing Foundation, Oticon Hearing Foundation and Miracle Ear Foundation. Some companies instead support nonprofits, such as the Hearing Charities of America.

Start by talking with your doctor or audiologist about help paying for hearing aids. They are probably familiar with resources in the industry and in your community. You can also try the links in the next section of this guide, which lead to nonprofit and community groups that help people get low- or no-cost hearing aids.


Look into nonprofits and state and community programs.

There are nonprofits and state or county agencies that provide help with hearing aids if you qualify for their programs. Here are some leads to get you started on your search:

Audient Alliance
National Hearing Aid Project
Better Hearing Institute
Hearing Loss Association of America
See also the nonprofit foundations formed by hearing industry organizations that are listed in the preceding section of this guide.

State Departments of Health, Human Services, Public Health
These state agencies can connect you with help offered through their offices and direct you to county-level medical assistance or human services contacts.

State Offices of Rehabilitation Services, Vocational Rehabilitation
If you are still working, your state’s rehabilitation office might be able to help you get hearing aids or lead you to other groups that can help.

State Assistive Technology Programs
These vary, but some offer low-interest loans to help with the purchase of hearing aids. They might also lend out recycled hearing aids or provide refurbished aids to those in need.