Say That Again. I Didn’t Hear You.



D.C.-AREA PSYCHOLOGIST Lisa Horowitz first noticed a problem while hiking in Peru with her husband. When he turned to her, saying, “Isn’t that a beautiful sound?” Horowitz heard nothing. The flute music he described was composed of those high-frequency sounds that are the first ones lost as hearing ages after years of exposure to noise, and especially to loud music.

Over time, tiny hairs in the inner ear responsible for most hearing are destroyed.   “Presbycusis,” with presby defined as old or aging, starts with diminished clarity: Losing the soft, high-pitched sounds makes it harder to distinguish words. Signs of hearing loss include complaints that others are mumbling; requests that people repeat themselves; needs for higher volume on TV or radio; and trouble hearing at public gatherings, in conversations with a large group and when the speaker is in another room.

Among reasons to pay attention to these signs, untreated hearing loss is both an indication and a cause of dementia—another use-it-or-lose-it situation. Fewer signals reaching the brain’s auditory system allow it to atrophy—called “adult-onset auditory deprivation”—after which hearing aids can no longer work as well to improve hearing.  Conversely, because symptoms associated with hearing loss are similar to those for early Alzheimer’s—depression, feelings of isolation, problems understanding what’s being said —what looked like dementia may disappear when hearing loss is addressed. For this reason, too, it’s important to get devices for both ears to keep stimulating both sets of auditory pathways.

High-frequency hearing loss affects about 15% of Americans between ages 20 and 69, and one in three by age 65. One study suggests that about 50% of U.S. baby boomers experience some hearing loss, and that boomers are losing hearing at a more rapid pace than previous generations. Of these, only about 20% get help. Anyone who encounters hearing loss also encounters an inadequate hearing-aid industry—an industry of “inadequate distribution and dispensing models that stifle innovation,” according to Jason Karlawish in a Forbes story, “Time to Clean the Wax out of the Hearing Aid Industry.”

For consumers, the obstacles to relief are money and lack of information. Hearing problems send people first to an ear, nose and throat (ENT) practice for an audiology test; then, if hearing loss is diagnosed, the practice offers a selection of hearing aids based on its relationships with one or two of the six companies that control the market. This “medical model” bundles costs for hardware with set-up and adjustments for a total that starts around $6,000, not covered by many insurers or Medicare.

Horowitz first explored the ENT route but was shocked at the $7,000 price tag. Then she discovered a recent innovation: hearing services in big box stores—notably Costco, which provides testing, hearing devices and check-ups for about $2,500 altogether, along with money back from Costco. Although all Costco stores have hearing centers, Horowitz chose the Gaithersburg store first because of the convenience and then because she “liked the lady (technician, not audiologist) there so much.”

Worried at first that the evaluation and/or the devices offered wouldn’t be good enough, Horowitz was impressed, saying the exam was “very thorough,” and the technician spent a lot of time explaining the options. Horowitz ordered aids made by Phonak and returned a week or two later to get them fitted and calibrated. The intensity is set low at first so you get used to them, Horowitz explained, and then can be reset at the next visit to be more sensitive. While her devices are digital and adjustments can be made via Bluetooth, Horowitz chose to get them done at Costco, where it took “just a few minutes, because I’m basically a technophobe.”

Good news also comes for those with milder hearing difficulties. Personal sound amplification devices (PSADs) or products (PSAPs) range from $27 on Amazon to $400 per ear for the Solo from Audicus and $600/ear for the Neutronic Ear. Unlike hearing aids, these do not require FDA approval. Some manufacturers offer packages that include an audiology test along with lifestyle questions—because different devices work better for different people or in different situations. For example, one wearer found the Soundhawk with its wireless microphone worked best in meetings, while the Sidekick helped with one-on-one conversations and in restaurants. Another preferred the Bean for opera and TV. Some have found that “smart PSAPs” can enhance sound in ways that hearing aids cannot, or that they work best when used along with hearing aids.

The difficulty arises if you embark on the PSAD route and find your hearing loss is, or becomes, serious enough to require hearing aids. At that point you need to begin the process again to be tested and get hearing aids. For people whose insurance covers the “medical model,” an audiologist (usually in an ENT practice) might be the best first step. Also, an audiologist may be needed to detect other causes of hearing loss, such as infection or wax build-up. For those whose hearing loss is too severe to be alleviated by external devices, the solution may be a cochlear implant.

Today’s hearing aids are digital and can be programmed (by an audiologist or by the wearer) to filter out wind or background noise and can be synchronized via Bluetooth to smartphones both for amplifying phone conversations and for using the phone to adjust the device’s settings. The latest technology uses algorithms that determine which sounds are amplified and which are muted to create an experience “substantially different from objective reality,” according to Ryan Budish in The Atlantic.

Hearing devices are categorized by where they’re worn, such as behind the ear or in the ear, with additional features that include a telecoil to pick up phone signals. Some devices reduce ambient noise using a directional microphone, multiple channels or a wind-noise manager. Annoying feedback noise, caused when sounds leak back to the hearing aid’s microphone, can be alleviated by tighter-fitting devices.

For help navigating the complicated choices, Hearing Aid Forums is “frequented by a grassroots community of extremely knowledgeable people,” according to Erica Manfred on Senior Planet.  Manfred said she wishes she’d surfed the forums before getting a pair of analog aids for $2,500 from the audiology department at a local university, where no one mentioned digital devices.

Even people who end up with devices that suit and help them, including Horowitz, don’t love them. They don’t use them on weekends or sometimes just because they’re sick of wearing them. Horowitz said it’s “because I’m lazy or don’t think of it.” But for work and whenever she does wear them, Horowitz says, they make everything easier.

— Mary Carpenter
Mary is the Well-Being Editor of MyLittleBird. Read more about Mary here.
Her last post was on risky foot fashions. 

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