Good Vibrations
They're still hearing aids. But they're better--and smaller
At first, awareness dawns that you are struggling to follow conversations amid babble and noise. Soon "your family and close friends joke about your getting deaf," says Joanne Pogue, 74, who as president of the library board in Washington, Maine, recalls finding it harder with each meeting to hear board members around the large table. "I joked about it." Better, perhaps, than to be patronized ("Uncle Jim, do you want me to listen to the specials and order for you?") or treated as barely there. Locked in growing silence, older people with impaired hearing often withdraw and grow isolated. Studies show they may even die before their time.
If their sight were declining, most people wouldn't hesitate to get glasses, a cataract operation--whatever is necessary. So where are the hearing aids? In a dresser drawer, says 1 person in 6 of those who own one--which under a quarter of the nation's 31.5 million hearing-impaired people do. No comparable device is burdened with such a neckload of albatrosses: It shouts infirmity, costs a lot, falls short regularly, and demands never-ending upkeep and adjustment. "A hearing aid is not a magical device that will let you hear the way you did before," says Lucille Beck, national director of audiology and speech pathology for the Department of Veterans Affairs and a leader in hearing-aid research. It is not, in other words, like a pair of eyeglasses.
But recent advances in design give holdouts reason to reconsider. And if they can adjust their expectations--and then adjust to the hearing aids themselves--the payoff is likely to be surprisingly rewarding. "You need to relearn how to listen," says Beck. That may take months, even a year or more, as the brain retrains itself to process sounds. (VA patients who come to see Beck are often startled, she says, when the ceiling fan above them suddenly becomes audible.) But in a recent survey, 85 percent of users said they were satisfied with the results; in studies, hearing-impaired veterans who use the instruments report a much higher quality of life than those who don't. Pogue fiddled with different hearing aids for a couple of years before an audiologist put her on her current ones--and advised her to lower her expectations, which she did. "Background noise is still a problem," she says. "But I feel very happy with the ones I have now."
Manufacturers have attempted to address squeamishness about wearing such an apparatus with a range of options less obtrusive than the familiar crescent-shaped instruments that fit behind the ear (box). With "BTEs," the crescent picks up sound and processes it into electrical impulses that are sent through a wire to the speaker, which sits quite visibly in the concha, the part of the outer ear that funnels into the canal. Instead, many people now prefer an innovative "mini" version, like the one Pogue wears, that dramatically reduces the size of the crescent and replaces the bulky wire and speaker with a clear, thin tube that carries sound into the canal and is just visible. "In the ear" (ITE) models sit entirely within the outer ear, and still smaller "in the canal" (ITC) hearing aids fit into just the inner portion of the concha. A "completely in canal" (CIC) aid, tucked so far down that it comes with a plastic thread to pull it out, is Lilliputian. You'd have to be looking straight into the ear to find it.
It's a small world. But near invisibility forces trade-offs. As a hearing aid shrinks, so does the space for circuitry--and for the battery to power it. That means people with severe or profound hearing loss aren't candidates for CICs or ITCs. Even the shrunken version of behind-the-ear hearing aids may not be enough for them. And the tinier the battery (and the higher the volume), the more often it has to be replaced. A CIC battery might quit after 80 hours, while one used in a full-size BTE may be going strong at 200 or 300 hours. The smallest CIC battery, moreover, is less than half the width of a contact lens--a challenge to arthritic fingers and imperfect vision.
Another annoying feature of the tiniest models is occlusion, a sensation almost like wearing earplugs; it can distort the user's own voice or create noise when the jaw moves. (To see what it's like, gently seal each ear with a finger, then talk or chew gum.) And because they are buried in the ear, CIC aids can't offer "directionality," an extra-cost option on larger models. This feature, switched on and off by the wearer, reduces the hearing aid's sensitivity to sounds coming from behind and the sides. That cuts down on overall noise and makes it easier to understand someone talking from the front. On the other hand, snug and unexposed CICs are superior at conquering telephone feedback, the irritating squeal that often occurs with small, exposed hearing aids. Sounds from the hearing aid speaker, trapped in the outer ear by the telephone receiver, feed back into the microphone a fraction of an inch away.
The slimmed-down BTEs offer an appealing mix of size and performance and can almost pass as wireless Bluetooth headsets. But they're not for everyone, either. "You have to put the unit in place behind the ear and then put the tube in the right position, and some people just can't do it," says Dennis Hampton, an audiologist in White Plains, N.Y., who writes a quarterly consumer newsletter on hearing aids. "I just took a man in his mid-70s off one and put him on a bigger BTE type. He just didn't have the dexterity or the vision to manipulate it."
Hearing aids of any size can unravel a nicely worked-out budget, although figures of $6,000 or more that circulate in horror stories are hardly typical. An average hearing aid cost about $1,840 in 2005, including testing, fitting, and follow-up visits. About three quarters of buyers need a pair. In general, the smaller the hearing aid, the higher the price. CICs command a premium of roughly $250 to $350, or $500 to $700 for a pair. And since life spans typically are only four to seven years--thanks to long daily exposure to moist warmth, skin oils, and earwax--this probably won't be a one-time purchase.
While prices may be lower than many people expect, they hardly amount to small change, and help is unlikely. Medicare doesn't cover hearing aids. Nor will most health insurers pay. Families who would be pressed can tap programs like Audient (www.audientalliance.org), launched last year by the Northwest Lions Foundation for Sight and Hearing. Cooperating local providers will fit two behind-the-ear digital hearing aids for about $1,000 for families whose income is less than 2 1/2 times the federal poverty level, or about $31,225 for a family of two or $47,125 for a family of four.
Almost all hearing aids are digital these days, which gives them the ability to emphasize some frequencies more than others. That seems to help wearers distinguish speech from noise, for example. For the small percentage of people whose problem is simply that all sounds are too soft, the old analog hearing aids, which mostly just make everything louder, may do fine. A pair typically costs about $1,700.
People who can do without in-person hand-holding can get a big break by shopping online or by mail. Online queries posted by the magazine Hearing Health and aimed at people who had bought hearing aids on the Internet attracted mostly positive responses. One satisfied customer is Edward Myer, 75. Last December, Myer, who is profoundly hard of hearing, paid $2,000 by mail for BTE hearing aids "every bit as good" as his last $5,800 pair. The semiretired chairman of the MyerEmco chain of audio-video stores in the Washington, D.C., area ordered his new aids from America Hears in Bristol, Pa. Myer had to send a detailed hearing evaluation (an audiologist can conduct one for about $100) along with impressions of his ears made from a kit sent by the company. Customers can download to their computers a free program that lets them tweak their hearing aids themselves--to adjust individual frequency channels for better intelligibility, for example. "It's simple," says Myer. Other mail-order purveyors include Lloyds, which discounts brand-name hearing aids; Hearing Health Express, which sells its own brand of BTEs and ITEs, and HearingPlanet, which arranges discounts with local audiologists.
The Food and Drug Administration requires mail-order vendors to obtain a written statement from a purchaser's doctor attesting to a medical evaluation within the previous six months and clearing you to use a hearing aid. Someone contemplating a hearing aid should do that anyway, to rule out a possible medical problem (or something as simple as built-up wax). As a requirement, though, it doesn't mean much. Sellers can offer customers age 18 or older a form that waives the medical exam.
Attitude adjustment. Success with any hearing aid requires reasonable expectations. "Most manufacturers B.S. the customer with all kinds of claims about how you're going to be able to hear at a restaurant or cocktail party," says Myer. "You won't." But you might, like Myer, be able to converse with someone one on one--no small thing.
Some audiologists suggest starting off with a new hearing aid for an hour or so a day and lengthening the period gradually. Forget the hopeful test run at a party or meeting: Disappointment is inevitable and could cut short a fair trial. You're bound to need fine-tuning--and more fine-tuning. Even after two years with her current hearing aids, Pogue visits the audiologist every six weeks or so for a readjustment. She has adjusted, too. "I used to be a decent skier," she says. "I used to be a decent tennis player. Not anymore. Well, I can't hear the same anymore, either. I've had to recognize that."
Here is a sampling of the many online resources that can be useful to those with hearing difficulty.
alt.support.hearing-loss: This is a public newsgroup, so heated opinions and a wide range of expertise are to be expected on topics such as the marketing and selling of hearing aids and how effective they are.
www.drf.org: The Deafness Research Foundation publishes Hearing Health, a monthly magazine of interest both to consumers and to professionals. A nominal donation buys a subscription.
www.shhh.org: The Hearing Loss Association of America is a consumer-oriented advocacy organization with 250 local chapters. The website provides advice, member chat rooms, and message boards.
www.hohadvocates.org: If Ralph Nader had run a website in the '60s for people with hearing problems, it might have been like Hard of Hearing Advocates. Nothing and no one are beyond criticism on this volunteer-run site. The message board is especially feisty.
www.audiologyawareness.com/hhelp/hhies.htm: How much of a hearing problem do you have? This self-screening test will determine how much, if at all, your impaired hearing compromises your activities and relationships.
This story appears in the May 22, 2006 print edition of U.S. News & World Report.