Sound Advice on Hearing

What did you say?

For many of us, that's a common question. Nearly 30 million Americans have some form of hearing loss, including one of every three people ages 65 to 75. Yet just a fraction of us seek help. Why?

For one thing, hearing loss is invisible. Age-related hearing trouble sneaks up over 10 or 20 years. People may not notice the changes.

"They're hearing a lot of sounds. They're just not hearing them as much as they should," says Dennis Hampton, Ph.D., an audiologist in White Plains, N.Y. "The description I get often is that, 'I can hear people fine. They're just not being clear enough.'"

But there's another reason: Hearing impairment carries a stigma. Many of us resist the idea of hearing loss, seeing it as a sign of age.

That could explain why just one in five people who need a hearing aid actually wears one—even though technology has made hearing aids much more effective. Most of us wait an average of five to seven years from the time we recognize hearing problems to the time we seek medical help.

How hearing fails

Your hearing can suffer in two main ways: conductive hearing loss and nerve loss.

Conductive hearing loss occurs when sound can't get from the outer ear to the inner ear (the oval window of the cochlea). This may be caused by earwax, scarring of the eardrum, perforation of the eardrum, or scarring or destruction of the ossicles—the three bones of the inner ear that conduct sound from the ear drum to the cochlea. Fluid or mucus in the middle ear—from ear infections—can cause hearing loss.

Nerve loss, also called sensorineural hearing loss, involves inner ear damage and is the most common form of hearing loss in older adults. The three main causes, according to Dr. Hampton, are aging, loud noises, and heredity.

"Typically, hearing loss starts in the higher frequencies," says Laura Voll, an audiologist in Madison, Wis.

It begins with losing high-frequency consonant sounds like "f," "s," "sh," and "t" sounds. Although the world around you seems loud enough, speech isn't clear because the consonants drop out of the words. So you're not sure if you have a hearing difficulty or if others just aren't speaking up. It's silent, it's painless and it's gradual.

Signs of trouble

Here are some signs that you could be experiencing hearing loss:

• People around you seem to be mumbling or not speaking clearly.

• You often ask folks to repeat what they say.

• Others say you've turned up the television or radio too loud.

• You find that watching someone speak helps you understand them.

If you suspect your hearing range has decreased, you should see an otolaryngologist (ENT), who can diagnose the problem and recommend a treatment.

Why you must act

Hearing is a large part of communication. When you can't hear, you begin to communicate less and less. You stop socializing because you feel isolated from the surrounding world.

"Hearing aids do work," Voll says. "If you're worried about what they look like, don't. If you haven't seen a hearing aid lately, it's probably because you can't see them anymore."

A hearing aid primer

You can chose from several sizes and types of hearing aids. According to Voll, nearly all sizes are compatible with new technologies.

Behind the ear

These sit over the ear with a customized earpiece. They're often suggested for children because they are more resistant to water and shock. But they're also handy because the user can add listening accessories, such as a wireless communication device. And they're used with severe hearing loss because they can deliver power through larger transducers.

In the ear

These fit into the bowl-shaped opening just inside the ear. These one-piece models, smaller than behind-the-ear types, use the ear's natural sound-collecting properties.

In the canal and completely in the canal

Very small and hard to see, they're worn within the ear canal.

The technology

Hearing aids run the gamut from conventional to high-tech. Prices range from $800 to $1,000 for economical custom-fitted models to $4,000 or more for high-end devices with digital and programmable features. More than half the hearing aids sold today use digital processing; three out of four are programmable. Here are the options:

• Analog programmable. Easy-to-customize technology lets you modify amplification of different frequency ranges through a computer. You can tailor such models closely to your needs.

• Digital programmable. Newer than the analog programmable models, these can be finely tailored to the individual even more closely. They're more flexible and improve understanding much better than the analog and somewhat better than the analog programmable hearing aids but are more costly.

• Conventional (analog). These economical units offer good performance. But they're not the best choice for those suffering from background noise interference. These hearing aids are broadband amplifiers amplifying equally all frequency ranges, background noise, and speech. They are the least effective of the hearing aids.