Do you strain to hear what your spouse is saying at the dinner table or regularly crank up the TV volume as high as it can go? If so, you’re not alone: About one in three people ages 65 to 74, and nearly half of people ages 75 and older, has some hearing loss. Yet about 80 percent of people who would benefit from hearing aids don’t use them.
Resistance to wearing hearing aids is high partly because of their perceived stigma. Some people deny they have a hearing problem or minimize the degree of loss, while others acknowledge their hearing loss but are too embarrassed to seek help. Older adults associate them with ageism and disability. For others, insufficient health care coverage for hearing aids, which are costly, and limited access to hearing health care are barriers to treatment.
Some people with hearing loss don’t feel their level of loss is severe enough to require treatment. Studies have found that people with hearing difficulties tend to underrate their degree of hearing loss compared to those around them.
Experts say the first—and often hardest—step to mitigating hearing loss is to acknowledge that you have a hearing problem. It commonly takes a person with hearing difficulties an average of 10 years before he or she tries wearing a hearing aid. That delay is problematic because the longer you live with hearing loss, the harder it is to adapt to a hearing aid. As hearing loss progresses, the brain “forgets” how to recognize certain sounds, making it harder for your brain to relearn sounds when using hearing aids.
Take this quiz
Not sure if you have hearing loss? Answer yes or no to these questions from the National Institute on Deafness and Other Communication Disorders. If you answer yes to three or more questions, you could have a hearing problem:
❏ Do you sometimes feel embarrassed to meet new people because you struggle to hear?
❏ Do you feel frustrated when talking to members of your family because you have difficulty hearing them?
❏ Do you have difficulty hearing or understanding co-workers, clients, or customers?
❏ Do you feel restricted or limited by a hearing problem?
❏ Do you have difficulty hearing when visiting friends, relatives, or neighbors?
❏ Do you have trouble hearing in the movies or the theater?
❏ Does a hearing problem cause you to argue with family members?
❏ Do you have trouble hearing the TV or radio at levels that are loud enough for others?
❏ Do you feel that any difficulty with hearing limits your personal or social life?
❏ Do you have trouble hearing family or friends when you are together in a restaurant?
Recognizing that poor hearing may be affecting your life—for example, causing you to avoid noisy group situations or isolate yourself from others to avoid embarrassment—is the next step toward acceptance of the problem.
Age-related hearing loss
Most hearing loss in older adults is caused by presbycusis, an age-related degeneration of the inner ear that results in lowered sensitivity to high frequencies and a loss in the ability to discriminate among speech sounds (so people seem to mumble). Presbycusis generally affects both ears equally.
Other causes of permanent hearing damage include long-term exposure to loud noises, such as power tools, heavy machinery, or loud music; brief, loud noises, such as gunfire or explosions; injuries to the ears, head, or neck; and side effects of chronic illnesses, such as diabetes, heart disease, and kidney disease.
Sometimes, though, the solution to your problem may be as simple as having your doctor clean out impacted wax from the external ear canal or adjust your medications—certain drugs such as diuretics, chemotherapy agents, and aspirin in high doses can affect your hearing.
Hearing loss repercussions
Poor hearing can result in consequences that go far beyond misunderstanding what someone says. A new study, published in September 2019 in the Journal of the American Geriatrics Society, suggests that wearing a hearing aid might help lower your risk of cognitive decline and dementia, depression and anxiety, and fall-related injuries. The study builds on a body of research that shows an association between hearing loss and poor health outcomes.
Reasons for the connections may be a result of social isolation and the lack of human interaction and mental stimulation, which can lead to cognitive decline, or broader age-related changes in the nervous system that affect both hearing loss and physical and mental decline. Hearing and balance are closely related, which can lead to worsened spatial awareness and falls.
Motivators and barriers
A 2017 study in The Laryngoscope concluded that the key motivators that drive patients to see a doctor about their hearing include the degree of hearing loss, difficulty understanding speech on TV and in the presence of background noise, self-confidence in their ability to make a health-promoting change in behavior, family support, and self-recognition of hearing loss.
The primary barriers to seeking care, according to the study, include financial limitations, the stigma of hearing devices, inconvenience, competing chronic health problems, and unrealistic expectations. If vanity or the fear of looking old is holding you back from wearing a hearing aid, you should know that the bulky analog hearing aids your grandparents wore are very different from the digital devices that are in use today.
On the Horizon: OTC Hearing Aids
The Over-the-Counter (OTC) Hearing Aid Act will allow for the sale of OTC hearing aids for mild to moderate hearing loss beginning in 2020. The act is meant to improve access to hearing aids and reduce some costs associated with the devices.
Adjusting to a hearing aid
Once you fully understand the implications of impaired hearing, you’ll need to adapt to wearing a hearing aid. Up to 40 percent of hearing aids sold end up not being used, according to one analysis. Reasons for nonuse include discomfort, side effects such as itchiness or rash, trouble handling the aid or inserting the earpiece correctly due to lack of manual dexterity (such as people with arthritis), audio feedback, poor sound quality, and problems adjusting the volume.
Some people have high expectations regarding what a hearing aid can do and are disappointed when the device doesn’t live up to them. Unlike eyeglasses, which can typically correct a vision impairment, a hearing aid can’t restore normal hearing and won’t capture sound as well as your own ear. But it can augment the hearing that remains and increase awareness of sounds and their sources.
Getting a proper fit for your hearing aid is essential to your comfort and satisfaction. A variety of models are available, and they differ by design, amplification technology, and features. Some analog models are still available, but most devices sold today are digital, which offer better sound and have greater programming flexibility.
Adjusting to using a hearing aid for the first time can take weeks. At first, sounds may be unusually loud—sometimes uncomfortably so. The more often you wear a hearing aid, the better able you’ll be to adjust to it as your brain relearns how to process sound through the new device.
Most hearing aids are capable of a wide variety of electroacoustic adjustments to control volume, background noise, and feedback. Often, making adjustments requires repeat visits to your audiologist or hearing aid dispenser.
If you have problems like discomfort or difficulty putting the device into your ear, see your audiologist for help. The good news is that most states require a 30- to 60-day trial period for hearing aids so you can test them out before committing to the purchase.
Once you purchase a hearing aid, consider audiological rehabilitation, which can be done individually or in small group sessions. Hearing rehab can help you adjust to your hearing loss, teach you how to use your hearing aid, and improve your ability to communicate.
The cost of better hearing
Hearing aids can present a significant financial burden. In one study, 64 percent of participants reported they couldn’t afford one. Medicare doesn’t cover the devices, fittings, follow-up care, batteries, and associated maintenance costs. Medicare only covers diagnostic hearing and balance exams if they’re done for a medical condition other than a hearing problem. Some Medicare HMOs will partially pay for hearing aids, and coverage among private insurers varies.
The average cost of one hearing aid is $2,300, and people with age-related loss usually need two. High-end hearing aids can cost as much as $3,500 apiece. The average hearing aid lasts about eight years. Be sure to ask about the length of the warranty period and whether it covers maintenance and repairs.
If you served in the military, you might be eligible to receive a discounted or free hearing aid from the U.S. Department of Veterans Affairs. Also, some nonprofit organizations provide financial assistance for those who can’t afford hearing aids. You can find a list of resources compiled by the Hearing Loss Association of America.
This article first appeared in the December 2019 issue of UC Berkeley Health After 50.
Also see Hearing Loss and Cognitive Decline.
Published December 16, 2019