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Roger was worried that Julie, his wife, was losing her hearing. One evening as she was at the stove making dinner he stood in the kitchen door and asked, “Honey, what’s for dinner?” Julie did not answer. Roger stepped into the kitchen and said, louder, “What are you making for dinner, dear?” Still no answer. So Roger walked to the stove, put his arm around Julie’s waist and said, “Smells good, sweetheart. What are you making? Clearly exasperated, Julie turned to him and said, “Roger, for the third time, CHICKEN! What’s the matter? Are you deaf?” Nearly one-third of Americans over 65 years old will develop significant hearing loss. A small percentage are caused by conditions such as infection, fluid in the middle ear, wax build-up, unusual tumors or growths, or foreign objects in the ear canal. These conditions, called conductive hearing loss, prevent sound from traveling through the outer and middle ear canal to the inner ear. They can often be treated successfully if given prompt medical attention. As people age, however, a different kind of hearing loss is much more likely to occur. Advancing age shows on the outside of our bodies with wrinkles, graying hair, and other skin changes, but it happens where it cannot be seen as well. Nerves and sensory cells in the ear, which transmit sound signals to the brain, can be damaged by time as well as by exposure to noise, diseases such as diabetes, some drugs, and injury. Heredity, however, is one of the most common indictors of presbycusis, the scientific name for age-related hearing loss. This type of sensorineural hearing loss, which affects the ability to hear high frequency tones first, develops gradually and is progressive. If your parents or grandparents had hearing loss, you are a likely candidate to experience the same condition, said Dr. Thomas Okner, a physician who practices with Midwest Ear, Nose and Throat Specialists in St. Paul and the eastern suburbs. Since age-related hearing loss develops slowly, a person is not likely to realize the extent of his or her impairment. It is, therefore, important to know risk factors and recognize symptoms of hearing loss. Sensorineural hearing loss is seldom treatable either medically or surgically but it can be helped with hearing aids. In the past decade, technological advances have improved hearing aids dramatically and models are available that can be used with almost any kind or degree of hearing loss. If you have difficulty understanding people, are dizzy or have trouble with balance, suffer from ringing in the ears (tinnitus), or have been exposed to loud noises over time or to even a single episode of painful noise, it is time to have your hearing checked. Dr. William Ogden, an internist with United Medical Specialties in St. Paul, said that a good place to begin is with your primary care provider. He or she can do a medical history and check for such conditions as wax build-up which can muffle and distort sound and make hearing difficult. Your doctor or nurse practitioner is then likely to refer you to an otolaryngologist, a medical doctor who specializes in the ear, nose and throat. If the otolaryngologist determines that the cause of your hearing loss cannot be treated medically or surgically, you will most likely be referred to an audiologist, a specialist in hearing testing and hearing aids, who can evaluate your need for a hearing aid and help you in making a selection. You may remember that your great uncle wore a battery pack on his chest that connected to his hearing aid, and he could dial it down when he was tired of listening to the racket around him. Over the past decade digital technology has led to almost unbelievable advances in hearing aids, though all of them still require batteries. Some hearing devices are so tiny that they fit entirely in the ear canal and are virtually invisible. Others are larger but still fit into the ear canal or the outer ear. Today’s largest hearing aids consist of a small electronic pack that is worn behind the ear and connected to either a tiny tube or an ear piece within the ear. Cami Lawless is a hearing instrument specialist and owner of Associated Hearing Maplewood, an independent retail service which sells hearing aids and offers free hearing screening. If a client is discovered to have a hearing deficiency, independent, dispensing audiologists are legally required to refer the client to a medical doctor or have the patient sign a waiver saying he or she does not choose to seek medical advice. “If there is any reason like a tumor, hole in the ear drum, or infection, we absolutely will not dispense a hearing aid until they have a medical visit,” Lawless said. Even if an audiologist diagnoses age-related hearing loss, a check-up by a medical professional is a good idea. “There isn’t a hearing loss without a medical reason,” Okner said. Nearly all ear, nose and throat specialty practices, including his, have audiologists on staff and also sell hearing aids. Okner calls it one-stop shopping for hearing but, he added, he always tells patients they can compare prices and services elsewhere. “Size and shape is not the issue any longer,” Lawless said. “Everything works on a computer chip in the hearing aid. There are pros and cons to each style, and there is not one hearing aid that is best for everybody.” Digital hearing aids can be programmed very specifically for the needs of the wearer, taking into account the music he or she listens to, how much time is spent in conversation with individuals or groups, and what ambient background noise will be heard. Prices range from around $600 for a basic device to $3000 ($6,000 for both ears) for the most sophisticated, programmable model. But, Lawless said, “you can’t tell by looking how sophisticated or expensive a hearing aid is.” If you find yourself in need of a hearing aid, pay careful attention to the services offered by the place where you make the purchase. Getting used to hearing aids is not a walk in the park, and follow-up care is likely to be critical to your satisfaction. A hearing aid sends sound signals to the brain, Lawless said, but it is up to the brain to interpret those signals, and for a time many sounds, including your own voice, will not sound normal. “The most unsuccessful hearing aid wearers are people who put it on [only] when they want to hear, like going to church, a concert, or out to dinner, sporadically,” Lawless said. “It will always be new, different, and hard. The brain will never accept the new sounds as normal.” “Hearing aids are very smart, but only as smart as we set them up to be,” she said. During the adjustment period, which can range up to eight weeks, clients visit their hearing aid professionals frequently for adjustments to be made. After a client has acclimated to the hearing aid, he or she should still plan on checking in with the provider every three months or so for follow-up service. At some practices, including Associated Hearing Maplewood, those visits are included in the price of the hearing aid. Dorothy Joy knew that hearing loss runs in her family, so several years ago she went to a free hearing screening at the senior center in her home town. An audiologist from a local medical clinic diagnosed a mild hereditary hearing loss and suggested that Joy follow up with more thorough testing, which she did. Joy chose a mid-priced, digital, behind-the-ear model and has now worn her hearing aids for nearly four years. “They can change them if my hearing gets worse,” she said. “They can change the volume and also the clarity. I can go in any time for free and have it adjusted if it needs it.” She puts in new batteries, which she describes as “relatively cheap,” about once a week. She usually wears her aids for 10 - 12 hours a day, and said “if you wear them all the time you don’t realize they are in.” Hearing aids are expensive to replace, she said, so she has developed the habit of putting hers in the same place whenever she is not wearing them. Her audiologist told her that water is the worst enemy of hearing aids, so Joy doesn’t wear them when she is walking or hiking, though, she said, “I would if I couldn’t hear anything.” Joy says people have told her she speaks more loudly when she doesn’t have her hearing aids in and, she added, “my voice does sound different to me when I have them in.” Her hearing loss was gradual, and it is only since she got her hearing aids, Joy said, that she realizes the compensations, such as lip reading, that she was making earlier. “When you have them,” she said, “you realize how much you were missing. I’d urge everybody at around age 60 to get their hearing tested.”
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Can You Hear Me NOW?