Over the Counter and Through the Woods
March 30, 2023
Over the Counter and Through the Woods
Navigating options for hearing aids
The advent of hearing aids finally becoming available “over the counter,” gives me hope that more people who struggle with hearing may begin to get help. But hearing is so individual, I also fear that many people will try a device that does not help them enough and give up trying.
Technology can transform your life, but only if you take charge.
In the following, I strive to help you do just that.
Test your hearing.
If you are curious at all about the status of your hearing—and in this noisy world, you should be—take a hearing test. You can go to an audiologist or test yourself, for free, online. An audiologist is a health care professional who evaluates and helps manage hearing loss and balance disorders. I recently had my ears tested at Mass Eye and Ear, and then took a slew of online tests. No surprise: many bogus tests await. If you choose to take a test online, I’ve provided some recommendations in the Resources section. Any of these tests will quickly give you a sense of whether you could use hearing help.
Why test your hearing?
Here’s the thing: Hearing is elusive. Unlike vision, where you can readily verify that the print you were formerly able to read has become harder to decipher, the sense of how loud or soft something is is contingent upon numerous variables. (The volume of the sound itself, the distance you are from the sound source, other sounds that may be competing for attention, and the acoustics—consider the difference between the sound in a tiled bathroom compared to the sound in a carpeted room with thick curtains, or the sound in a subway station compared to a lush forest, for instance.) The most common form of hearing loss occurs gradually over time; the mind adapts: you get used to what things sound like, and may not necessarily realize you are missing anything. Even if you have “perfect” hearing, you have no doubt experienced circumstances where some sound is barely audible. So if there’s a problem, it’s natural to assume the problem is not you.
Your brain has been processing a lifetime of sound, and as you go through your day, it can be virtually impossible to differentiate between aural intelligibility produced by a sound source or environment, and the quality of sound delivered by a physically degraded ear. So a hearing test will help you know what’s what.
I don’t want to appear old.
Alternatively, you may be aware that you are not hearing as clearly as you used to, but you might think you can cope, and wearing a hearing aid will identify you as “old.” The irony of course is that when you mis-hear what is said, you run the risk of repeating a point that was already made, or responding to a question that wasn’t asked. Wearing a hearing aid is not what gives the impression that you are addle-brained, not paying attention, and might be written off as “old.”
The strain on your brain, and your heart!
As the mechanics of the ear degrade, the brain works harder and harder to interpret the signals the ear can deliver. You fatigue more easily. Although conversation ideally fosters connection, your repeated “What?” “Hmm?” “‘Excuse me?”puts the burden of your hearing loss on your conversation partners. Without intervention, compromised hearing can lead to isolation and depression. Yet you may not attribute your exhaustion, your sense of isolation, or feelings of depression to hearing loss.
Ok, so say you test your ears and determine you do indeed have some hearing loss. What now?
Start by listening.
Hearing is a function of perceiving sound. What you hear relies not only on the mechanical functioning of your ear, which of course matters, but also on the degree of attention your brain accords the signals that your ear delivers. Since sound is more or less constant, the brain tunes a lot of it out so you can sleep, or so you don’t go crazy. Thus if your ears are functioning at all, by paying attention to sound, i.e., by conscious listening, you can identify situations that are most critical to you. Perhaps you can even discern aspects of sound that are most pleasing or annoying. Whether you decide to go to an audiologist or not, your ability to assess what you hear and identify what you like or don’t like can greatly help you get the aid you need.
Incorporating sophisticated sound processing, contemporary hearing aids are programmable from low to high pitches to compensate for diminished volume at different points across the sound spectrum. Some hearing aids can be set up with different profiles to correlate with various listening environments. Some also provide programs intended to mask tinnitus. Many hearing aids incorporate a telecoil, Bluetooth™ technology, and smart phone compatibility intended to give the wearer even more control.
Depending on the severity of your hearing loss, devices that are available over the counter (OTC) may not help you enough. By law, OTC hearing aids only provide amplification that is sufficient to mitigate mild-to-moderate hearing loss. If mild-to-moderate amplification is not enough for you, you will need to see an audiologist to access more powerful hearing aids.
Hearing aids are notoriously expensive, and insurance coverage is pathetically thin. If you do go to an audiologist, be sure to check your insurance before your visit so A) you don’t have any surprises and B) you don’t waste valuable time that could be spent on addressing your hearing. If you are at all inclined to do research, I have included a few reliable sources at the end of this article that can help you identify what is feasible from a hearing device.
If I go to an audiologist, what can I expect?
A good audiologist will not only (1) test your ears and generate the all-but-inscrutable audiogram, they will also (2) try to assess your communication needs. If you purchase a hearing aid from them, they will (3) program the hearing aid to fit your hearing profile, conduct ‘real-ear' measures to calibrate the fitting in your ear canal, and schedule a follow-up appointment. At the follow-up, they try to evaluate how well your needs are being met and then modify the hearing aid programming as needed.
An audiological hearing test is typically conducted in a soundproofed chamber that is nothing like the world in which we live. The soundproofed chamber provides the most reliable conditions for accurately measuring what you are hearing, nonetheless, the experience is disorienting. It can be challenging to retain perspective or hold your ground in such an uncommon environment. If before you land at the audiologist’s you have been paying attention to sound and have, in a sense, practiced listening, the process of taking the hearing test may not be as daunting.
Accurate assessment of your communication needs relies on your ability to identify circumstances that you find most enjoyable, and most challenging or annoying. If you are like me, perhaps your mind goes blank in the clinical atmosphere, so here too, it would be wise to prepare ahead of time.
Do this on your own or in tandem with an audiologist.
Audiologists use various tools to assess your communication needs. One such tool, the Client Oriented Scale of Improvement (COSI), suggests a range of listening scenarios and asks if you have difficulty hearing:
conversation with one or two others in quiet, one or two others in noise, a group in quiet, a group in noise?
in church or meetings?
TV/Radio @ normal volume?
a familiar speaker on the phone, an unfamiliar speaker on the phone?
the phone ringing in another room?
the doorbell or a knock?
traffic?
music?
It asks you to consider what circumstances are most critical to you. Do you crave more social contact? Feel left out? Get upset or angry trying to communicate?
Even if your audiologist does not use the COSI per se, if you identify circumstances that you find particularly challenging, you will help your audiologist focus on addressing your priorities.
What if I want an over-the-counter hearing aid?
OTC hearing aids are certainly less expensive, but unless they achieve what you need, they may end up wasting your money. If you choose to get a device from a retailer, make sure that it comes with a trial period and money-back return policy—not all of them do! Then be rigorous in testing it during the trial period.
Help your brain adjust to your new hearing aid.
Once you get hearing aids, it will take a little time to get used to them. Remember your brain has been interpreting the world of sound based on the information your ear delivered before you got a hearing aid. Now things have changed, and the brain needs to adjust. Conscious listening will speed up the adjustment and/or identify what areas would benefit from further modification. Follow-up appointments are critical to ensuring that the hearing aids accurately “fit” you.
Your hearing experience is as unique as you are.
If you are inclined to try over-the-counter options, take the time to identify what you need and do the research to find a good match for you. If you are working with an audiologist, your ability to assert your preferences can make the difference between you coming away with a lackluster gadget and a life-transforming technology. It’s worth it.
~ ~ ~
photo: Darleen Wilson