Doctor fitting a hearing aid on a senior patient's ear — Hearing loss affects 48 million Americans. Here's what active adults need to know.

Hearing loss is an uncomfortable subject for most people. To many of us, it's a sure sign of aging, indicating that our bodies aren’t quite what they used to be. However, as a condition that affects some 48 million Americans, including 50 percent of those over the age of 75, it's something most of us will either experience either directly or through a loved one. It's certainly nothing to despair about, and you shouldn’t feel any shame in it.

Left untreated, hearing loss can have profound social and psychological effects that come about due to social isolation. Luckily, the same technologies that have given us smartphones and tablets have also led to something of a renaissance in hearing aid technology which has improved the lives of millions.

First, a bit about myself that I’m happy to share. Despite being a middle-aged man, I myself have experienced hearing loss due to noise and environmental factors. In my younger years, I worked in noisy environments (factory floors and construction sites) and played bass in a pretty loud indie rock band. I have difficulty following conversations in noisy places, especially when speaking with adults with higher-pitched voices or children.

Prior to writing for 55places, I also spent many years in the hearing aid industry helping those with hearing loss improve the quality of their life. However, I no longer have any financial interest in that industry and, as such, I hope to give honest and straightforward information to help you make the best decisions for yourself.

First, let’s explore some of the basics:

What is hearing loss?

Hearing loss is caused by a wide variety of factors. Diseases, neurological conditions, medication interactions, and traumatic injury are more common causes of life-long hearing problems. In the case of those who experience hearing loss later in life, environmental factors like noise are a major cause of hearing loss. If you’ve worked near heavy machinery, loud motors, or served in the military, you may already be aware of this. Even common household appliances like hairdryers and vacuum cleaners can be contributing factors. Aging and genetics are also factors that can cause hearing loss.

Inside your ear, there as thousands of nerve cells attached to the cochlea (the coiled, snail-shaped part behind the eardrum). Attached to these cells are tiny hairs that “translate” sounds or changes in air pressure, into signals sent to the brain. As these hairs die, hearing loss occurs. There's no known cure or method by which to restore these hairs.

Tinnitus is a condition associated with hearing loss. It's most commonly perceived as a high-pitched ringing in the ears. Its causes are not well-understood, and though there's plenty of snake-oil on the market, there's no known cure. Hearing aids can offer some relief, but be leery of supplements or other unregulated treatments.

Focusing on hearing loss due to noise exposure and age, the result of this damage most commonly manifests in a loss of high frequency or higher-pitched sounds. Practically speaking, this makes it difficult to do things like keep up with a conversation in a noisy room, understand the speech of children or those with voices in higher registers, or hear things like beeping alarms.

What can I do if I think I might have hearing loss?

If you or your loved ones are beginning to suspect you might have hearing loss, make an appointment with your primary care doctor (if you experience sudden hearing loss, contact your doctor as soon as possible). Your doctor will be able to make a preliminary assessment to rule out any more serious causes and be able to refer you to an audiologist or hearing specialist. Take this step first before visiting any of the hearing aid dispensers you see advertising in the local newspaper. Heading to a medical professional first will help you avoid any sales pressure that often comes with hearing aid retailers.

An audiologist will likely examine your ears with an otoscope and ask you some general health and life questions. You’ll also participate in a hearing test in which you’ll be presented with tones and simulated speech to assess how well you are hearing across the frequency band. These are all painless tests akin to an eye exam, so there’s nothing to worry about there. After the testing is over, your audiologist will consult with you to help you understand the results and plan from there.

Be sure to ask for a copy of your test results (commonly called an audiogram), if you’d like to do some comparison shopping from there.

OK, so I need a hearing aid, now what?

First things first, don’t get down yourself because of it. Millions of Americans wear hearing aids and many models are so small nowadays, you may not have even noticed those wearing hearing aids around you. “I wish I had gotten these sooner!” was a common refrain among those I worked with when I helped people select hearing aids.

Hearing aids are, at their most basic, small audio amplifier circuits that use a tiny microphone to pick up sounds, a circuit to process the sounds, and a receiver to send the amplified sound down the ear canal towards your eardrum. With modern advances in digital signal processing, your audiologist or hearing aid dispenser will be able to tune or program the hearing aid to your unique needs.

Be mindful of low-cost listening devices, often sold in magazine or newspaper ads. While some people with mild hearing loss report good results, these often lack many of the features that distinguish higher-priced hearing aids and may be more trouble than they’re worth.

What are my hearing aid options?

There are two primary categories of hearing aids, in-the-ear (ITE) and over-the-ear (OTE). ITE hearing aids sit either in the bowl of the ear, partially in the canal, or completely in the canal. They are an attractive option to many as they are small and discreet. However, they're limited in the amount of amplification they can effectively deliver, and they're easier to lose. Additionally, they're often more prone to feedback, that high-pitched whistling sound, than other types of hearing aids.

Over-the-ear hearing aids sit behind the ear and have a small tube and earpiece routed into the opening of the ear canal. This style of hearing aid offers greater amplification, and they're easier to maintain than an in-the-ear hearing aid. Additionally, open-ear earpieces can reduce a phenomenon known as occlusion. This is that plugged-up feeling that makes everything sound flat. You may have experienced it after swimming or when wearing tightly fitted foam earplugs.

While your preference is an important consideration, it's best to follow the advice given to you by a medical professional or licensed hearing aid dispenser. This brings us to our next point.

What should I expect when buying a hearing aid?

Right away, you should know that you’re walking into a sales environment. While most people who sell hearing aids chose their profession to help people, there's still a bottom line. Be prepared to ask a lot of questions and comparison shop to find the best value.

Choose a reputable retailer that sells major hearing aid brands like Starkey, ReSound, Widex, or Phonak, among others. Local dealers may sell one brand or a variety. In a move that should surprise no one, Costco even sells hearing aids now and boasts a pretty high rate of customer satisfaction (don’t worry, you don’t have to buy in bulk). If you served in the military and have access to Veteran’s Administration healthcare, that’s another great option.

There are so many hearing aid brands on the market today that it can be difficult to know which one is the best for you. Sources like Consumer Reports are well worth exploring as they can offer some insight into the reliability and other factors. That said, be cautious of anyone telling you what the “best” brand is. Hearing is sensory and subjective, so what may serve one user quite well might be a poor choice for another user.

Most retailers will offer onsite testing which you should take advantage of. I know you already have your audiogram, but it can be helpful to compare results. The more data, the better. For an in-the-ear hearing aid, you'll likely need to have an ear impression made. This is another painless procedure in which a small amount of polymer is put into your ear to create a custom-made aid or earpiece.

Any hearing aid dealer should offer a generous trial period and return policy. All the testing in the world is useless without your real-world feedback. If a retailer seems stingy on their trial period policy (offering less than 30 days, for instance), you should walk away. You should also ask about the reliability of the model you’ve chosen and what, if any, fees are involved with reprogramming or re-tuning.

In general, if a retailer seems more interested in making a sale than ensuring your long-term success with a hearing aid, it's likely best to find another source. $1,500 and up for a set of hearing aids is not uncommon and, with such a significant outlay, your satisfaction is extremely important.

Tips for Getting Used to Hearing Aids

Hearing aids are, well, just that; they're an aid to hearing, not a cure for hearing loss. They take some getting used to in order to get the maximum benefit from them.

Get accustomed to taking them off and on and changing the battery or charging them before you head out on the town with them. Given how small they are, this can take a little practice, and it's best to do this at home rather than in the car or in a restaurant. If a hearing aid is too small or difficult for you to confidently manipulate, this is something to address during the trial period. Frankly, you’re unlikely to use them much if they’re too hard to put on. You may also have an app for your smartphone or tablet to control some of the features. Make sure you download this app and become familiar with the interface.
Start slowly. You’re going to be hearing a lot of sounds and frequency ranges your brain has become accustomed to doing without. This can be tiring both physically and mentally, so don’t push it and follow the advice given to you by your audiologist or hearing aid dispenser. Your level of comfort should increase after a few days or weeks.
Next, wear them a lot! This is important for determining if the fit is correct, but it also allows you to use them in a variety of settings. Try watching something on TV, going out to lunch with friends, and having the grandchildren over. You’ll come to understand how the hearing aids respond in different situations. Your experience, especially in identifying shortcomings of the hearing aids in certain situations, is very valuable in helping your hearing aid dispenser or audiologist make adjustments. This leads us to my next point.
The process isn’t over when you first leave the office with your new hearing aids. You can and should return to the office as many times as needed for adjustments, whether it be for the fit or for their performance. You’re not being fussy, so don’t worry about that. With programmable hearing aids, there's a huge array of adjustments that can be made to improve their performance. It's normal for hearing aids to feedback or whistle when you’re handling them, but if it's happening when you’re wearing them then that’s a sure sign more adjustments are needed.

Maintenance and Upkeep

Unlike your phone or other small electrical devices, hearing aids require modest maintenance to stay functioning at their highest levels.

Do:

Take your hearing aids off before going to bed, going for a swim, or stepping out into a downpour. Moisture is the number one enemy of hearing aids and can degrade the circuitry over time.
Related to the above point, consider buying a dry storage container. These can range from fancy electric models to jars of desiccant material (like the little pouches that come with a new pair of shoes). This is one of the best and cheapest ways to extend the life of your investment. I’ve repaired thousands of hearing aids in my time and can say without a doubt that these storage containers are well-worth the cost, doubly so in high-humidity areas of the country.
Brush off your hearing aids once a day. No one likes to talk about earwax, I get it, but it's going to happen and, so long as it isn’t excessive, it's a sign your ears are functioning normally. You likely got a small bush with your hearing aid, but I always preferred a soft, dry toothbrush for daily cleaning. Gently but firmly brush away the sound opening every night or every morning. Keep that small brush in your travel kit for when you’re away.
Get your hearing aids professionally cleaned and serviced once annually. Hearing aid specialists have the training and tools to perform deep cleaning. This is another service that's well worth the modest expenditure in the long run.

Don’t:

Store your hearing aids in the bathroom. It seems logical to do so, keeping them handy for when you’re getting ready for the day but the moisture created by steamy showers will wreak havoc on your hearing aids. Best to keep them by your bedside or on a dresser.
Similarly, if your hearing aid requires batteries, don't store them in the medicine cabinet. The humidity can cause corrosion and significant declines in performance.
Use any solvents or cleaning chemicals to clean your hearing aids. They can, and likely will, damage the circuit, possibly voiding your warranty and leading to expensive repairs.
Poke anything inside the sound opening of a hearing aid when cleaning. This is best left to the professionals with the tool and training to do so safely.
Put up with discomfort. If you’re experiencing discomfort or a raw feeling in your ear, return to where you bought the hearing aids for adjustments. It seems strange, but the shape of our ears does change slightly as years go by which can cause a hearing aid to fit improperly. It's oftentimes less trouble than you might think to alter the fit of a hearing aid.

With so many Americans experiencing hearing loss, I wish it was talked about more in an open and honest way. Sure, it can be a drag, but it also doesn’t have to be. Hearing aids, while not a cure, offer an immense quality of life benefit that can help you better handle social settings and simply enjoy yourself more. By preparing yourself to ask the right questions of your doctor, audiologist, or hearing aid dispenser, you’re taking that first step; one that you, your family, and your friends will reap the rewards of.