Senior lifestyles: How to navigate hearing loss

Do you ever notice that it’s tough to follow a conversation when you are in a space with a lot of background noise, like a crowded restaurant or public meeting? Have you found yourself asking people to repeat themselves or slow down when speaking to you? Are you slowly pumping up the volume on your TV or radio so you don’t miss the dialogue in your favorite program?
If so, you may be among the millions of people experiencing hearing loss. According to the Mayo Clinic, roughly one third of people in the United States between the ages of 65 and 75 experience hearing loss; that number jumps to one in two people over the age of 75.
Hearing loss is generally an irreversible process involving the outer or middle ear (called conductive hearing loss), the inner ear (called sensorineural hearing loss), or both.
The anatomical process of hearing operates within a delicate system deep inside the inner ear whereby tiny hairs attached to nerve cells in the cochlea transmit vibrations to the brain and are interpreted as sound.
Over the course of our lives, exposure to loud noises, harsh conditions, ear infections and hereditary factors will damage those tiny hairs, causing them to become less and less sensitive. By the time a person reaches the later years of life, after countless music concerts, airplane rides, lawns mowed, babies reared and fireworks displays, it’s no wonder those little hairs can’t keep up!
But despite how common the occurrence or understandable the causes, there is still a kind of stigma that exists around hearing aids that prevents or delays many people from seeking assistance when they start to experience hearing loss. And while hearing loss is clearly a medical condition, most basic healthcare plans do not cover hearing assistance and therefore patients often face a hefty price for reclaiming some of their hearing.
That may help explain why an estimated 24 million people in the United States have hearing loss and aren’t doing anything about it, says Dr. Robert Hartenstein, an audiologist at Audiology Associates in Middlebury and Rutland.
Moreover, with the huge range of services and practices that offer solutions to those facing trouble hearing it can be overwhelming and confusing to navigate the field and figure out what you need and why.
Most agree that the best option for patients is to at least start with a diagnostic evaluation performed by a doctor of audiology.
“Hearing aids are very individual,” says Dr. Julie Bier (pictured, left), one of two audiologists Better Living Audiology of Middlebury and South Burlington. “There are many things that go into making a hearing aid recommendation, and this can only be done by meeting with a professional and reviewing test results and the patient’s communication needs.”
Most (if not all) audiology practices offer a variety of hearing aids that they will recommend and fit to each patient. However, Dr. Bier cautions that even some professionals and offices work exclusively with certain hearing aid brands and therefore will steer clients toward those aids rather than another that might in fact be a better fit for them.
“Also, the hearing aid function is limited to how well the professional is able to program it,” Bier says. She recommends that patients consider the professional’s training and whether they have a full understanding of all of the programming options within the hearing aid to make sure it is programmed accurately to their individual hearing loss.
Additionally, the professional should be able and willing to provide verification (post-fit) measures to ensure that the hearing aid is functioning the way it should in the patient’s ear.
“Many professionals are either unable or unwilling to complete this step due to cost and time,” she says. That could be a red flag.
While it may be wise to start with a visit to your local audiologist, other options do exist for actually purchasing hearing aid devices that could offer other benefits, particularly if you’re on a tight budget.
Hearing aid dispensers, or vendors, are practices that may or may not have trained audiologists on staff, but will rather specialize in knowing a wide variety of hearing aid devices and may offer more competitive pricing.
Bernie Sage (pictured, right) is a hearing aid vendor who owns Advanced Hearing Technologies, with an office in Middlebury as well as in eight other Vermont towns.
With 28 years of experience in the industry and hundreds of hours of specialized training on the wide variety of options that his patience face when selecting hearing aids, Sage is proud to offer individualized care to each customer he works with. He offers in-home hearing tests and works with every brand of hearing aids that he knows about.
“I like to find out what a person’s lifestyle is like and consider which aid I think matches their unique needs,” he says. His style is to present options to the client and offer free trials with as many devices as a client would like before they make a selection.
“The performance of these devices varies significantly,” Sage explains, “with varying numbers of channels and frequencies that each will pick up.” The higher the number of channels and the more frequencies offered, the more nuanced and sophisticated the hearing will be.
When facing a purchase of several thousands dollars, it is wise to do your homework on who is offering the best rates, but make sure that you’re comparing apples to apples.
Some brands will offer a lower-tech model through retailers like Costco, so while it might be the same brand that your audiologist talked about, the devices are not the same.
However, hearing aid dispensers are often part of buying groups that can negotiate very competitive pricing during special sales events even for the highest end models of hearing aids.
“During a special sales event we can offer hearing aids that might normally be $5,900 for $4,000 or so,” Sage said.
But while pricing is certainly a concern for many patients, specialists recommend being careful not to buy just based on price.
While audiologists do go through four years of specialized medical training, vendors do not need any formal education. They do need to complete the state-administered written exam to obtain a license to dispense hearing aids. They will perform hearing tests for the purposes of fitting hearing aids, but generally cannot provide diagnostic explanations for individual patients and help explain the extent of hearing loss or underlying causes or concerns about the ear canal.
So while most providers have the best intentions at fitting you with an appropriate device, in some cases a patient may be able to avoid a many-thousand-dollar set of hearing aids because their hearing problem was really just due to a buildup of ear wax that was resolved with a simple cleaning.
The hearing aids offered at Audiology Associates cost between $1,200 and $6,500 per pair, Hartenstein says, which is a lot of money. Bier agrees. With price tags that can reach up to $8,000, she says, it’s important to get it right.
According to product specifications, devices should last between three and five years, although Hartenstein says he sees patients still happily wearing hearing aids that he fit back in the 1990s. “If they’re happy and don’t need the new technology, I’m happy,” he says.
However, like most things, advancements in hearing aid technology are rapidly changing the industry. And as Hartenstein put it, “about 95 percent of my patients end up choosing the most expensive option when they experience the difference in their quality of hearing.”
THIS 3-D EAR scanner is used to create models of the inner ear — which are used in customized earpieces for hearing aids, earplugs and ear protection. Local audiologist Dr. Robert Hartenstein helped develop this digital scanner made by Lantos. The tip is inserted and inflated within the inner ear, allowing the probe at the end to collect precise imagery of the ear canal.
Photo courtesy of Lantos Technologies
Hartenstein happens to be one of the people really in the know when it comes to new technology. In addition to his practice as a Doctor of Audiology, Hartenstein is also a clinical research consultant for companies working on cutting edge technologies for ear scanning.
Until recently, in order to obtain a model of a patient’s inner ear, the only option was to make a physical mold using silicone. The process is rather laborious and has some obvious risks and drawbacks, Hartenstein explained. “Many doctors are understandably nervous about damaging the ear drum and inner ear and therefore don’t model deep enough into the ear canal to get the measurements that are most important for custom-fit ear pieces.”
However, Hartenstein is working with two companies (Lantos and Otometrics) now offering digital modeling scanners that create a computer model of a patient’s inner ear in a matter of seconds using a non-invasive laser device that outputs a near-perfect 3-D image of a patient’s ear, from the inner ear all the way out the canal to the outer ear. While the doctor scans the patient’s ear with the laser probe, the model takes shape on the screen right before your eyes.
While these scans can be useful for customized hearing aid tips and devices, they are also useful for many other purposes — noise-cancelling for musicians and DJs, muting for machinery techs, as swim plugs for someone with sensitive ears or simply comfortable ear plugs to muffle the snores of your partner so you can sleep better at night.
Customers may be relieved to learn that scans and models performed by even the most cutting edge tools are usually included in the price tag of the hearing aid or earpiece, rather than added on as additional charges.
Customization of hearing aid devices extends beyond the physical shape of a customizable ear piece as well. These sophisticated devices can be programmed using apps that can adjust the magnification based on location and how broad or targeted your hearing needs are in any particular situation. Users can program specific settings for places that they frequent (for example a favorite restaurant or theater) so that with one click of a button their device hones in on the settings that enable optimum hearing.
“Hearing aids now have Bluetooth technology where they can connect directly to cell phones,” Bier adds, “Not only is this a convenience, but it can help people tremendously when talking on the phone, watching TV and movies, or even listening to music.”
“It can really affect quality of life and enjoyment in a meaningful way,” Hartenstein says of fitting his patients with proper hearing aids. “Most frequently, the comment I get is ‘why didn’t I do this sooner,’” he says.

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