My mom wore analog hearing aids 30 years ago that made her miserable. She went out to dinner with friends every night but had a hard time understanding what everyone was saying.

I find it a lot easier with my digital aids, but they’re far from perfect. I still can’t hear when there’s a lot of noise in the restaurant or get what people are saying at the end of the table.

You’d think with all the advances in modern medicine and technology these past 50 years, you’d be able to go get a hearing aid and presto — the world’s sounds would come into focus. That’s not the case. Among the millions of seniors who have significant hearing loss — that’s one in four age 65 to 74 and half of those age 75-plus — too many still have trouble hearing. And that can lead to health issues that include dementia.

It’s not just the cost of hearing aids that’s to blame, though that’s a big roadblock. Many of us don’t exactly know which type of technology would work for us based on our listening needs. I didn’t. I just got handed my hearing aid and went home with it. That’s because audiologists I saw never evaluated me for my individual needs. And that’s after spending $2500, which was supposedly a big bargain at a university audiology department.

Turns out my audiologist wasn’t doing his job very well. He was just selling me hearing aids.

Why Getting the Right Hearing Aid Is So Tricky

Helping people hear well is much harder than helping them see well. Unlike simple vision problems, hearing loss is sneaky. It varies according to the setting you’re in, so you might not even realize you have a problem. For example, you may hear fine in a quiet place and at close distances when facing the speaker, but if you have high-frequency hearing loss — the most common type as we age — you’ll have a hard time hearing in a noisy room, because the noise interferes with your better lower-frequency hearing.

Unless your specific type of hearing loss and your individual needs are addressed, you might end up still not being able to hear, even with hearing aids.

What’s more, even today’s hearing aids don’t always help us distinguish between certain words that sound alike. And hearing aids still do not give you natural hearing, although they’re getting closer.

“Consumers have been taught by professionals and by the hearing aid industry to think that hearing aids are the solution to hearing difficulties,” says Dr. Cynthia Compton-Conley, an educator and consumer advocate who specializes in needs assessment and hearing assistance technology. “But while hearing aids can definitely lead to improved communication, they’re not perfect.”

This means you have to buy a hearing aid that suits your particular needs and you might have to add some bells and whistles to make it work better.

Assistive Listening Devices

So, what’s the answer? According to Compton-Conley, you may need an Assistive Listening Device or ALD along with your hearing aids, or an ALD instead of hearing aids, depending on how bad your hearing loss is and how well you recognize words.

What are assistive listening devices? “Think binoculars for the ears,” Compton-Conley says. An assistive listening device helps you hear in certain challenging situations — in a place with bad acoustics or where there’s lots of background noise, for instance, or when you’re far from the sound source.

Assistive listening devices include telecoils, personal amplifiers and microphones. Here’s a link explaining the different assistive listening device options.

What You Should Expect From an Audiologist

Two Assessments

When it comes to treating hearing loss in adults, Compton-Conley says best practices should include:

1. A comprehensive hearing assessment.
2. A communication needs assessment that considers your unique lifestyle.

Your audiologist should take into account both your specific hearing issues and your individual needs when prescribing a hearing aid or ALD. Make sure the audiologist does a thorough needs assessment before recommending a specific technology.

“Two people having a mild to moderate hearing loss might need hearing aids to make speech audible and understandable in quiet,” Compton-Conley says.  “But recommendations change when these people encounter a noisy situation such as a restaurant. The first person may do well with a set of directional microphone hearing aids, whereas the second person has such poor speech understanding in noise that she needs to ask her dinner partner to clip a wireless microphone onto his lapel. It’s only via comprehensive hearing assessment and needs assessment that these two solution scenarios can be known.”

Matching Technologies to Needs

In a needs assessment, your audiologist should ask you a series of questions to determine if you’re having trouble meeting any of the four listening needs. He or she should then match the technology to your needs.

1. Face-to-face communication. We need to be able to communicate with people both in a one-on-one and a group situation. Assistive Listening Device — for example, hardwired and wireless microphone systems that can be used at home and in public areas — as well as hearing aids can help you meet these needs.
2. Media: We need to be able to enjoy TV, a tablet, a movie theater, etc. If you’re having trouble in this area, you may be able to use hardwired and wireless technologies along with hearing aids, or just with a set of earphones instead. For example, a wireless TV transmitter can send the TV audio directly to your hearing aid or earphone. The transmitter can be a proprietary one that works with certain makes and models of hearing aid or a generic wireless technology such as an FM, infrared or loop system. Captioning is also available.
3. Telecommunications: We need to be able to communicate on the phone. Here, you’ve got several options, from hearing aids that can accept streaming from a cellphone, to generic devices that can send a cellphone signal to hearing aids that have telecoils. You can also get captioned phone systems and captioning services for videoconferencing.
4. Alerting Needs: We need to be aware of events in our environment — our alarm clock, a timer, the doorbell or smoke alarm, for example. There are systems are available that use an enhanced audio signal, flashing lights, and/or vibration to alert you to these. Some phones have these built into accessibility settings (for example, you can set your iPhone to flash when there’s a call or text message).

For more information, see www.soundstrategy.com.

Adjustments and Real Ear Measurement

Your audiologist should test your hearing aids once you get them to see whether they meet your needs. He or she should adjust and verify the aids using a small microphone placed next to the eardrum— it’s called real ear measurement and it tests whether the hearing aid provides enough amplification at each frequency for soft, medium and loud sounds. The goal: good sound along with comfort.

Once your audiologist has verified your aids, the final step is making sure you’re getting the benefit in the real world.

How to Advocate for Yourself

Not all audiologists follow these procedures or recommend the right ALDs, so you might have to advocate for yourself. Here’s what Compton-Conley suggests:

1. Make a grid of the four needs: communication, media, telecommunications and alerts.
   1. Write the four needs along the top
   2. Along the side, list all the settings where you find yourself or want to be able to hear: home, work, social settings, and so on.
   3. Taking each need one at a time, think about whether or not you experience difficulty. For example, under Face-to-Face Communication, do you often have trouble understanding what’s being said when you’re talking to someone at home? At work, list all of the situations in which you have trouble hearing: Does it happen in your quiet office or in meetings? Socially, do you have difficulty when the person you’re talking to is close up or far away, in a quiet or noisy place, like a restaurant?

This information in your list will help the audiologist determine whether hearing aids can help and whether or not you could benefit from an additional hearing aid technology, Compton-Conley says.

How to Find an Audiologist Who Will Work With Your Budget

Look for an audiologist who is patient and who listens to your concerns and answers all your questions, Compton-Conley says. “It’s all about you and your unique hearing needs.” And your budget.

She recommends talking to the audiologist before you make an appointment. Explain that you’re looking for someone who can evaluate your needs and is willing to use a range of technologies and price points. For example, one budget-friendly solution is to opt for a hearing aid telecoil along with a generic ALD instead of splurging on a high-end wireless hearing aid. Also ask for the bill to be “unbundled”: an audiologist can bill separately for their services and the hardware, which provides transparency and can save you money.

Review the warranty. Hearing aids are typically covered from one to three years, and the first year may include replacing lost ones. An extended loss and damage warranty is a smart idea since hearing aids are so small.

The good news: New technologies, policy shifts and other advances in the pipeline may make paying for hearing aids easier and improve results. Stay tuned!

See also “What I learned from Browsing the Hearing Aid Forums” on SeniorPlanet.org

How has your experience been with audiologists?