Eddie's Bad Hearing

Dear George,

Our neighbor Eddie turned 95 this week.  I think he’s doing great.  He does Sudoku, takes long walks in the park, and can still do the cha-cha-cha.  However, he is more grumpy than he used to be.  He’s not upset about the Tea Party or potential terrorism at the Olympics.  It’s more about the vicissitudes of everyday life.  According to Eddie, people nowadays have lost the ability to speak correctly.  They mumble all the time, slur their words, talk too softly.  Because they don’t enunciate correctly, their “f’s” and “s’s” and “th’s” all run together.  Women, believe it or not, are even harder to understand than men.  Eddie is also irritated at the manufacturers of modern appliances.  Radios and TVs don’t put out enough volume, doorbells are faint-hearted, and half the time you can’t hear your cell phone ringing at all.

I’m sympathetic to Eddie’s views because I’ve obsesrved some of the same annoyances myself.  I told Katja about Eddie’s complaints, but she said it was a bunch of hooey.  She was surprised I hadn’t noticed how Eddie’s hearing has been getting worse in recent years. That was puzzling to me, but I Googled some stuff to get more info.  Here are a few of the things I learned.  [Note: numbers in parentheses refer to sources listed at the end.] 

What is “hearing loss” anyway?  There are various symptoms of hearing loss.  Some are: muffling of speech; difficulty understanding words, especially with background noise; often needing to ask others to repeat themselves or speak more loudly; turning up the volume on the TV; and/or avoidance of conversations or particular social situations (6).

How common is hearing loss?  According to WebMD, hearing loss is the third most frequent health problem in the U.S. (10).  A national survey in 1971 estimated that over 13 million American adults reported hearing loss.  That’s increased substantially, with about 36 million adults reporting hearing problems today (7). 

How is age connected with hearing loss?  Advanced age is the single most common cause of hearing loss (10).  However, hearing loss affects all age groups, and nearly two-thirds of people with hearing loss are younger than 65 (14).  Decline in hearing begins in early adulthood but doesn’t usually interfere with understanding conversations till much later (1).  The National Institutes of Health estimate that 18% of American adults between 45 and 64 have some degree of hearing loss (7).   That figure goes up to 30% for persons between ages 65 and 74 and to nearly half (47%) for those 75 or older.  Men experience more hearing loss than women.  Researchers don’t know exactly why hearing declines with age.  However, it’s presumed that lifetime exposure to noise and other damaging factors wear down mechanisms in the ear (10). 

What are the causes of hearing problems?  Experts distinguish between “conductive hearing loss” and “sensorineural hearing loss” (11).  Conductive hearing loss involves a mechanical problem with the ear due to things like buildup of ear wax, fluid in the ear, foreign objects, or damage to the eardrum.  Often such causes can be treated through surgery.  Sensorineural hearing losses, on the other hand, are permanent and can’t be reversed.  This happens when the tiny hair cells that detect sound in the ear are injured, diseased, don’t work correctly, or have died.  They don’t grow back.  This is most frequently linked to age-related hearing losses, but may also be caused by birth defects, genetic conditions, repeated exposure to loud noises, some medications, certain illnesses (heart disease, high blood pressure, diabetes), or other factors.  Sensorineural hearing losses are usually treated with hearing aids and/or other assistive devices (11).  

Do hearing aids really work?  Hearing aids can help some kinds of hearing loss by making sounds louder.  However, they also magnify background noises which interfere with how well you can hear.  Using hearing aids is much more complicated than, for example, getting glasses to improve one’s vision.  You may need to have several fittings of a hearing aid (8), and it may take months to learn to use a hearing aid successfully.

You need to learn to adjust the volume and to program the hearing aid for loud and soft sounds.  Hearing aids may be uncomfortable at first, and people's own voices may sound too loud to them.  You can get feedback in the form of whistling sounds, wind noises are bothersome, and cell phones can cause buzzing sounds (3)  Many people quit using hearing aids because of the resulting frustration (2).

How many people use hearing aids?  About six million Americans currently use a hearing aid (12).  On the other hand, most people with hearing loss don't use hearing aids.  The National Institute for Deafness estimates that about 20% of people who could benefit from a hearing aid actually use them (3)

Why do people choose not to use hearing aids?  A major obstacle to hearing aids for many people is cost.  A high-quality hearing aid can run from $2000 to $6000, and they aren’t covered by Medicare or most insurance plans (16).  In addition, according to the Disabled World website, people think that a hearing aid will make them look older or will have a negative impact on how strangers interact with them.  Some think they don't need a hearing aid because they  can do just fine by using visual cues to adjust for their hearing loss (4). According to Psychology Today, "many people with mild to moderate hearing loss can manage well enough without them" (16).

How satisfied are hearing aid users?   In a 2008 national survey study, researchers at the Better Hearing Institute found that 74% of hearing aid owners are "satisfied" with their hearing aids, 9% were "neutral", and 17% were dissatisfied.  12% no longer used hearing aids they owned.  82% of consumers would recommend hearing aids to their friends, and 48% would buy their current brand of hearing aid in a new purchase.  On average, people wear their hearing aids about 9.5 hours per day (13).        

Why do hearing aids cost so much?  Tricia Romano, health writer for the New York Times, reports that buying a hearing aid has become more confusing and difficult than buying a new car (and almost as expensive).  According to the Hearing Review and House Institute, the average cost of a hearing aid of $3,000.  And it’s standard practice for people to have hearing aids in both ears.  Since a hearing aid is basically a microphone and amplifier in your ear, it isn't clear why prices are so high.  TVs, computers, and cellphones have gotten cheaper and cheaper, but prices for hearing aids have increased about 8% a year for the last twenty years.  Romano cites the CEO of a hearing aid company who states that microphones, speakers, and processing chips cost $10 to $15 apiece and that most hearing aids cost no more than $100 to manufacture.  Most of the price of a hearing aid goes to audiologists and retailers because of additional services.  One industry source said that the high prices are connected to research and development, customized service from audiologists at private clinics, multiple follow-up visits, and overhead costs.  Another observed that every new technological development is used to justify price increases.  Less expensive hearing aids are available online for prices from $400 to $600, though they need to be mailed back in when one needs adjustments (which is a nuisance).  Costco is one national discount firm that has nationwide hearing centers which offer face-to-face service and audiologists for custom fittings.  Costco sells hearing aids made by the major companies for $500 for basic models and $1,300 for the most advanced models.  Needless to say, Costco is resented by competitors in the industry (15)

What psychological benefits can be associated with hearing aids?  According to the Mayo Clinic, depression, anxiety, and an incorrect perception that others are angry at you are common consequences of hearing loss.  Sometimes older people are erroneously thought to be confused or unresponsive simply because they don’t hear well.  People using hearing aids tend to report greater self-confidence, closer relationships with loved ones, and overall improvements in their outlook on life (6).

I passed along all this information to Eddie.  To his credit, he has concluded that he may have a hearing problem.  Now he’s mulling it over.  It’s hard to predict what he’s going to do next.  I think he wants to talk to some of his 95 year old chums about their experiences.  In the meantime, we talk loudly to one another over the back fence. 

Love,

Dave

SOURCES:

(1).  “Deafness,” www.wikipedia.org; (2). “Hating your hearing aid,” www.blogs.nytimes.com/2008; (3). "Hearing aids," www.nidcd.nih.gov/hearing; (4). “Hearing aids -- How they work and reviews", www.disabled-world.com; (5).  “Hearing loss,” www.entnet.org; (6).  “Hearing loss,” www.mayoclinic.org; (7).  “Hearing loss,” www.nihseniorhealth.gov; (8). “Hearing loss and aging,” www.medicinenet.com; (9). “Hearing loss and older adults,” www.nidcd.nih.gov; (10). “Hearing loss: Information and resources,” www.webmd.com; (11). “Hearing loss: Medline Plus,” www.nim.nih.gov/medlineplus; (12). "How do hearing aids work?", www.audiology-today.com; (13): “Marke Trak VIII: Consumer satisfaction with hearing aids is slowly increasing” (Sergei Kochkin), www.thehearingjournal.com; (14). “Myths about hearing loss,” www.betterhearing.org; (15). "The hunt for an affordable hearing aid" (Tricia Romano), www.blogs.nytimes.com/2012; (16).  “Why we don’t wear hearing aids,” www.psychologytoday.com.