Friday, April 26, 2013

Hearing loss is a misfortune: What you need to know about deafness and investing in hearing aids

"I am just as deaf as I am blind. The problems of deafness are deeper and more complex, if not more important than those of blindness. Deafness is a much worse misfortune. For it means the loss of the most vital stimulus-- the sound of the voice that brings language, sets thoughts astir, and keeps us in the intellectual company of man." - Helen Keller

Hearing Loss FACTS:
- Americans with some level of hearing impairment: 37 million
- Hearing loss in the total population: 12.1 percent
- Hearing loss among adults, 65 and older: 29 percent
- Causes of hearing loss: Noise, 33 percent; Aging, 28 percent; Infection or injury, 17 percent; Loss at birth, 4.4 percent.
- Hearing loss is the third most common health problem in the U.S.
SOURCE: Centers for Disease Control, CDC, Atlanta, Ga., Gallaudet Research Institute, Washington D.C.

Do you regularly ask family and friends to repeat themselves?
Does your spouse complain that the sound on the television is too loud?
Do you hear crackling noises?
Do you hand the phone to your spouse when someone calls?
These are signs of hearing loss. Join the club, nearly 12 percent of all Americans and 30 percent of those 65 and older have trouble hearing.
The good news is that recent advances in technology are making hearing aids smaller and more effective. The bad news is costs are not coming down and Medicare doesn’t cover the expense, which typically can range from $750 per hearing aid to as much as $3,200.
For Sally Bliss, Camas, Wash., the cost was worth the expense.
A non-malignant brain tumor diagnosed 13 years ago affected her hearing and the balance mechanism in her ear. By 2004 she had 5 percent hearing loss in one ear and 50 percent in the other.
“I was feeling a lot of emotion around this…I was having the biggest pity party,” Bliss remembers. “My advice is go get help; don’t be afraid of spending the money and stay engaged in the process.”
Bliss says wearing hearing aids with Bluetooth software technology has changed her life.
“Hearing loss can be devastating…and wearing hearing aids is a huge adjustment,” she said. “But you just can’t give up on life. I can now watch TV, go to movies, communicate with my husband and talk to my kids on the phone.”
Bliss, 73, is a success story but experts say many people slip into isolation because of untreated hearing loss.
A recent national study showed that hearing loss in older people may exacerbate frailty, cognitive decline and other serious medical conditions. The study reported in JAMA Internal Medicine found that annual rates of cognitive decline were 41 percent greater in older adults with hearing problems than in those without.
Addressing hearing loss, however, is about more than buying a hearing aid to amplify sound, said Brad Edgerton, PhD audiologist and director of audiology for Ear, Nose and Throat Clinic of the Northwest in Vancouver, Wash.
“Hearing loss is a tough problem for a lot of people because it’s complicated and involves their social structure, their family,” Edgerton said. “It’s all about how you apply the technology to make life easier and better for people.”
Edgerton with 35 years of experience agrees that some patients resist hearing aids for simple cosmetic reasons because they “make them look old.”
“My impression is that cosmetics is always important even though attitudes are changing,” he said. “There used to be a real stigma with hearing aids because only older folks needed them. As the technology has gotten smaller, younger people are more willing to explore hearing aids. We now see as many people under age 65 as are over that age.”
Miniaturization related to digital computer-chip technology continues to bring changes and improvements to the hearing aid industry. Some digital devices now feature Bluetooth software that allows receiver-in-canal connectivity to smart phones or televisions. For example someone with hearing loss can enjoy direct amplification from the TV while their spouse and family hear the sound at normal levels. 
Even with these advances, no hearing aid can completely restore normal hearing, experts say. The best that can be expected is improved hearing that requires commitment on the part of the patient to manage the device and embrace professional support.
“We try to get a happy customer who will use their hearing aid seven days a week,” Edgerton said. “If it’s in a drawer unused, it’s been a failure.”
Cost can be daunting
Amit Gosalia, PhD. audiologist and owner of Audiology Clinic Inc. in Vancouver, Wash. agrees that hearing aid costs can be daunting.
“But first of all, not everyone needs a hearing aid so the first step is to find out why you may be having hearing loss,” Gosalia said. “A full audiology evaluation can reveal a lot.”
And there are numerous ways to get financial help, he said.
Medicare will cover a hearing medical exam and an audiologist’s test if ordered by a physician. Some private Medicare Advantage plans may cover part of hearing aid costs.
Industry fragmentation, confusing messages
Hearing aids are sold with a multitude of brand names but the reality is that they all are produced by a few manufacturers, among them Starkey, Siemens, Phonak and Microtech. Consumer Reports magazine describes the market as “fragmented and confusing” where consumers face “difficulty sorting out good hearing-aid providers from the less-capable ones.”
Prices of hearing aids remain high because research and development costs related to digital technology are increasing. In fact, development and manufacturing costs have risen faster than global demand for hearing aids. Wholesale prices have doubled, Edgerton said.
Meanwhile, high prices, mediocre fittings and lack of product information about what they were buying makes the experience less than satisfactory for many, said Consumer Reports. The magazine’s writers said the most important decision when buying hearing aids was to “find the proper professional from whom to buy because it’s likely going to be a long-term relationship” with follow-up fittings and device upgrades.
Be prepared to then ask a lot of questions:
Does the device have suppression feedback?
Does the device have directional microphones, which help with conversations in noisy situations or when watching TV?
What does the warranty and return policy look like?
Will follow-up services be available? How many fittings are allowed with the purchase?
What’s the return policy?
Make sure office hours and location are convenient. Does the office handle walk-in repairs rather than by appointment?
If a loan is part of the purchase agreement, make sure you know what you’re signing. Some may claim no interest for 12 months but 14 percent interest on a three-year loan.
Financial assistance for low-income clients may be available from several sources, said Vancouver audiologist Gosalia.
“Look at your cash flow…can you do monthly payments,” he suggested. “But keep in mind you’re not buying just a hearing aid but also follow up services that go with it – rescreening, refittings.”
Lions Club International operates the Lions Affordable Hearing Aid Project. The Starkey Hearing Foundation may be another option. Sertoma provides mostly refurbished hearing aids to people who need assistance and state Medicaid programs also may provide hearing aids to people of very limited means.
For more information, contact your local social services agency for an appointment to determine your eligibility for Medicaid. If you’re a veteran, seek assistance through the Veterans Administration. The state Dept. of Labor & Industries may be a resource, if your hearing loss is tied to work.
Ask your provider for help in finding low-cost ways to buy hearing aids.
1. Get a check up. Before shopping for hearing aids, see an ear, nose and throat physician or a trained audiologist for a hearing test and medical exam. An accurate diagnosis of your problem is essential in selecting the best hearing aid. Some people don’t need hearing aids.
2. Look at follow-up service provided by the vendor. Service is a big part of what you’re buying. Check for a warranty.
3. Ask for a trial period.  If a device doesn’t meet you needs return it. Be aware of misleading sales tactics -- hearing aids can not restore normal hearing.  
4. Involve spouse and family members in the process of buying and learning to use a hearing aid. Classes may be available.
5. Price is secondary. The most expensive device may not be the best for your needs.
6. Don’t be afraid of new technology. Try it and find out what it will do. At the fitting visit, practice talking on the phone and other activities.
7. Be honest with yourself. Wearing a hearing aid is much less noticeable than asking people to repeat themselves.

SOURCE: Ear, Nose and Throat Clinic of the Northwest and Audiology Clinic Inc., both Vancouver,
- Conductive Hearing Loss: Caused by something that stops sounds from getting through the outer or middle ear.  Often can be treated with medicine or surgery.
- Sensorineaural Hearing Loss: Occurs when there is a problem with the inner ear or hearing nerve.
- Mixed Hearing Loss: Includes both a conductive and a sensorineural hearing loss.
- Auditory Neuropathy Spectrum Disorder: Occurs when sound enters the ear normally, but because of damage to the inner ear or the hearing nerve, sound isn't organized in a way that the brain can understand.

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