Hearing Aids: The Cost, Stigma and Evolution of Technology

Apr 10, 2012

Nearly two out of every three Americans will suffer significant hearing loss by the age of 70, says a recent study in the Journals of Gerontology. But many do not get hearing aids. Health and Science's "Aging Well" section featured stories that discuss the stigma associated with hearing loss, the technological innovations and the expense.

Two of the experts quoted are Margaret McCabe, director of audiological services in the Department of Hearing and Speech Sciences at the University of Maryland, and David Myers, a psychology professor at Hope College in Michigan and author of "A Quiet World: Living with Hearing Loss." At 11:30 a.m. EDT on Tuesday, April 10th, both experts discussed hearing aids and loop technology.

I was surprised to learn that my insurance provider, as well as the insurance providers of people I know, consider hearing aids to be "cosmetic" and therefore either aren't covered or are covered at such an absurdly low rate as to make it not worth filing the claim. While people may shy away from getting hearing aids due to social stigmas surrounding them, cost is also a factor. Do you know why insurance companies have taken this position? I consider hearing as important as vision; my provider covers routine eye exams and eyeglasses, but not hearing aids.

Insurance coverage for hearing aids is improving. However, consumers need to be persistent. If your policy offers coverage, you may need to press the point.

My father is 81 and his old hearing aid is no longer useful to him. I don't think he can go through the process of getting used to a new hearing aid and making sure it is tuned well to his needs. Are there other types of technology that might help him hear conversations better? Thank you!

There are many options for helping someone to hear.  An evaluation by an audiologist who offers information on auditory rehabilitation and other assistive listening devices - besides hearing aids - would probably be helpful.

Will a hearing aid delay and/or mitigate the impact of dementia by reducing the sense of being cut off from people?

The NY Times recently had an article on some provocative work by Frank Lin, M.D., Ph.D. on hearing loss and cognitive decline . . . and on how hearing assistance, such as hearing aids and hearing loops for assitive listening, might be preventative. See here

I have been dealing with Meniere's Disease for more than 25 years. Typical symptoms including severe hearing loss and vertigo. I had a Labyrinthectomy in 1995. Zero hearing in left ear. Went bilateral in 1998 and I have severe hearing loss in my right ear. I have tried top of the line digital hearing aids twice. Unfortunately, the HAs provide little help and just increase the distortion. In quiet surroundings, it can be helpful. But, otherwise it just annoys me. It sits in a drawer right now. I need clarity, not just volume. My question is: have the HAs improved in the last five years so they are better performing for those of us with Meniere's?

Yes, HAs have improved significantly in the last 5 years.  Your hearing loss may be a difficult one to manage, but there are always options.  You need a caring professional to assist you, with counseling and instruction.

I find I can hear faint sounds in a silent room, but cannot follow even loud voices in a noisy environment. It seems my brain locks onto the noise rather than the signal (voice) I want to hear. Is there a way to train my brain to ignore the noise and track the signal instead?

This is one of the most difficult problems associated with hearing loss.  Some features of newer hearing aids are designed to help with managing background noise but it will never be perfect.  That said, hearing aids should make your hearing loss manageable, especially with proper fitting and counseling.

For a 70 year old with moderate to severe loss (I have the most trouble hearing conversation in restaurants, TV and lecture halls), how many program settings do I need? I am testing a Resound Alera 9 w 4 program capability--is this enough?

The number of programs a user wants to have is really a matter of personal choice.  Some users don't want to have to change programs - and they may not need to.  Other users like having lots of control.  Your audiologist should discuss with you the pros and cons, and help you to understand what kind of listener you would like to be.

I'm 63 and have had some hearing loss for a long time (first noticed by a friend when I was in my 30s). It's getting worse, but very slowly. For example, there are some speakers that I can't hear adequately in a meeting of 20; everyone else hears them. But I hear most of what is said. I turn the TV volume about 10% higher than my wife and 25% higher than my teenage daughter. I ask people to repeat in conversation, perhaps a couple of times in a long conversation. People do not speak to me any more loudly than they speak to others. In short, it's a bit of a pain; but just a bit. Is it reasonable to wait until hearing loss becomes more bothersome to get a hearing aid? Or is there some urgency about starting early?

I would advise everyone not to wait too long.  It is harder to adjust to amplification if you have lived a long time with hearing loss - like turning on all the lights after you've become accustomed to no light in a dark room.  Also, there's some truth to that old adage about "use it or lose it" - auditory skills can decline if you live too long with hearing loss.  Sooner is definitely better.  Hearing aids are meant to make your life better.

I have tinnitus (ringing in the ears), as do both sisters and our father. The medical consensus is 'Yep, you have tinnitus, and there's nothing we can do to change that.' I believe I'm approaching the need for hearing aids. Is there any advice you can give me?

Hearing aids can often be a significant treatment in managing tinnitus.  By introducing the normal ambient sounds in the environment, many individuals find relief from their tinnitus.  I would recommend that you explore this option if you have any hearing loss at all, even if it's mild.

Is there any promising research on tinnitus? (I already know about white noise and "learn to live with it"--hoping to hear about possible treatments or cures.)

I'm not an expert, but am encouraged by new research that seems now to be coming out every month. See, for example,



There are many efforts on-going that are directed at treating tinnitus.  So far, hearing aids and tinnitus maskers, and counseling programs are the most prevalent avenues for treatment.  Don't give up hope.  Find an audiologist who can work with you.  There is a good tinnitus treatment program at the University of Maryland Medical School in Baltimore - see Dr. LaGuinn Sherlock.

I have clumsy arthritic hands that make it very challenging to deal with small items and any small controls that items may have. I also frequently drop things, particularly small items that I may be trying to handle. I am in need of hearing correction, but I am concerned about whether or not I may be able to manage hearing aid controls, batteries, and use. Plus, I am likely to drop any hearing aids that I may have from time to time. Am I am poor candidate for hearing aids based upon these concerns? Would dropping hearing aids damage them? I know that I would feel that dropped aids would need some kind of cleaning and decontamination. Would I have problems with aid controls and replacing batteries?

I wouldn't let this issue stand in the way of your exploring your options for amplification. An audiologist should spend time with you to determine your wishes and any physical limitations you may have to assist in finding a good solution.  A remote control can be a great assist for you.

My HAs have a telecoil mode (for the "loop system") but this has only been useful in Europe. Is this going to show up more in the US?

Good news . . . it is indeed showing up in more and more places--hundreds of places here in West Michigan (most worship places, three airports, lots of auditoriums, many home TV rooms, and even the Michigan State basketball arena).  Now thanks to wonderful hearing advocates in NYC, Wisconsin, Illinois, Florida, NM, AZ, Seattle and many other places, hearing loops are coming to more and more places . . . including all NYC's subway booths (450+ now installed) and all future taxis.  For more, see www.hearingloop.org.  Other resources are available at the Hearing Loss Association of America website:  www.hearingloss.org

How can I encourage my father to wear his hearing aid? He misses so much and he's often one step behind in most conversations.

This is a hard question - it's difficult to make anyone do something they don't want to do.  I have had families who tried convincing their loved one that hearing better amounted to a safety issue - that you would worry less about his/her health and safety if you knew they were able to hear things , i.e, the phone ringing, someone at the door.  He/she must feel the "need" to do something about his/her hearing loss.  Also, the idea that hearing loss can be so isolating and it can lead to depression and other health issues can be a convincing argument.  Good luck to you!

I'm ready to explore getting the hearing aids I've long-needed. Everyday it seems I get an offer from some company or audiologist offering a free trial. Clearly the offers are coming from folks with a vested interest (commission) in selling me a particular make. Even independent audiologists are affiliated with some company or at least getting commission from them. Where can I find an audiologist who is familiar with the large variety of hearing aides out there who has no conflict of interest?

Our Clinic at the University of MD is a training facility.  Your tax dollars assist us in running a clinic where the mission is the training of future audiologists.  We would be happy to assist you.  (Call 301-405-4218 for an appointment.)

To generalize, can we say that using an external FM transmitter with ear receivers is the best solution for noisy ambients and large meetings, assuming partial loss of hearing? Thank you!

I do find benefit in using a wireless mic (which, for example, I can hang on a tour guide) that transmits to a neckloop, which connects to my hearing aid telecoils.  Where I live--when I listen to TV at home, worship, attend lectures on my campus, listen to airport announcements in Grand Rapids--the venues are looped . . . so all I need do is push a button to activate my hearing aid telecoil (an inexpensive magnetic receiver) and voilà !--my hearing aids become wireless loudspeakers.  This is technology that's everywhere in the UK and Scandinavia, and is gradually coming to the USA.

They told me I need hearing aids. I refused. Reason? I know no one who has them or tried them who is happy with the results. I cannot see spending $7,500 on two aids when they won't help and may drive me crazy trying to get them adjusted. Have you found this to be true with most patients?

No, I have many very successful and happy patients.  Please don't give up.  Amplification is supposed to make your life nicer.  Better hearing is part of better health.

I know what a hearing aid looks like, but what's a hearing loop? Where is one used and not the other?

Please check out our infographic on how hearing loops work.

A hearing loop is an "assisitive listening" system that picks up sound from a TV or PA system, and transmits that sound magnetically through a wire loop hidden in or beneath the room.  Most new hearing aids and all new cochlear implants now come with magnetic receptors, called telecoils.  When activated these telecoils can receive the sound from the hearing loop--thus enabling the hearing instrument to serve as a wireless in-the-ear loudspeaker that delivers sound customized (by one's hearing instruments) for one's own needs.  I use hearing loops when listening to TV in my home (with sound broadcast by my hearing aids), when worshiping, when attending lectures on my campus, and when listening to gate announcements at my airport.  The clarity is stunning and the convenience--no need to locate and check out special equipment--is wonderful.  And that's why a whole national network of hearing advocates, supported by more and more hearing professionals and new companies, is bringing this technology to the USA.  (It's everywhere in the UK and Scandinavia.)  For more, see www.hearingloop.org

While there have been significant technological improvements in the effectiveness of hearing aids, there are two areas that are lagging. First is the constant need to replace batteries (every couple of days). The other is that unlike other devices, the cost of hearing aids have not diminished over time. Do you see any advances in these matters?

Battery technology is advancing - like everything else.  However, at the same time the hearing aids are becoming more and more complex.  Depending on the size of the instrument, battery life can be as short as 2-3 days, or as long as 2-3 weeks.  The cost of hearing aids has not really gone down, but it really hasn't gone up either.  It's a bit about the law of supply and demand.  The number of people who need hearing aids is much greater than the number of people who purchase them.  We all hope the prices can come down but the market place is dictating cost.

I Am 62 years old, have worn hearing aids for.more than 30 years now. Why is that it is so difficult to compare brands and models before buying? I have mostly just gone along with whatever the auduilogist suggested, but I have had different audis through the years and some were clearly much better and more up to date with technology than others. What can a consumer do to find the best audi and to seek out a few comparisons before spending all that money? My last aids cost me $6000; there is nothing else in my life I would spend that much money on before comparing a few options.

Some audiologists will provide a demonstration of several models but the choices are really overwelming.  You would very likely do well with any number of instruments.  There is no one instrument that is the best and only for you.  However, there are surely some choices that are better than others.  It would be nice if you had a longstanding relationship with your audiologist so you could reach a clear understanding of what your needs are.  Remember that a trial period  - usually 30 days -is associated with any hearing aid purchase.

My son is hearing impaired (36dB biaural) and has worn hearing aids since he was 3. He has had T loop and radio aid support in school (not in the US) but now finds that US colleges don't do well in supporting his needs, even when he goes to the disabilities officers significantly in advance of classes starting. He does not do well in large lecture situations where the teaching staff talk to the blackboard. He is brilliant, engaging, interesting, and able--but the lecture hall requirements at the start of college curriculums are a roadblock.

On my college campus we're in the middle of "disability awareness week," but you won't be surprised to know that this awareness effort typically focuses on motor and visual disabilities.  Hearing loss is the great invisible disability.  If your son (or any of us) found a lecture inaccessible because he was in a wheelchair and could not access the room, people would be rightly alarmed and the college would spend money for a wheelchair ramp or elevator to make the facility accessible.  Hearing loss, being invisible, is often unnoticed.  Hence our consumer-led and increasingly audiologist-supported advocacy (with support from the Hearing Loss Association of America and the American Academy of Audiology) to make public facilities--including college and university auditoriums--accessible to people with hearing loss . . . and conveniently so, via hearing loops that are directly hearing aid compatible. 

Why are hearing aids so expensive and what economical alternatives do consumers have?

Please check out today's Insuring Your Health column, "Unlike most insurers, UnitedHealthcare is offering big discounts on hearing aids."

I will soon be in the market for new hearing aids. My requirements are 1) ability to withstand moisture as I run 30+ miles a week and 2) Bluetooth. I've seen hearing aids that are supposed to meet #1. Are there any good aids out that can link to Bluetooth without a second device? I don't want to wear something around my neck or carry something that I might wind up losing. Thanks!

For an interesting analysis of Bluetooth, which can communicate over short distances, such as  to one's telephones, see http://www.hearingloop.org/Bluetooth.doc.  This report, by a prominent Chicago audiologist, compares Bluetooth and hearing loops as well.

Why doesn't medicare cover hearing aids, since they are as vital to communication as other aids that it does cover? My hearing aids cost $5,000, up front, and now I may have to replace them (only 3 years old) with more effective ones since those aren't adequate. Another $5,000, uncovered by insurance, which I can't afford, so I may have to make do with these.

That's a political question, and an interesting one given that insurance and Medicare will often cover cochlear implants at ten times the cost of hearing aids.  Part of my vision is a future in which hearing aids have doubled functionality--by serving as wireless loudspeakers in venues ranging from home TV rooms to auditoriums to ticket windows to airports--and in which hearing aids therefore become commonplace "glasses for the ear."  Such a world would bring down the cost of hearing aids (with greater sales volume) and increase public support for Medicare/Medicaid/insurance reimbursement.  That's part of the utopian vision behind our grassroots advocacy (see www.hearingloop.org)

I've read about a hearing aid being developed that went in your mouth. Do you have any updates on that? My husband refuses to let me buy a hearing aid because he says it will only make me more dependent on the aid and ultimately make my hearing worse because I will keep increasing the sound. How can I respond to that?

I'm unaware of an in-the-mouth hearing aid (perhaps aiming at bone conduction via teeth?).  But to your husband:  "use it or lose it" is an axiom that applies to much of life and brain functioning.  Extreme and sustained noise can be toxic to hearing.  But see the recent NY Times article on new research on hearing loss and cognitive decline (here).  This research implies that hearing aids and assistive listening systems such as hearing loops may assist both hearing and cognitive health. 

My church uses this technology for congregants with hearing aids and it's been very successful.

Terrific.  That's been the experience of so many churches and synagogues.  An assistive listening system that requires people, when having trouble hearing, to get up, locate, wear, and return conscipicuous equipment will rarely get used.  A system such as a hearing loop that requires one merely to push a button that transforms the hearing aid into an in-the-ear loudspeaker is much more likely to get used.  Moreover, this (unlike movie theatre FM and IR systems) delivers not generic sound, but rather sound customized for one's own hearing needs.

My hearing loss (mild, at the moment) does not seem to call for amplification per se -- everything is plenty loud enough, sometimes even too loud. It is, rather, a problem that some speech comes across as noise, and I can't make out the words. When my daughter is speaking, for instance, I have to constantly ask her to repeat, or even spell, words. Is there a remedy for this problem?

Many patients feel that "I can hear you but I can't understand you" - in most cases, the solution is still hearing aid usage.  Hearing aids may be fitted with amplification applied just to certain frequencies, so that the quality of sound can "brighten" or become sharper, without increasing  "loudness" in a way that is uncomfortable.

What about incidence of ear infections complicated by hearing aids?

Hearing aids do not typically cause ear infections, unless there is an underlying medical condition.  Then your physician should be consulted in the management mix.  There are hypoallergenic earmolds and, depending on the degree of hearing loss, an "open" fitting may be available to reduce the incidence of infection.

I've been in the digital computer field all my working life. It is hard to understand why hearing aids cost so much more than a digital computer, which is much more complicated than a set of hearing aids. Can you explain this to me?

I think the answer lies in the numbers.  How many people own a computer?  How many people wear hearing aids?  I hope it will change some day but right now, there are far fewer people wearing hearing aids than those who need them.  It's a bit of a "catch-22" - perhaps  more people would buy them if they could afford them.  The changing demographic of our population and increasing coverage by insurance companies  may play a role  in bringing about future changes in pricing.

I had to smile a bit when you told a hard-of-hearing person to call your phone number at University of MD for an appointment. Guess hearing loss really is invisibile, even for those who work in the field! For those of us who are hard-of-hearing and can't use telephones, do you have an e-mail address at the clinic for those seeking appointments? Thank you.

Absolutely.  I'm so sorry to be this unconscious.  You may contact us at hespclinic@umd.edu.

Thank you for joining us! Please read today's Health and Science articles that quote experts David Myer and Margaret McCabe.

In This Chat
David Myers
Hope College social psychologist David Myers is the author of seventeen books, including A Quiet World: Living with Hearing Loss (Yale University Press). He is also the creator of www.hearingloop.org. In recognition of his collaborative efforts to transform American assistive listening, he received a 2011 Presidential Award from the American Academy of Audiology.
Margaret McCabe
Dr. Margaret McCabe is an instructor and audiologist at the University of Maryland Hearing and Speech Clinic in College Park. She has worked with patients and students for more than 30 years and she has taught graduate level coursework in Hearing Aids. McCabe is licensed to practice Audiology in the State of Maryland and an active member of both The American Academy of Audiology and The American Speech/Language and Hearing Association.
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