What Did You Say?

Elaine White, 60, a professional mediator, remembers the precise moment 10 years ago when she realized she had a hearing problem. She and a colleague were leading a prejudice-reduction workshop in Rochester, Minn. One of the participants uttered a racial slur. "I didn't hear it," White says. "Fortunately, the other facilitator made an appropriate response. But if I had been there by myself, I would have ignored it--and the point of the workshop was to encourage people not to ignore racial slurs." Shortly thereafter, White got her first hearing aid.

White is one of 28 million Americans--about 10% of the population--with hearing loss. That number will only grow as the baby boomers age, since hearing tends to decline over a lifetime: less than 2% of people under age 18 have a hearing impairment, in contrast to more than 40% of those over age 75. Fortunately for White and others like her, hearing-aid technology has vastly improved over the past decade.

White does not know what caused her hearing loss. The likely factors: heredity (her 87-year-old mother is also hearing impaired), cumulative exposure to environmental noise or simply the gradual deterioration of her ears owing to aging--a condition known as presbycusis. Like more than 80% of hearing-impaired people, White cannot be treated medically or surgically because the damage to her ears is sensorineural. That means some of the 30,000 to 50,000 hair cells in the inner ear, which are responsible for transmitting sound information to the auditory nerve, have been injured or destroyed, leaving the ear "like a piano with missing keys," according to David Fabry, director of audiology at the Mayo Clinic and president of the American Academy of Audiology.

The hair cells that respond to higher pitches are the most vulnerable. So White finds women and children particularly difficult to understand. Another early sign is poor discrimination of consonants, which--in both male and female speech--tend to be higher in pitch and lower in intensity than vowels, so that thin, for example, may be indistinguishable from fin or shin or sin.

For most folks with sensorineural hearing loss, the best help is a hearing aid. But only 20% to 25% of those who could benefit from hearing aids actually own them. That can be a tragedy, since studies show that older people with untreated hearing loss suffer disproportionately from depression, anxiety, paranoia, emotional turmoil and reduced social activity. Brenda Battat, 58, acting executive director of Self Help for Hard of Hearing People (SHHH), with headquarters in Bethesda, Md., knows firsthand the psychological costs of going without hearing aids. "I was the queen of denial," she recalls. "It took me a long time to start wearing hearing aids full time, and I got very, very depressed. I became withdrawn. I refused to go out and meet with my friends. Once I started wearing them, I bounced back."

Why don't more people use hearing aids? For most adults, a decline in hearing occurs so gradually as to be imperceptible--except to family and friends who chafe at having to repeat themselves or at being subjected to the blare of a television turned up to accommodate their loved one's poor hearing. Some discover their disability during a physical exam. Fred Smith, 92, a retired San Francisco businessman, got his wake-up call in the Navy. He was taken off sea duty in the Pacific and transferred back to the States during World War II after he failed a hearing test. But only 16% of physicians routinely screen for hearing loss. And even after people realize they are having trouble hearing, many delay--on average 10 years--before seeking help.

Cost is one barrier. Medicare does not cover hearing aids, nor do most private insurers. Hearing aids range in price from $500 to $3,000 or more. "Here's this thing that's the size of a peanut," says Nicolette Toussaint, 49, communications director for a San Francisco nonprofit organization, "and it costs as much as a used car." Toussaint got her first hearing aid more than 15 years ago. It lasted 10 years--until she left it in the pocket of a pair of jeans she threw into the wash. The replacement cost $4,000. For many people the cost is doubled, since audiologists typically advise patients to buy two hearing aids if they have a loss in both ears. But many hearing-aid providers offer installment plans.

Advances in technology cause many to hold out in hopes of getting more for their money. Audiologists caution against waiting too long, however. "It's much easier to get used to a hearing aid when the loss is mild and you're younger," says Susan Rezen, an audiology professor at Worcester State College in Massachusetts and co-author of Coping with Hearing Loss. "If you delay too long, you're taking the chance that your brain may get used to not processing speech."

Another deterrent is fear. Knowing that excessive noise is a major cause of hearing loss, some mistakenly believe that hearing aids, which amplify sound, will cause further damage. Truth is, hearing aids have volume limiters that prevent them from boosting sound to levels capable of causing injury.