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Hearing Loss Treatment and Medicare

Hearing

Hearing loss is one of the least attended health problems in the United States. That's just my opinion but take a look at the statistics. According to The New York Times:

Hearing loss affects 45 percent of people age 70-74

Hearing loss affects 80 percent of people who are 85 and older

Fewer than 20 percent of people with hearing loss use hearing aids

Some of the 80 percent who do not use hearing devices are concerned about the stigma that still attaches. There are other, more serious reasons people do not seek help for their hearing difficulty:

  1. Medicare, by deliberate legislation when it was created in 1965, does not cover hearing loss examination, treatment or devices

  2. The hearing aid business has an anecdotal reputation problem most of us are familiar with. That organizations such as AARP warn [pdf] people to carefully check the credentials of hearing specialists doesn't create a great deal of confidence

  3. Average hearing aid cost is about $2500 per aid, many people need two of them and that is for the devices only, not examinations and other specialist fees

Here is one person's – mine - hearing story.

Although I've had trouble since I was 30-something hearing nearby voices in noisy rooms such as restaurants, I just avoid them. For 10 years or so, I have lived with tinnitus but except that I long for some silence in my life, it doesn't affect hearing in general which is a good thing since there is no treatment for it.

More recently a different hearing problem has developed; it has become hard to hear dialogue on television.

The difficulty is not volume. In fact, I no longer go to movies in theaters because the audio is jacked up so high it hurts my ears. Instead this new-ish issue is that voices at certain timbres or pitches turn into gibberish. I can hear them perfectly well; it is just that the actors could be speaking Martian as far as I can tell.

But not all television audio is unintelligible. I hear news programs, documentaries, talk shows and other kinds of live broadcasts perfectly well (radio too) along with replays of these shows.

My hearing problem is specific to a large percentage of scripted programs, original TV and theatrical movies broadcast on television. I have become an adept lip reader but drama – and comedy – is such that half the time the person speaking has his/her back to the camera.

Two months ago, Consumer Reports published a “Hearing Aid Buying Guide” which is as useful and thorough as we have come to expect from this organization.

There is an overview of the causes of hearing loss, an excellent explanation of types of hearing aids with their various, individual features along with a list of considerations in choosing a hearing aid provider - from a medical doctor to hearing specialists:

”The professionals you might encounter at independent hearing-aid providers could fall into two categories: Audiologists or hearing-aid specialists (also called hearing-instrument specialists). Both types of professionals can evaluate your hearing and fit your hearing aids. But their training varies significantly.

“Audiologists must have a doctoral degree (Au.D.), and more than 1,000 hours of clinical training. Hearing-aid specialists generally have six months to two years of supervised training or a two-year college degree.”

Even if you have no hearing difficulty now this Consumer Reports guide is worth saving for possible future use.

Earlier this week, writing in The New York Times, reporter Paula Span looked at the Personal Sound Amplifiers (PSAPs).

”...many of us with mild to moderate hearing loss may consider a relatively inexpensive alternative: personal sound amplification products, or P.S.A.P.s. They offer some promise — and some perils, too,” she writes.

“Unlike for a hearing aid, you don’t need an audiologist to obtain a P.S.A.P. You see these gizmos advertised on the back pages of magazines or on sale at drugstore chains. You can buy them online.”

As Span notes, PSAPs are unregulated and, in fact, manufacturers are not allowed to label or market them as usable for hearing loss. And, many of them are terrible ripoffs. But some, she says, are not:

”Dr. Reed has tested just 29 participants so far, he cautioned, and real-world results will vary. Still, he and his colleagues were impressed with three P.S.A.P.s.

“The Soundhawk, which operates with a smartphone, performed almost as well as the hearing aid, with a list price of $399. The CS50+, made by Soundworld Solutions, and the Bean T-Coil, from Etymotic, worked nearly as well and list for about $350.”

If that sounds like something you want to look into, be sure to read the entire Times piece and the Consumer Reports guide that, like Span, warns of the shortcomings:

”These over-the-counter products generally have fewer features and less functionality than hearing aids...These are designed for people who want to amplify certain sounds—and they aren't subject to the same safety and effectiveness standards that hearing aids are.”

Probably not coincidentally, this same week Lori Orlov, the marketing expert who publishes the Aging in Place Technology Watch blog, has a short, informative list of five of the latest hearing technology gadgets. No reviews, just information about what is new on the immediate horizon.

As to my hearing? It is a big concern that my problem is gobbledegook, not volume because I suspect that makes it a brain, not ear, issue. So I'll start with my physician. If the outcome is interesting or useful, I'll let you know.

Meanwhile, it is unconscionable that Medicare does not cover hearing loss. Actually, you can think of this failure as cutting off the heads of elders; Medicare also does not cover routine vision and dental care.

Comments

Dental care is so very related to health and well being. Vision and hearing can seriously impact ability to function in life and are also often related to other medical conditions. I have often wondered why these senses were excluded from medical coverage. Of course I blame the insurance industry somehow.

Closed captioning is a huge help for people with hearing loss like yours. This is also available in some theatres, along with personal devices for closed captioning.

Ronni, I will be most interested in your findings regarding the gobble-de-gook of some tv shows. I have the same thing happening to me. It isn't consistent, but when it happens, it is quite disconcerting.

As I was reading your posting above, my thought went to it being a brain connection, and as I read on, and you stated so---you have my attention.

I have avoided the hearing issues of tinnitus and some loss in one ear for the same issue you have stated. Right now I am typing to the sound of hundreds of cicadas (tinnitus) which only comes to mind for me on occasion. I know it is there all the time, but I don't always notice it.

Thanks for you so timely and open posts.

Ronnie, this is a topic near and dear to my heart, not to mention my ears.
About 7 years ago I lost all hearing in one ear due to nerve damage caused by a conflict of medications.
After being told by a number of s0-called audiologists that a hearing aid would not help my condition, I decided to visit, one last time, a licensed Au.D.
She told me that a hearing aid would definitely help my condition, but there was just one problem. Because the hearing in my other ear was more than 50%, I would not be eligible (under Medicaid) to receive that $2500 device for free.
She suggested that I wait a couple of years (no kidding) until the hearing in my "good" ear became worse and then I most likely would qualify for a hearing aid.
Wow!, I can't wait to go deaf in my other ear.
Oh, and BTW, I too have a problem with hearing some TV programs. Fortunately, most programs are closed captioned, which I now keep on permanently.
The government has no trouble supplying people with expensive mobility devices and portable oxygen concentrators (which cost well over $2000) not to mention Dialysis treatments, but evidently does not think that hearing is very important.
Where are all our lobbying groups when we need them.?
Know what I mean AARP?

Very useful and timely.
Thanks,
Jan

I have experienced hearing loss. I can no longer tell which consonant is being used at the beginning of words. Also when too many people are talking I have trouble understanding. I went in a got diagnosed and then went to a local specialist.
My hearing aids...match my skin and hair color so they are almost invisible. Batteries need changing about every four to five days. When I do not wear the aids they rest in a safe place with the devise open to ease battery use. Batteries are always aired for anywhere from one to three minutes before they are used. They have levels of volume that can easily adjust. I know when the battery life is diminishing because I cannot hear as well.
If the sound is too loud in a movie theater I just take them out and safely store them. It is a pleasure to be able to hear what people are saying. They were $1800 a piece.

Yes, unconscionable...............Medicare not helping elders defray the cost of aids for eyes, ears, and teeth. What's the rationale??? Research has shown that elders who do not get hearing aids when needed are more prone to dementia, perhaps because they are more isolated. The price tag for hearing aids is formidable, even for those of us who are fairly well off. Thank you for addressing this topic.

After noticing a gradual hearing loss for several years, I mentioned it to my M.D. She was not particularly interested, and said there was not much that could be done unless it was significant enough for hearing aids. She then commented that most people didn't like hearing aids. -- In other words, don't bother. I finally referred myself to an audiologist/hearing aid group. I ended up paying $6000 for two hearing aids. They have helped significantly in group conversations, classes etc. I do still have the problem with garbled TV even at a loud volume. I was recently called for a "checkup" with the audiologist, and was dismayed to find out that at 4 years my aids are considered old due to changes in technology. The appointment turned out to be a sales pitch. I was astounded, and said I was not considering paying another $6000 anytime soon! I plan to see how long these will last...


I've been wearing hearing aids for several years, and yes it is a big expense. They can be adjusted over the years but eventually you need an "upgrade". I hope this last pair which I got at Costco will last as long as I do because I cannot afford another pair.

...The Hearing Journal also has many articles than can be accessed online. One that was given to me was "Wear your hearing aids or your brain will rust" (January 2004) which addresses the brain connection. It's convinced me to keep wearing my h/a rather than put them in a drawer.

I also have tinnitus which I've learned to largely ignore...either a "motor running"-I've actually checked outside to see if a truck was there! I also have "musical ear syndrome"...More fun!...either a chorus singing in the background , or maybe a kazoo playing a silly ditty...usually not too annoying until the same few notes keep playing over and over...not so much fun!

As for TV...than heavens for closed captioning. The problem with the newer flat screens is that the sound comes from the Back! Now who's idea was that?! I suppose the company that sells 'sound bars' in order to hear the program.

Medicare really should pay at least for exams for hearing, vision and dental, but of course these are all expensive costs. However it would be nice to know where we stand with these problems of our older years and then decide what we want-or can afford to do about them.

Thanks for a great article Ronni.

Another factor to explore is that many television shows that are not being broadcast "live" when you are watching are in fact speeded up when being re-broadcast. This is done to allow more time to squeeze in more commercials. This is especially a problem with older syndicated shows. It can make it difficult to follow fast conversations. You can Google "television show speed up" or something similar to learn more about this.

I feel compelled to set a few things straight. I have worn hearing aids for 26 years, so I know a thing or two from my experience.

1) You can get hearing aids from a reputable audiologist for $1400 each if you are willing to take last year's model without the latest bells and whistles.

2)Medicare will pay for the hearing test if your primary orders it.

3) Aids are waranteed for a certain length of time - varies with manufacturer. After that your audiologist should offer you an inclusive waranty for additional years, usually three, for a fee of about $150 per aid. It is well worth it. Ask questions! After that they are five years old, and I replace them, as they are no longer eligible for a waranty

4) When I watch TV I remove my aids and use headphones. There are several good brands out there for under 100. Check Amazon. They are well worth it. I also use close captioning for British programs, as I have trouble understanding the accent.

5) Hearing aids don't do any good in their case. Put them in when you get up (after your shower, of course) and take them out in the evening when you know you will not need to hear well, or when you go to bed. Your brain will love you.

6) Ask questions of your audiologist. Ask if there is a previous year's model. Ask what the waranty is. For the first year at least you should have them checked every three months. Fine tuning can mean the difference between hating them and finding them a useful thing in your life. Keep going back if you are not satisfied. They can adjust the programs as needed. I bought new ones this summer and I am still going back for fine tuning. A nuisance, yes, but it beats the alternative.

7) Hearing aids have helped with my tinnitus. It's much louder when I take them out. That being said, I've learned to live with that high-pitched squeal, like and oil truck pumping oil (remember that?) I largely ignore it.

Sorry to sound so forceful here, but as I said at the beginning, I have worn aids for 26 years, so I feel I know what I'm talking about. I highly recommend an audiologist over a technician. The latter are in business to sell you something, usually expensive. And audiologist is a highly trained specialist which wants you to hear in the best way possible.

I have trouble understanding many young women who have adopted "vocal fry" in their speech patterns -- their voices drop way down into their throat and is something like a gargle and a froggy croak. I think it's tribal bonding of some sort, but it's 'way annoying. Time will tell if constant use of vocal fry creates long-term harm (to the speaker). I cringe when women in the media use it because --I personally think-- it makes them sound less serious or mature.

I live in Seattle and wish I could find a list of "restaurants in which one could hear conversation." As far as I can find, there is no such thing on Yelp. I have thought of creating such a list but it would mean a lot of costly dining out. So we just end up at the same restaurants time after time.

I've heard of some device you can put in the middle of the table that cancels ambient noise but I'm not sure how that works. I guess it hasn't gotten that bad or I just work around the problem by knowing which restaurants to avoid.

Agree about the penny-wise pound-foolish Medicare policy that denies coverage for hearing, vision, and dental care. And the problem with losing hearing and vision is that they sneak up on you, unlike a heart attack. Hence, including these in the annual check-up would be cost-effective.

Thanks for the links to more information -- and for the ideas to use headphones and closed-caption on TV.

I have otosclerosis and was told amplification wouldn't help so putting off surgery, anyone out there have a similar situation. It's only one ear, and it helps with my husbands snoring, which is now helped by his CPAP machine, thanks for all the advice, and yes, the costs for Dental and hearing problems not covered, but Opthalmologists yes? How come?

I recently purchased a pair of hearing aids from Costco. The change is very subtle, but definitely a difference. I only wear them when I go out, and I notice I'm not asking people to repeat themselves. With the TV, I use closed captioning.

I don't know if I have hearing loss, haven't been evaluated. But I keep the closed caption on TV and have gotten used to reading along (and it allows me to keep the volume down, since commercials are blasted at a louder volume than programs, typically). And finding a restaurant in NYC where you can have dinner and actually hear your dinner companions? Fuggetaboutit. Great topic, Ronni -- thanks!

Great topic, and fantastic comments! I'm just beginning this journey, but have many family and friends who have been on the "hearing treadmill" for years. Some have found a solution, some haven't. I noticed a difficulty with hearing subtle vocalizations lately—not a volume problem. I will start with my family doctor, and see what she suggests. In Canada, some of our hearing expenses are covered, especially if you have extended insurance, which I do. This post was helpful. Thanks!

People who have followed me on my (now defunct) blog know that I have gone beyond hearing aids and have a cochlear implant. Ironically, since the implant is surgery, medicare does pay for it. I am a member of an HMO and the first processor, mic and 4 batteries were paid for by medicare as well. I would never have been able to afford the CI had it not been paid for by medicare.

I recently had to upgrade my system and, after being approved by my HMO, my cost was a co-pay of 20% and my share was nearly $2,000. Do the math and you will see that hearing aids are much less expensive.

Ask your audiologist if there is an organization in your city, or a city nearby, for the hearing impaired. in Tucson it is ALOHA (Adult Loss Of Hearing Assn.). The group where I attend has a treasure trove of helpful information, such as a list of low noise restaurants and of theaters with a loop. (Your hearing aids can have a program to make use of the loop - a sound processor that makes hearing much easier.) Some big churches are "looped" as well.

I recently purchased a Phonak "Com Pilot and microphone" that works with my CI and helps in restaurants, watching TV, at lectures, etc. I am not very pleased with it as it does not help enough. Because it's new I may not be using it properly or have it adjusted right so I am not giving up on it. It consists of 2 parts; a microphone that clips onto the speaker's clothing and a sound enhancer that is on a cord worn around the hearing impaired person's neck.

New things are being developed all the time, so if it has been a while since you checked hearing equipment out please see an audiologist again.

Even though I have an implant, I still have to use a closed captioned telephone and need the captioning on TV.

As mentioned above, I was going to suggest headphones for the TV. They have a variety of capabilites for changing the sound input that might be helpful to you. Also, have you checked the sound options on your TV? Mine offers some variables on sound -- stereo, surroundsound, home theater, etc., and as I recall, there was one that emphasizes voices over other sounds. They all sound different and one of them might be just what you need.

What wonderfully helpful comments - as a hearing aid user I want to stress that no matter how fancy or expensive they will not give you back your natural hearing. If you can accept that aids can be wonderful.
I was evaluated by an audiologist at a local university clinic by a Phd student under the supervision of her professor. That cost was quite reasonable. They felt aids would help, but as they don't sell them, there was no push. I took their report and went to Costco where I was able to buy my aids for about $1800.00 though I think they are a bit more now. Really the fact is that the fancy bells and whistles do not really help that much, so I stick with the simple aids. Lucky for me, my insurance covers hearing aids every three years! I have been very happy with my aids, but like many people say - they do not solve all the problems. However, they can help a lot - just don't expect them to give you back your youth AND you have to wear them if you want them to work.

I have been super pleased with the Costco service and even though I moved to another state they have continued to take care of my aids at no cost to me. And I have found that their batteries are just about the cheapest you can find.

When I was working as a social worker it was nearly impossible to find help for clients who needed hearing aids or dental work. Guess that has not improved.

My Advantage Plan Medicare covers one exam a year for my ears and my eyes. I've had my hearing aids for 4 years and they want me in there every three to six months and I'm not charged for any of those visits. I do go to a specialist and see licensed audiologists each time.

Like others, I watch TV with closed captions all the time. Like others I have difficulty hearing TV a lot of the time. The doctor assures me that it has nothing to do with my brain. The audio on 1/2 of TV is terrible and friends who hear well complain about it too. When I attend family gatherings and everyone talks at once, or any other group thing, I can only get the gist of the flow of conversation. I do hear very well when close to one or two people. My Doctor says that's just the way it is, and to be glad I can hear at all. I am almost completely deaf in my right ear with considerable hearing loss in the left.

It is nerve wracking sometimes and I hate having to ask people to repeat themselves and of course , most are not aware that they talk at the speed of a machine gun, or down in their chest as if speaking to their shoes. .. And once more, it is what it is and I am grateful to be living in this age and that I had help obtaining my hearing aids and that I'm more a homebody most of the times.

I appreciate this discussion however, and it does boost one up to hear that others have difficulty too... company with a problem is always welcome. Thanks Ronni for your input on so many issues we face at this time of life.

A very important topic.

Excellent research and comments.

I can still hear most normal conversations when there's not a lot of surrounding noise (noisy restaurants are OUT). TV can be a problem, and thanks to many TGB readers' responses to this post, I'll be trying headphones very soon. I hadn't considered myself ready for closed-caption (after all, I'm not totally deaf), but I may try that, too. As for hearing aids, I hope I'll be able to get along without them because I certainly can't afford them--although TGB readers have some excellent suggestions for reducing the very high cost.

Medicare needs to acknowledge the realities of older age in the 21st century and beyond! When the program was initiated, relatively few Americans lived into what is now called "old age". There may not have been a sufficient level of perceived need for hearing/vision/dental services for older people at that time. Now there are many more of us living to see our last quarter of a century. Having these essential services available under Medicare would not only improve health and functionality for many elders but could also save healthcare dollars by delaying the onset of mental decline related to poor hearing, falls related to inability to see clearly and poor nutrition due to dental issues.

So many excellent comments on a typically excellent article, Ronni. Thank you.
I found Lola's, Lorrie's and Leela's remarks particularly interesting. Thank you all.
Just one question in re the possible brain connection ... if it were the brain, wouldn't the problem be noticeable in more situations than just those related to television? (VERY useful to know about the speeding-up for commercials!)
I have come to believe that part of the problem is that enunciation, whether by actors or by others, has become a lost art.

I have hearing loss as well and I've found that using a sound bar attached to my TV is helpful. Not perfect - I still use closed captioning, but it has helped. I use a very basic one ($100) as I cannot afford one of the expensive ones (up to $3000). So people might want to try that as well.
I bought a hearing aid when I was working ($2000) but could not afford that now. And I cannot use the hearing aid because the excess wax in my ear makes the damn thing fall out :(

My hearing aids are zebra striped to match my salt and pepper hair. I could have gotten bright pink ones, had I been more daring.

I go to the Univ of Arizona's Audiology Clinic. I see a Doctor and two students at each appointment. They are not in the business of making money, so they don't try to sell me a new device at every appointment. I asked about new technology at my appointment last week (mine are 4 years old) and the doctor mentioned the lapel pin for your interlocutor to wear and the device in the middle of the table that Cat mentioned (that one is remotely connected to your device). Since I can still hear in (most) restaurants, I passed on the upgrades.

The Clinic cleans my devices for free.

As for the tv, in response to the doctor's "What gives you trouble?" I responded "British mysteries on tv... I can't understand a word they say!" The doctor threw up her hands, laughed delightedly, and said "No one can!" Now, I just have to convince the husband to put on the closed captioning.

I'm 6 months from Medicare and Totally Depressed that it doesn't cover hearing..... or vision.... obviously two unnecessary skills for my dotage. Sigh...........
a/b

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