Hearing aids offer a way back into world of sound

From: Minneapolis Star Tribune, MN - Dec 28, 2004

Mary Duenwald
New York Times
Published December 28, 2004

Without his hearing aids, Dr. Don Thaler has trouble holding a conversation in a crowded restaurant. With the devices in, however, the ambient noise -- the clinking of dishes, the shuffling of feet, the drone of table talk throughout the room -- can be intolerable.

"I just hate 'em," said Thaler, a retired dentist in Amagansett, N.Y., of his hearing aids -- digital ones that fit completely inside the ear canal and cost more than $7,000 for the pair. He wears them only when going out with company. Even then, he said, "I always carry a leather pouch because inevitably I end up pulling them out of my ears."

Thaler's wife, Cabot Paley, on the other hand, embraced hearing aids from the moment she tried them more than 10 years ago. "All of a sudden, the world around you is just filled with sound," she said, "and it's a wonderful feeling to be able to take part in it."

Only about 22 percent of 30 million people with hearing impairments in the United States get hearing aids, according to Sergei Kochkin, executive director of the Better Hearing Institute, a nonprofit organization financed by hearing aid makers. Yet they offer the best way for many people to maintain a social life and connection to the world.

The newest hearing aids feature two tiny microphones and digital circuitry for improved sound. Yet they still can disappoint new users because even the most expensive kinds do not restore normal hearing.

"It's not like putting on a pair of glasses and getting 20/20 vision," said Dr. Bevan Yueh, an otolaryngologist at the University of Washington, "because hearing loss is about more than just amplification of sound. It also affects the way we process sound."

Many people who try hearing aids are, like Thaler, dissatisfied with them. Doctors say that is partly because they have unrealistic expectations and partly because it takes time to adapt to a new way of hearing.

In 90 percent of 10 cases, hearing loss is caused by a deterioration in the hair cells of the inner ear because of age or exposure to loud noises. These same hair cells are what we use to zero in on the sounds we want to pay attention to and screen out what is uninteresting. So when hearing goes, the ability to focus on favored sounds goes with it.

One reason people neglect even to ask their doctors about hearing aids is that they do not realize their hearing has deteriorated. "It happens gradually and it can be very, very subtle," Yueh said. "And other people in a position to notice often attribute problems not to hearing loss but to the person being a little clueless."

Hearing aids cost anywhere from $800 to $3,500 each. Health insurance usually does not cover hearing aids, or if it does, it pays only part of the cost.

About 20 companies make hearing aids. The six biggest brands are GN ReSound, Oticon, Phonak, Siemens, Starkey and Widex.

Hearing aids that fit entirely inside the ear canal are popular because many wearers want to avoid the stigma of having plastic visible in their ears. "People will readily wear glasses, which change your appearance more," said Robert Jackler, chairman of otolaryngology at Stanford. "But with hearing aids, the perception is that the person is old and maybe has diminished intellectual capacity."

The downside of the hidden devices is that their components are tiny. "The batteries are very, very little," Thaler said, from personal experience, "and the dexterity you need to replace them is incredible."

Digital hearing aids are gradually supplanting the old analog type because they can enhance the clarity of sound and cut back on feedback -- the whistling that plagues wearers of older devices. The most advanced ones are capable of recognizing human voices so that they can selectively enhance speech.

Many hearing aids now hold two microphones, which point in different directions.

"Multiple microphones are really the biggest advancement in hearing aids, more than digital technology," said Robert Sweetow, director of audiology at the University of California, San Francisco, "because they do more to cut down the background noise."

In the pipeline are hearing aids that mimic the hearing apparatus of a kind of parasitic fly, Ormia ochracea, which has a keen sense of where sounds come from. This insect's ears are connected by a platelike structure that senses both vibrations and pressure in such a way as to act like a tiny directional microphone, said Dr. Lynn Luethke, an audiologist and neurologist at the National Institute on Deafness and Other Communication Disorders in Bethesda, Md. Hearing aids patterned after the fly's ear are expected to be ready in the next three to six years, Luethke said.

It can be less expensive to buy hearing aids over the telephone or on the Internet, but doctors advise patients to consult audiologists or other licensed hearing aid dispensers to make sure the devices are right for wearers' hearing loss and daily needs, and to get a good fit.

Many states require that consumers be allowed to return hearing aids within 30 days. And some sellers will extend the trial period further.

Audiologists are also beginning to provide training to help new hearing aid users adapt to a different way of hearing.

After three years with his hearing aids, Thaler admits that even he is slowly learning to appreciate what they can do.

"Every now and then," he said, "I hear a bird, which I may not have heard before, and I think, wow, I like to hear that."

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