“Honey, it’s time to get a hearing test.”
“Hey, I don’t have a hairy chest!”

Misunderstandings like these can be funny, but to us, hearing loss is no laughing matter. Over time, people may withdraw from conversations to avoid being laughed at by friends and family. People may even deny their hearing loss and refuse to get their hearing checked for years, if ever.

Hearing loss tends to come on slowly, and it can take years before being noticed. Yet early diagnosis and treatment are important. And recent studies have shown that the effects of hearing loss extend far beyond the ears and may even impact cognitive decline.¹ Research also suggests people with untreated hearing loss may have greater risk of dementia, depression, heart attacks, and falls when compared to people without hearing loss.^2,3,4 When the brain puts effort toward understanding words because of hearing loss, it can take brain resources away from other important areas like memory or balance.

What are the signs of hearing loss in older adults?

Common signs indicating your hearing may be changing:

• Frequently asking family members to repeat themselves, or the feeling that people seem to be mumbling
• Difficulty hearing in places with background noise, like restaurants (Moving to quiet environments makes listening easier, and you might even understand most of the conversation)
• Others telling you the TV volume is “too loud” or, on more than one occasion, suggesting you get your hearing tested
• The voices of grandchildren are harder and harder to hear
• Trouble understanding in large gatherings such as places of worship or lectures
• Feeling tired after listening for long periods of time

What can you do at home when you start recognizing the signs of hearing loss?

To become informed about your own hearing, you have a few options. You can learn more about hearing loss from the nonprofit Hearing Loss Association of America (HLAA).

Also, you can take a test to help determine what hearing solution action may be needed. And you can bring the home test results to a hearing health provider for insight into your particular hearing loss situation.

To help figure out where and to what extent different listening situations are problematic, you can take the Better Hearing Institute's (BHI) Better Hearing Check , a validated paper and pencil hearing test with 15 quick questions, that provides hearing loss norms. Want to dive even deeper into your hearing ability? You can check your hearing using this app on your iPhone. Another option: use a reputable, online hearing screening test, such as those listed by BetterHearing.

Or maybe you wish to skip checking at home, and your first step is to find a hearing provider for a professional hearing test or to have your questions answered.

How to find a competent and caring hearing provider

Getting to the bottom of your change in hearing is important, and so is the provider you pick. To help organize your ideas on a sheet of paper, you can make a simple grid to compare different providers against your list of criteria.

You want a professional who will refer you to a specialist if your hearing loss is the kind that can be medically treated. Look for someone who does more than just a “one-off” hearing aid sale. Look for a professional provider who:

It is very important that the hearing aid provider listens to you. Hearing aids are not like getting eyeglasses: select, buy, and use. Instead, hearing aids take additional adjustments: maybe a different model or manufacturer? Is there a need for gradual adjustments so you can adjust to hearing sounds you haven’t heard in a while? Or maybe when you return home, the kitchen dishes are obnoxiously loud and a hearing aid adjustment for that pitch range is needed.

The right provider will understand these concerns and make sure your hearing aids are adjusted to your needs.

Ask around. Do you know others with hearing aids? Are they happy with the services from the provider? You can even ask your primary care physician. To find an audiologist, you can also search on Hearing Tracker. Also, you can read reviews on Google or the Better Business Bureau (BBB). You may work with this professional for years, so take the time to find someone you can trust.

Studies have shown that finding a good provider you connect with can be more critical to a successful hearing aid experience than the type, style, or level of technology in the hearing instruments.⁵ While using hearing aids results in significant benefits for most users, it is not automatic that the most expensive hearing aids and advanced sound features will always be better for you. Unless the provider listens to you and adheres to a fitting protocol known as “Best Practices,” you might end up with hearing aids that do not meet your needs.

What are hearing care best practices?

Best practices are a set of professional procedures that are accepted or prescribed as being correct or most effective for the diagnosis and treatment of hearing disorders. They are determined following years of clinical and laboratory research.

Hearing aid fitting best practices include:

• Services such as testing in a sound-treated room
• Speech testing in quiet and in noise
• Creating a set of individualized hearing goals
• Careful assessment of your special listening needs
• Evaluation of the best hearing aid style and features
• A discussion of realistic expectations (hearing aids do not restore hearing to normal)
• Extensive training in the use and care of the hearing aids
• Objective real-ear testing of performance of the hearing aids
• Ongoing counseling on how to live successfully with hearing aids
• A referral to local hearing loss support groups
• Providing connectivity to ADA assistive listening systems to improve hearing clearly in public places, including presentations and events, as well as one-to-one conversations

For even more on hearing care best practices, the American Academy of Audiology lists standards and guidelines. You can also learn more from this best practices article from HLAA.

Which type of hearing provider is best?

In most states, hearing instrument specialists and audiologists are licensed to sell hearing aids. Both professionals are trained to test hearing and to fit and adjust today’s hearing aids. Tests are usually conducted in a soundproof booth and should include speech comprehension tests of spoken words in quiet and with background noise.

Training for hearing instrument specialists can vary widely, and the credential acronym behind their name can, too. They can't diagnose conditions associated with the ear but are trained to recognize problems that require referral to an audiologist or medical doctor. See 'What is a hearing instrument specialist?' for further information.

Audiologists usually have a doctoral degree in audiology and are recognizable with an AuD and/or a PhD behind their name. Audiologists are trained to interpret hearing test results from a medical perspective, to use advanced testing to determine the need for further medical treatment, as well as careful evaluation of your residual hearing abilities. Many audiologists also specialize in the non-medical treatment of tinnitus (ear ringing) and balance disorders.

In addition, you may look for the type of practice that fits your needs and lifestyle: a private practice, a nonprofit, a practice that is part of a larger chain, or a practice that is connected with a university and training of audiology students and/or research.

What can you expect at your first hearing testing appointment?

During the appointment, a lot of information will be covered, and you might be processing some emotional reactions. You should consider taking someone else along to your appointment: Two sets of ears hear and remember more than one!

Discussing next steps or the results of the appointment with a friend or partner can lower stress and anxiety.

Your hearing instrument specialist or audiologist will ask you several questions about your medical history and the communication needs for your lifestyle. They will lead you through several hearing tests using different pitches, beeps, and background noise to determine your level of hearing ability.

Results will be summarized in one-page audiogram, and the results will be interpreted with you. At the end of the appointment, you have the right to ask for a copy of the audiogram that you can review again later at home. If this initial provider wasn’t a match for your needs, you can take the copy to another provider. It is important to keep a paper copy record for yourself.

Take care of your hearing, and encourage others to do the same

Some people may think that hearing loss isn’t any big deal: a missed word here and there or missing the microwave beep that food is ready. But with hearing loss you are missing out on communication—essential for living well today and into the future.

Encourage yourself, friends, and family members to learn, pay attention to what isn’t being heard well, and listen to what others are saying. Take action and take care of your hearing today.

Sources

1. Hewitt D. Age-Related Hearing Loss and Cognitive Decline: You Haven't Heard the Half of It. Front Aging Neurosci. 2017;9:112. Published 2017 Apr 25. Found on the internet at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5403920/

2. Loughrey DG, Kelly ME, Kelley GA, Brennan S, Lawlor BA. Association of Age-Related Hearing Loss With Cognitive Function, Cognitive Impairment, and Dementia: A Systematic Review and Meta-analysis. JAMA Otolaryngol Head Neck Surg. 2018;144(2):115–126. doi:10.1001/jamaoto.2017.2513. Found on the internet at https://jamanetwork.com/journals/jamaotolaryngology/fullarticle/2665726 

3.Lin FR, Yaffe K, Xia J, et al. Hearing Loss and Cognitive Decline in Older Adults. JAMA Intern Med. 2013;173(4):293–299. doi:10.1001/jamainternmed.2013.1868. Found on the internet at https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/1558452

4. Dementia prevention, intervention and care: 2020 report of The Lancet Commission. July 30, 2020. Found on the internet at https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30367-6/fulltext

5. Sergei Kochkin, et al. Correlations between dispensing protocols and successful patient outcomes. The Hearing Review. April 2010. Found on the internet at https://hearingreview.com/practice-building/practice-management/marketrak-viii-the-impact-of-the-hearing-healthcare-professional-on-hearing-aid-user-success