Can you hear me now?

hearing_aid
hearing_aid

Widex Inteo hearing aid in translucent black

I've recently been experiencing the acquisition of a new set of hearing aids, two Widex Inteos. I had my previous hearing aid (Oticon Adapto) for about 5-6 years, and it was conking out on me, sputtering from repair to repair. I finally made the decision to go for hearing aids in both ears (binaural), which has been long recommended to me by audiologists. I understood the argument behind it very well, in that your ears and brain are designed to hear in stereo, and so trying to get amplification through just one ear was providing a lot less improvement than I could be getting. The benefit of two aids over one is supposed to be an exponential improvement.

But as a longtime user of hearing aids, I want to make a few observations about what I see as the significant obstacles to getting, using, and enjoying the benefit of hearing aids. These are the barriers that made me wait a lot longer than I should have to get a hearing aid in the first place, and have prevented me from trying two aids until now.

First, there's the cost/investment side. Hearing aids, particularly the new digital technologies, are extremely expensive. The type that my hearing loss requires usually run in the neighborhood of $2,500-3,000. Each. Multiply that times two, and you're talking about wearing an enormous sum in delicate electronic devices on your head (which are subject to damage or breakage from dropping or getting caught on something, getting wet, or being exposed to radiation or chemicals.) In short, the value of a mid-range Rolex, with none of the durability. And the standard hearing aid is not expected to have a shelf life beyond 5 years. That's an investment of $100 a month, if you're lucky enough not to break or lose one during that time. And no, health insurance does not cover hearing aids and the warranties typically cover only the first 1-2 years. Therefore, there is a strong financial consideration to be made between making do with just one hearing aid, or splurging on two.

Second, there is the appearance/design factor. I've been wearing hearing aids since I started college. I have been hard of hearing my whole life, but I had learned enough coping strategies as a child, like lipreading and defaulting to writing and pictures whenever possible, that I was able to compensate fairly well through my school years with the help of teachers and friends. That changed when I went out into the larger world, away from home and familiar surroundings. The primary thing that kept me from taking advantage of a hearing aid before that is the stigma associated to how ugly and strange these devices look. As a hard of hearing person, you already feel like an outsider. As a kid, I was terrified by the idea of drawing more attention to my disability (as I'm sure most hard-of-hearing children and adults are). The stigma of wearing a medical device (even one as small as a hearing aid) is significant. Wearing one is bad enough. Two always seemed over the top for me. For a long time, hearing aids have been ugly, ugly, ugly. You know this is true because all of the marketing features pictures of happy people and beautiful landscapes—it never features images of the actual product on a human wearer. It seems that no matter how high-tech these devices become, the engineers see fit to make them look as clinical and awkward as possible for the wearer. Sure, they are getting gradually smaller (I remember the pocket-sized unit my great-uncle wore wired up to an earpiece). But one thing I don't understand why the industry clings to the paradigm of the prosthesis. A hearing aid isn't replacing an ear or any other body part, and yet it's made of awkward, icky-looking skin-toned plastic. Ten years ago I remember looking in the window at a Bang & Olufsen store in Boston at the beautiful and tiny stainless steel headsets and wondering why my hearing aid couldn't look like that.

delta
delta

When bluetooth and the iPod arrived, and suddenly everyone seemed to have a hip gadget hanging from their ears, there were really no more excuses for the hearing aid manufacturers and their complete disdain for the styling of their products. And so things have progressed in recent years with the introduction of the Oticon Delta [see left], a cute little triangular BTE (Behind The Ear) aid that came on the market in 2006 and comes in a wide choice of colors and patterns, primarily aimed towards the growing market of hard-of-hearing boomers. (Alas, this great-looking aid does not suit my type of hearing loss.) The success of the Delta, along with the iPod, seems to have emboldened manufacturers to pay a little more attention to the appearance of their products, but they are still far too conservative in considering the importance of good design. Who says a hearing aid can't look cool?

Third, the distribution side of the industry sucks. It's not that they aren't developing good technology, but the way that hearing aids are delivered to the market leaves a great deal to be desired. The manufacturers would defend themselves by saying that they are hampered by the excessive regulation that exists around the sale of medical devices. This is not untrue, but it seems obvious, from the lack of information available from the manufacturers about their products, that they also benefit a great deal by the restricted channels available to consumers. It's near impossible to be an educated consumer when it comes to hearing aids. Choice is practically nonexistent. I challenge you to try to price different models against one another, feature-for-feature, based on what you can find online. It's all very mysterious.

It's the law that you have to have a hearing aid prescribed (or "dispensed") by a trained audiologist. This is to prevent people getting the wrong type of hearing aid, or failing to have it fitted correctly. This is fine. It works the same way that getting glasses requires at least an optometrist's, if not an ophthalmologist's, prescription. The problem is that most audiologists tend to be affiliated with just one or two manufacturers. It's as though you went shopping for eyeglass frames and had to choose between two styles. I've never understood why this is, because you'd think that a successful audiologist would want to have a full range of technology and brands to recommend to patients. I'm told that this is because many manufacturers offer such similar products, that there is redundancy in offering multiple brands, and also that each manufacturer requires the audiologist to acquire and learn its own proprietary programming software, and this becomes a burden.

Usually it is impossible to know ahead of time which manufacturer an audiologist represents. You pay an audiologist to produce an audiogram, which then helps to determine the type of hearing aid best suited to your hearing loss. But if you try to take one audiologist's audiogram to another audiologist, they typically won't accept it, and will insist on doing their own test. So forget about shopping around.

So it's left a bit up to chance whether you end up with an audiologist who can or will recommend the hearing aid you would choose, if you had all the information yourself. Yes, they are trained professionals who's interest is in getting you the right aid, but sometimes you wonder if they aren't just meeting some kind of quota for a particular model or manufacturer. It doesn't help that hearing aids are a bit like car models, and each year, manufacturers introduce tiny tweaks to the features of existing models, so you never feel like you can compare apples to apples.

Oticon Adapto and Widex Inteo hearing aids

Oticon Adapto and Widex Inteo, the old and new hearing aids

In my recent hearing aid purchase, I sought out an audiologist here in Chicago who had the largest available representation of different manufacturers. I ended up choosing AHS, primarily because they provided a lot information on their website and a good variety of manufacturers. I could have had my hearing test covered by my insurance if I had gone to their one approved audiologist, but that audiologist did not carry the brands I was interested in looking at. Since the hearing aids themselves aren't covered at all, and I knew I'd be plonking down significant cash, it was more important for me to get the right audiologist than a free test.

This ended up being a good choice, because I think I got the most thorough hearing test I've ever had, and Theresa Jabaley, the audiologist, was willing to treat me like an intelligent adult. She laid all the options out for me, with her recommendations, and helped me understand the various costs/benefits. I felt good about the choice we made together. It is a bit experimental, since the Inteo has a new feature called the "audibility extender", which transposes high frequencies to low. I'll report back on that experience another time.

So, back to the exponential improvement that two hearing aids may bring for my interactions with other people. Definite improvement so far, though it is taking some real adjustments to get used to all the extra amplification and the weirdness of using the phone with a hearing aid (before, I always had my left ear free). At times it is pretty overwhelming to get so much sound that I'm not used to, especially all the background noise that my hearing loss normally allows me to tune out completely. But if it means that I will be able to participate more fully in conversations and not miss out so frequently on what's happening around me, it will be worth it. My thirty day trial period just ended, so at this point I've committed to my purchase. (Personally, 30 days isn't really enough to be sure, but that's another aspect of the distribution problems above.) I'm hoping that I will be gradually learning to hear better .

Oticon Delta image copyright Tony Cenicola /The New York Times