Hearing aid for elder (what a f-ing racket) any suggestions?
July 23, 2021 8:44 AM   Subscribe

My mom at 90 needs one, badly. It's impossible to communicate. As I enter this process with her it feels like I'm sliding down a slippery slope of bullshit. $1,600 to $2,000 for a unit? I read somewhere they cost $100 dollars to manufacture. Anyway:

She's had the appropriate testing done and now, next month, we have to choose the hearing aid.

The technician told her that she does better with her hearing from the bone behind her ear (or something like that). Are there special hearing aids that are worn behind the ear instead of in the ear?

15 years ago she tried a hearing aid and it drove her insane in the way it amplified ambient noise all around her, dogs barking out the window, clocks ticking in the room, etc. I'm hoping technology has improved on that lately.

Any advice, warnings, things to avoid, brands to look for that the hive would recommend? Thanks.
posted by zenpop to Shopping (10 answers total) 18 users marked this as a favorite

Costco. I just can't emphasize costco enough.

Modern hearing aids are tuned for specific frequencies. Often those hearing appointments where they "tune your hearing aids" are expensive, but they are good because if your hearing is only weak in certain areas and not others (clocks ticking) the hearing aids won't amplify those noises. But, while that helps, ambient noise is still a slight problem. It's definitely improved.

Costco sells the $2K hearing aids for $800 and includes a free replacement, and free tuning as often as needed. It's insane how cheap it is. My father got $6K bluetooth-all-the-bells-and-whistles ones from costco for $2K. We price compared, and nothing else even came close to the comparison.
posted by bbqturtle at 9:05 AM on July 23, 2021 [10 favorites]

My mother wears hearing aids and can confirm that the technology has come a long way recently, mostly because of the headphone/earbud technology advances. She needs to pick on that is comfortable for her, otherwise she won't wear them so make sure she can try them on and tell the tech what she does and doesn't like. A good audiologist is gold, and you should work directly with them. That said, yes, they are still quite expensive. Please make sure you are reviewing her medicare and any other insurance coverage.

If she watches a lot of tv or uses a cellphone, getting ones that can connect directly are really helpful.

And bone conduction is the kind that goes over the ear rather than in the ear.
posted by magnetsphere at 9:06 AM on July 23, 2021

Yes, Costco, from what I've heard from all the hearing aid wearers I know.

They also seem to have a 180-day money back guarantee, and by that time it's possible that they will available over-the-counter (and therefore much cheaper) under the new Biden order, though this report says it will be more likely next spring or summer.
posted by Mr.Know-it-some at 9:18 AM on July 23, 2021 [2 favorites]

Lots of misinformation in here.

$1,600 to $2,000 for a unit?

Hearing aids are expensive. They are medical devices. They can put out 140 dB sound pressure all day long with less than 10 ms delay on a tiny battery that lasts a week. They can do a bunch of other fancy signal processing in near real-time. Just like with medicines, you are paying for a lot of research and development that goes into making hearing aids that are efficacious and effective, rather than just the cost of the actual cost and material of the hearing aid (or medication) itself.

You are also (or shouldn't be) just paying for the device. You are paying for a skilled professional, ideally with a doctorate degree, who will program the hearing aid and provide appropriate counseling for your mom. A good audiologist will make a much bigger difference in the outcomes for your mom than the fanciest device. There's a lot of good clinical evidence to support this.

Hearing aids only seem expensive because, unlike health problems below your neck, they aren't covered by medicare.

15 years ago she tried a hearing aid and it drove her insane in the way it amplified ambient noise all around her, dogs barking out the window, clocks ticking in the room, etc. I'm hoping technology has improved on that lately.

This is - by far - the most common reaction for a first time hearing aid user. All the quiet sounds they have never heard or haven't heard in decades are very overwhelming. Technology has gotten better, but a good audiologist can also make this more manageable with programming adjustments. But - she will also need to get used to this. With regular use your brain acclimatizes to hearing these types of sounds again and they become less bothersome.


In general, I like Costco. But with some caveats. Their devices are typically good. They are re-branded from the other Big 6 hearing aid manufacturers. Often they are a generation or two old, sometimes not, but that doesn't usually make a big difference for folks. Last time I checked, the current Kirkland's were Phonak Marvel 90, which is very good device, but their contracts change a lot. Certainly they are cheaper because hearing aid manufacturers, like most manufacturers, price to providers based on volume of sales.

Some caveats. Depending on your state, the person fitting your mom may only be a hearing instrument specialist. The requirements for this are a GRE, a 1-year apprenticeship, and taking a test. An audiologist, on the other hand, has a doctorate degree and an audiology license and is certified by one of the two major professional organizations in the US.

Now, there are certainly very good hearing instrument specialists and bad audiologists. One thing you should inquire about if you go to Costco is whether they do real-ear-measures. This is a critical element that measures exactly what sounds are reaching your mom's eardrum. Many Costcos do not do these (many audiologists don't either, and you should ask).

The other thing to keep in mind is some Costco hearing aids are locked, meaning they cannot be programmed or serviced by anyone outside of Costco.

Remember: the effectiveness of the hearing aid is more about the service than the device.

The technician told her that she does better with her hearing from the bone behind her ear (or something like that)

If this is true she should absolutely not go to Costco and needs to go to an ENT and an actual audiologist. Better hearing via bone conduction indicates conductive hearing loss, which may require medical intervention. A hearing aid may still be indicated, but there may be other issues that need to be ruled out and other options. Either way, you need to clarify this.

And bone conduction is the kind that goes over the ear rather than in the ear.

Totally untrue. Both behind and in-the-ear hearing aids are typically for sensory hearing loss, though they can be used for conductive loss as well. A bone conduction hearing aid is a completely different thing that would usually require surgery and service from an actual audiologist.

it's possible that they will available over-the-counter (and therefore much cheaper)

OTCs already kind of exist without FDA approval as officially a hearing aid but there will probably be better ones down the road. It may be a good option for her if she has run-of-the-mill sensory hearing loss (and you are wrong about her bone conduction being better than her air conduction). Biden has accelerated the release of the rules for the creation of OTCs (which was actually made law by Trump), and some companies are likely poised to release OTCs quickly after approval. But it is hard to say what the timeline will be, or how well they will work for people at this point. Probably they will work well for certain types of patients and less well for others - hearing loss and hearing aid effectiveness is a lot more complicated than just the hearing thresholds someone has. OTCs are a sort of generic, one-size-fits-all hearing aid designed for mild-to-moderate, sensory, age-related hearing loss, and may work well for some.

Hearing aids are not a scam or bullshit, but like any medical field there is scammy and bullshit stuff out there. That said, hearing aids are amazing and life changing and can work extremely well, given the right combination of device and qualified professional. Hearing well is critical to life, and untreated hearing loss is associated with myriad negative life outcomes, including depression, anxiety, dementia, and all-cause mortality. My recommendation is always to see a well-regarded, qualified Doctor of Audiology.

source - am an audiologist, hearing aid researcher, and published scientist in this area.
posted by Lutoslawski at 9:44 AM on July 23, 2021 [186 favorites]

I feel you. Dealing with my mother's hearing aid was a nightmare, on many levels. The more convenient (ie smaller) they are, the easier to lose. Given her dementia, that expensive little twist of wire and plastic often went missing. Replacing the batteries was problematic (and weirdly, the convenience store in her retirement community didn't sell hearing aid batteries). I read somewhere recently that in many cases an old ear trumpet gives better results than a modern hearing aid. Of course, it all depends on the individual.
posted by Rash at 10:38 AM on July 23, 2021

What Lutoslawski said x 1,000. I was recently diagnosed with a hearing loss and hearing aids. I did a lot or research prior to my appointment with the audiologist. The only thing I would add to what Lutoslawski wrote is along the line of OTC devices. Right now, to be both compliant with the rules and to go around them, there is a category of devices called "hearables". Nuheara puts one out. (Disclosure: I purchased the Nuheara buds. I love them, but I would not recommend them to a 90 yo. Also, they are cumbersome --large-- for everyday, all-day use.)

Also, there is a secondary market for hearing aids. A person buys aids and either does not use them or dies and they are offered on eBay. You could consider buying one or a pair from eBay and then having them programmed by an audiologist. I would only buy ones that are less than three years old. Buy them after she sees the professional and they discuss the brand and model she would benefit from.

What is her hearing worth to you or her? Hard to put a number on it, but what I learned early in life, my grandfather used to say to me, "Augie my boy, sometimes I cannot afford a bargain." That goes for the device and for the technician and I agree to see an audiologist. My hearing aids do amplify sounds I do not want to hear and they have been tuned. Got to get used to it by WEARING THEM. They bluetooth connect to my phone and to a bluetooth device I have hooked up to my TV. Not sure your 90 yo mother wants that, but hey, it is a feature.

I am going to suggest that if your mother is resistant to change or is doing this to appease others rather than for herself, it will be a long road to acceptance and working. If she is enthusiastic about it, then she will benefit greatly from good hearing aids.
posted by AugustWest at 10:51 AM on July 23, 2021 [5 favorites]

I have worn hearing aids for forty years now due to a rare genetic condition that caused sudden irreversible hearing loss in childhood. I have answered several AskMe questions about hearing aids over the years under my old profile.

I do sympathize with any MeFites who might be audiologists. I'm sure one does enter the field intending to help people with hearing loss. I also work in a field that people always want to undercut and underpay. However, the hard reality is that for probably 65-70% of Americans, paying $2,000+ out of pocket is a significant stretch. Elizabeth Warren teamed up with Chuck Grassley to create greater access to affordable hearing aids. Although their bill passed, the linked article states that there hasn't been much regulatory movement yet. I do appreciate the arguments for the R&D that goes into hearing aids, but ultimately they are not more advanced than a pair of AirPods.

As a very long time hearing aid wearer, I do have a few suggestions:

1) I did buy my most recent pair from eBay, as was suggested above. I did a little research into some models, and then just searched from a combination of brands and hearing aid styles. I ended up with a pair of Starkey over the ear hearing aids, and have worn them pretty successfully for about five years or so. I believe they were a few years old when I got them. IIRC, they were about $600 for the pair.

In my experience, with care hearing aids can last a long time. I kept my first pair working from age 4 to age 18 because my parents had no money and got that first pair through a charity. When I moved to my second-ever pair, the originals were still working.

The sound quality and overall digital processing of hearing aids has improved, but many of the current bells and whistles are unnecessary in my opinion. I really don't want my hearing aids to have bluetooth and try to answer my phone. In fact, my one gripe with my current pair is that I can hear them frequently try to dampen sounds and it's much more distracting than just letting me hear the fan or the car engine, etc. It's kind of like if your glasses got fuzzy because they detected roadkill. I guess some people would pay for that kind of feature, but for me, I think I would just be more likely to notice (and ruminate on) roadkill because I'd notice the fuzzy patches popping up in my glasses.

2) In my experience, over the ear style hearing aids last longer and are more rugged. Most of the other styles get the sensitive electronics closer and closer to, or even in, your ear canal. Although I do not have scientific research backing this up, my own experience wearing a few different models over the decades is that the smaller, in-the-ear styles tended to need to be repaired more often. I have mostly lived in the US Southeast, so that may impact their lifespan, too. Bene gesserit voice: Moisture is the hearing aid killer.

3) You might look for a nonprofit speech and hearing center. I switched to such a place in my city and have done much better - they were willing to adjust and repair my eBay hearing aids, and didn't fuss about them like my previous audiologist. I pay them on a per-visit basis to lessen the urge to try to upsell me on new hearing aids.

4) The issue of background noise becoming loud is largely due to the fact that hearing loss for most people is gradual. So, elderly people who are trying hearing aids for the first time have been acclimatized for years to a gradual diminishment of sound and have gotten used to a very quiet world. I have only tended to go without one aid at a time, for maybe a month, while I scrounge funds to repair them, and even there I experience a bit of a shock when I finally get back a nice, clear, repaired hearing aid. Everything's so loud! But you do get used to it.

Good luck to your mother! Both my mother and mother-in-law will be getting their first hearing aids soon and will be having me go along to help them.
posted by Tchozz at 2:08 PM on July 23, 2021 [14 favorites]

Hearing aid wearer here, just a suggestion:
15 years ago she tried a hearing aid and it drove her insane in the way it amplified ambient noise all around her, dogs barking out the window, clocks ticking in the room, etc. I'm hoping technology has improved on that lately.
This is going to happen regardless, like Tchozz said, because of how progressive hearing loss works. My suggestion, in order to improve her acclimation to the hearing aids, would be to go up slowly, not immediately. Talk to your audiologist or hearing aid technician and see if you can get them to get the hearing aids up to the prescription she needs gradually, over the course of a month or two of gradual adjustments. 20% of what she needs at first, 40% a week or two later, etc, etc. My audiologist did it for me when I got a fresh hearing test and new hearing aids after entirely too long without a checkup and having gone all the way up to the new prescription immediately was giving me day-long headaches from all the noise I was unused to hearing.
posted by sailoreagle at 4:44 PM on July 23, 2021 [1 favorite]

Your natural hearing does excellent filtering, but hearing aids mess with that; wearing a hearing aid, I'm very aware of keyboard sounds, car and road noises, and other sounds that I wouldn't ordinarily notice. This improves greatly when you wear hearing aids a lot; so if someone struggles at 1st, persistence will really help.

The hearing aid industry is pretty closed. It's very difficult or impossible to find comparisons of different brands, or models within brands. There seem to be top, middle and low tier options; go for the top tier manufacturer, even if not the most expensive models. Medicare advantage plans in some states may cover hearing aids; Maine just started requiring health insurance to include hearing aids. Yay! Deductibles often apply.

I have to go through a not-helpful company called something like Hearing Care Solutions because my insurance requires it to do the billing and insurance claim. I am not able to buy through Costco or Sam's Club; this makes it more expensive, but Anthem was unresponsive to my grievance. I was pressured into getting a device to connect my hearing aids to my phone; it did not work reliably, and I ended up getting an iphone because the app doesn't work on Android. Yes, I think it's not okay that they don't support more affordable phones. A friend who's had hearing aids for years is happy with price and service from Sam's Club; they have an audiologist. No Costco in Maine, but I'd travel if it were an option.

I'm certain it's an extremely profitable industry because the advertising and sales approaches are pretty fierce. Take the time to make sure you're getting good quality hearing aids. I've me-mailed Lutoslawski in the past, and have gotten helpful replies, for which I am appreciative.

Poor hearing contributes to dementia and social isolation. Hearing aids do not correct hearing fully, but are a huge help, especially if you wear them regularly and adjust as needed. I'll still miss all the parenthetical remarks and jokes with friends, but I'm able to have conversations. Good luck
posted by theora55 at 2:10 PM on July 24, 2021 [1 favorite]

ENT doc here.

There's not much for me to add after Lutoslawski's excellent comment, but I would reiterate the point that she should see an ENT doctor and an audiology doctor (typically ENT offices have both and you can see both at the same visit). If there is a conductive hearing loss (hearing better through bone than through air), there *may* be a relatively simple fix that can restore some of the hearing (for instance, if there is fluid behind the ear drum, a tube can help tremendously).

In addition, some ENT offices may be able to get her a bone-conduction hearing aid that can be worn with a headband and have it covered by insurance. These situations are few and far between, but she may be able to get something that can help her a lot without surgery and for less money than a more conventional device.
posted by Fritzle at 10:10 AM on July 30, 2021

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