General Question

bossob's avatar

My hearing is gradually getting worse. What professional should I see first?

Asked by bossob (5904points) January 6th, 2013

I know that I have high frequency loss in one ear, and I’m having more and more trouble understanding conversation in a room with background noise. It just doesn’t seem right to go to a store that provides hearing tests and recommendations, that also makes most of their money from selling hearing aids. So, do I go to an audiologist first? Insurance will cover some of my expenses, but a big chunk of money will come out of my pocket, so I’m trying to minimize my expenses, without sacrificing proper medical care.

Where would you start the process?

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16 Answers

filmfann's avatar

Make an appointment with an audiologist. Many things can cause substantial hearing loss, and you don’t want to wait till it is all gone. Do it now.

wundayatta's avatar

You can always see your GP, and they will refer you to the appropriate doctor. Also, an ENT (ear, nose and throat) specialist could be a place to start. It depends on your insurance, too. You may have to start with an internist if your insurance requires you to get a referral.

Rarebear's avatar

Yup audiologist.

zenvelo's avatar

An ENT will check your hearing and will check for other problems. The ENT will have an affiliated audiologist and will review the audiologist’s report. Plus, it helps if you have a prescription from an ENT for hearing aids when dealing with insurance.

gailcalled's avatar

When I took a bad fall and broke the stapes bone in my middle ear, I was sent to the audiologist at the hospital for a hearing test.

When I got the bad news (70% hearing loss in one ear) I then officially hooked up with an ENT who did have an affiliated audiologist on staff.

Neither Medicare nor my AARP Medigap insurance will pay for a hearing aid. The newest generation is very costly (well over $3000 out of my pocket) but I can take it as a medical deduction on my taxes.

You want your diagnosis and possible hearing aid designed for your unique problem and ears.

JLeslie's avatar

I would go to an ENT. Many have audiologists in the same office and can do a hearing test during your apppointment. When you call around you can ask if they have that service and can do it during your initial appointment. I have had two hearing tests done in the last 5 years and both were done during a visit to an ENT that were not appointments first scheduled for any hearing trouble, but they were able to fit me right in while there to have the test done.

I’ll send your Q to hearkat. She is on of our hearing expert here.

I would not start with a GP, to me that is just an extra doctor and extra money out of your pocket. In the end you will have to see a specialist I would think? Unless your insurance requires a GP first.

hearkat's avatar

Here I am! Why is it that questions about hearing aren’t posted until after I go to bed?

Your primary doctor can’t do much but check your ears for wax or obvious signs of infection. Most primary physicians won’t even clear the wax these days. So unless there is acute pain, I don’t advise seeing the primary doctor if it is not required by an HMO-type of insurance.

Selecting an ENT (Otolaryngologist) can be done by checking the physician finder on your insurance company’s website. Most insurance will cover the Audiological evaluation when it is done in conjunction with the ENT visit, and you’ll only pay your standard co-pay. Be sure to specify that you are coming in for hearing loss, and that you want to be seen by an Audiologist and not a technician. If the hearing test is added on, like Gail mentioned, it is frequently done by technicians who do not have the education or licensure to counsel you or answer your questions. Even if the add-on is being performed by an Audiologist, that means you’ve been squeezed-in so they may not have the time to spend, or it shows that the practice has a culture of treating the Audiologists like technicians, which does not suggest that you’re likely to get the care you’ll get from a professional who is in a respectful environment.

Asymmetrical hearing loss is not typical. You say that one ear has high frequency loss – do you know why? Make sure you report any tinnitus, balance or dizziness, headaches, facial symptoms, or anything else – especially from the neck up – even if it seems unrelated. The ENT may order additional testing – such as an MRI – to take a closer look at the auditory nerve and brain to be sure there is no neurological factor to having one ear poorer than the other.

Once testing is done, get a copy of your hearing test results. If hearing aid(s) are recommended, also get a medical clearance not from the physician. If hearing aids are dispensed at their office, ask if the Hearing Aid Evaluation (HAE) is free. It is the typical practice here in the Mid-Atlantic to not charge for the HAE. It is usually beneficial to go through an ENT-based Audiologist for the hearing aids, because the physician is right there, if needed. Also, private practices and hearing aid dealers have hearing aid sales as their primary source of revenue, so it is a higher-pressure sales environment. Still, there are some very good Audiologists in private practice, so I suggest consulting with a few before placing any orders. If you are near a University or Hospital that has an Audiology department, you may want to see if they dispense hearing aids.

Do not shop by price alone. All manufacturers have a range of products, and prices can go from $800–1200 for very basic technology, to $3500–4000 for a state of the art device (yes, that’s price per aid). Now that you’re looking, you’ll notice a lot of ads with lowball prices. That’s a bait and switch to get you in the door. You want to know that when comparing offers, that the technology is actually compatible.

You want to be sure that you will get a trial period of at least 30 days, during which the aids can be returned for a refund (less a portion, such as a deposit amount, to cover expenses). You want to be ask about follow-up care not only during the trial-period, but beyond that. You will have the devices for 4–6 years, and want to know what costs will incur over the course of that time. Find out of they provide routine maintenance and/or batteries with the purchase.

But most importantly – find a professional who cares. The degree earned does not always guarantee a level of care. I’ve known some with Doctorates who had a sales mentality, and I’ve known dispensers who really stay on top of things and go the extra mile.

As you go through the process, I’ll gladly offer advice so you can feel a bit more confident, and if you happen to be in Mis-Atlantic, I might be able to recommend someone to you.
(and now I’m late for work…)

Response moderated
bossob's avatar

Thanks jellies. I will make some phone calls today. I’ve known this day was coming for several years. Two recent events have made it a top priority for me: At our family Christmas gathering, I felt oddly alone, detached, and a bit bewildered amongst the normal revelry because I couldn’t understand the person talking 3 feet in front of me. Then, a couple days ago on Fluther, someone made a brief comment in a thread not related to hearing, that (paraphrasing) recent research is showing that hearing loss is being associated with cognitive failures. That scared me.

I doubt youngsters are reading this topic, but here’s my P.S.A. contribution anyhow: Loud environments, even if it doesn’t hurt your ears, cause slow, long-term damage. During the first half of my life, average citizens (ie non-medical people) weren’t aware, believe, or care about such issues. Most of my jobs were in loud environments, and I didn’t wear hearing protection unless it hurt, or when I realized that the continuous noise, while it didn’t hurt, was making me irritable and edgy to the point where I was making unsafe decisions on the job.

But don’t take my word for it. I’m amazed at the awareness and concerted efforts to publicize the potential danger of hearing damage in the rock music world. I’m amazed at the quantity of free ear plugs that are distributed at loud public venues such as sporting events, motorized races, and convention centers. I’m amazed at the high priority that hearing and eye safety as achieved in the private sector. Keep in mind that the business people aren’t investing the time and money to provide hearing protection out of the goodness of their hearts. They have learned through experience that preventive precautions are much less expensive in the long run than lawsuits. Understand that the preventive measures you take today will save you time, money, and heartache in the long run.

Hopefully, my message doesn’t fall on deaf ears. ;-)

hearkat's avatar

Amen, @bossob

Sadly the earphones and ear buds are breeding a whole new generation of folks with hearing loss. While I jokingly say that it’s job security, it bothers me because you know the kids that age don’t listen even if they do have good hearing.

JLeslie's avatar

I wish I had listened when I was young. I have some hearing loss, some probably from going out to loud dance clubs a lot when I was younger. Now I am at loud race tracks several times a year, but I try to wear ear protection as much as possible. Also, movie theatres for several years had the volume way to high. It seems like it has a been a little better recently, maybe something was done? I was seriously considering making complaints regarding the major cinema chains. The last musical I went to the sounds was way way way too loud. Completely ruined my experience. My hearing loss is a little worse on one side. The doctor pointed out that is unusual. I just started wearing ear pkugs smetimes at my zumba classes.

I think it is great you are considering getting some help for your hearing. It’s awful to be out of the conversation when with people.

hearkat's avatar

Six months have gone by, @bossob… how are you doing?

bossob's avatar

Six months already? Time sure flies on the downhill side of life!

I ended up purchasing Phonak Bolero from an audiologist at an ENT clinic; BTE open ear fit. I felt the post-purchase support/service would be more to my liking. So far, so good.

The first few days of wearing them, I became acutely aware of how dependent I had become on watching people’s mouths in order to comprehend their speech. It took a while to break that habit.

I’m still not confident about what speech I should and shouldn’t be able to understand, and will ask other people if they can understand a certain person when they speak. Some people are just poor speakers: mumble, low volume, etc.

Wife and I got several good laughs when I asked ‘what’s that sound’ when I heard a noise in the house. One was a driveway buzzer; one was the microwave timer. I’ve heard them for years, but I didn’t recognize the sound with my aids in.

Previously, I thought I could hear birds, but soon realized I was only hearing part of their song.

As for being able to converse in an environment with lots of background noise, it’s hard to quantify the improvement. I don’t dread being in that situation anymore, but some of that comes from feeling more confident. I find myself watching other people to see if they are having trouble understanding speech amongst the same noise. I haven’t become comfortable with what the new normal is for me.

It took me by surprise when four work acquaintances, upon learning that I had purchased hearing aids, asked me how they could get their husbands to have their hearing checked. They were tired of playing the accommodation game. I figure everyone is different, so I just gave them my audiologist’s business card.

Thanks again, @hearkat, for taking the time to share some of your professional world. I gained some confidence, and it made my journey into the unknown a lot less stressful.

hearkat's avatar

Thanks for the update, @bossob! I’m glad to learn that you’re doing so well. As you adapt to hearing more sounds again, you may want to go back for some fine-tuning. We often set the aids conservatively for first-time users, so as not to overwhelm them with sound. Also, a person’s sound preferences for tonality can change as they become more used to having those sounds back in their environment again.

The new Phonaks are quite good, and have a lot of adjustments for specific environments. The level of sophistication in the processor is designated by the model number. Bolero is the BTE style, but there are Q30, Q50, Q70 and Q90 processors, with the higher number indicating the more features. So if you discover that there are still environments where people with fairly good hearing are understanding more than you are, you might make note of the noise levels and sources, and your audiologist may be able to make the aids respond a bit more aggressively to filter noise in those situations.

Also, when you are in a crowded/noisy environment, you want to help the instruments work for you. Since your devices have directional microphones, you want to position yourself so that the majority of noise that you don’t want to hear is behind you, and so there is less noise beyond the people you are wanting to hear. So in a restaurant, it is best for your companions to sit against the wall and for you to have your back to the rest of the dining area. If the test results showed that you have one ear that recognizes words better than the other, you want your companions to be on that side of you at the theater. Depending on which model you got and how they are set, you may be able to increase the volume a click or two, and that will simultaneously increase the noise reduction features, as well. The fact that you intuitively developed some lip-reading skills is also to your benefit in those noisy environments, go ahead and use it if it enhances your communication skills.

My patients worry that they’re being a bother if they come in with a list of questions or concerns, but I prefer that they come back until we are both satisfied that we’ve tuned the aids to the best we can get them. By investing more time in the beginning, their overall benefit and success is higher over the long term. Of course, there are some who have unrealistic expectations of what their auditory system and/or the devices can do, so I have to counsel them more extensively that nothing can be perfect.

bossob's avatar

I should have mentioned that I got the model Q70. The button is set for volume. I’ve experimented with the volume, going both up and down, and I can’t perceive a difference in a noisy environment. I can tell a difference on certain TV shows with poor audio, but that’s in a quiet environment.

I will try your suggestion to put my back to the source of the background noise; it certainly makes sense.

My audiologist did start me out conservatively, and attempted to fine tune over a period of weeks. I’m mostly retired, somewhat of a homebody, and don’t have daily commitments such that I have a ‘normal/typical’ (for me) environment in which to comparatively evaluate the adjustments that are made. It was hard to give her specific feedback about how helpful, or not, an adjustment was.

I should be having my first 6 month cleaning and checkup in a month or two.

hearkat's avatar

The Q70 is a very good model for someone who isn’t often out and about. The volume can still be programmed as a “Flex Volume”, which rather than simply increasing overall gain, it raises the frequencies for speech clarity and increases noise reduction feature at the same time. If the six-month checkup is a complementary clean and check, you may want to ask if that appointment includes adequate time for program adjustments, or if you should schedule it differently to ensure that they have time to do the fine-tuning.

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