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At my annual physical, I told my internist about a new (albeit minor) annoyance: ringing in my ears. He referred me to an audiologist.
“Just want to make sure nothing else is going on,” he said.
Before my audiologist appointment, I was completing the new patient paperwork. There were a few questions about my overall health history, but an entire page focused on my attitude about hearing aids.
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I was asked about my willingness to use hearing aids, my level of interest in getting hearing aids and any stigma I attach to them. Rather than follow the instructions and rate my response to each question on a 1-to-10 scale, I kept scribbling “N/A”.
“I bet they’re going to try selling me hearing aids,” I thought, “even though my hearing is fine and that’s not why I’m here.”
Sure enough, that’s exactly what happened. After administering a hearing test, the audiologist ushered me into her office and hyped hearing aids. She had already checked my health insurance coverage (boy, that was fast) and started talking price.
On what basis did she conclude I could benefit from hearing aids?
One of the tests involved assessing my ability to hear about a dozen monosyllabic words that she recited and asked me to repeat. My word recognition score was 88% in my left ear and 92% in my right ear.
“That’s not good enough,” she said. “That makes you a candidate for hearing aids.”
I explained that my reason for the visit was tinnitus. She replied that hearing aids could help relieve the ringing.
At this point, I realized that outside of buying hearing aids, there was no other treatment plan or solution to silence the ringing.
I’m not against hearing aids. It’s great that so many people benefit from them. But my experience made me wonder if audiologists are a tad too motivated to sell them.
“Getting a hearing aid shouldn’t be based on a hearing test alone,” said Nicholas Reed, a clinical audiologist and assistant professor at Johns Hopkins University School of Public Health. “A hearing test assesses how you pick up sounds. It doesn’t assess how you process those sounds or how hearing loss affects your everyday life.”
For a better measure of whether hearing aids might help you, Reed suggests asking questions such as:
What’s your personal struggle with hearing loss?
How is it affecting you in your daily life?
Are you starting to avoid difficult hearing situations, such as conversing with kids who tend to speak in high-frequency voices?
“A good audiologist will ask about situations where you’re having trouble hearing,” he said. “On the phone? In a meeting room? And if you’re changing your everyday life, like not going to restaurants because you can’t hear as well, that might also be an issue.”
Of course, some people with poor hearing live in denial. They refuse to accept that they have a medical problem—and look for other reasons why they can no longer capture what others say.
To self-diagnose your ability to hear, survey those who know you well.
“The best advice is to talk to a family member or friend who’s close to you,” said David Zapala, Ph.D., an associate professor of audiology at the Mayo Clinic School of Medicine. Ask, “Are you working harder to communicate with me?” and “Are you talking louder around me?”
Another strategy is to notice how you respond to surprising or unpredictable comments. Often, we compensate for hearing loss by using verbal and nonverbal cues to decipher what others are saying.
But it’s the moments that catch us off guard that prove most revealing. For example, consider how you respond when someone tells a joke that you’ve never heard before.
“If you miss the punch line, that may be because you don’t expect it,” said Lise Hamlin, director of public policy at the Hearing Loss Association of America. “Normally, you may be able to fill in the blanks in everyday conversation. But in this case, you can’t do that because the end of the joke isn’t what’s expected.”
As our brain processes what’s going on around us, we piece together what we think we hear. Context plays a huge role, making familiar interactions easier to understand even with mild hearing loss.
“What we know has an enormous influence on what we hear,” writes Nina Kraus in her book, “Of Sound Mind” (MIT Press, 2021).
If you wind up seeing a hearing specialist like I did, know that they operate under different business models. Ideally, they’ve earned a Doctor of Audiology (AuD) and operate a practice that includes diagnostic and rehabilitative services. Other providers conduct free hearing tests in shopping malls and other public venues.
Reed cautions consumers to tread lightly with “free” hearing tests from providers “that are trying to get you in the door for a sale because they’re living and dying by whether they’re selling hearing aids.”
Transparency in the pricing of services is a sign of a quality hearing care professional. You can also check whether any academic centers in your area provide audiology services, he adds.
The best audiologists don’t just give hearing tests and analyze the results. Like a primary care physician seeing a patient for the first time, they should begin by getting to know you, reviewing your medical history, asking about your lifestyle (and any occupational hazards or hobbies that might affect your hearing) and learning your reason for the visit.
My audiologist skipped the initial consultation and escorted me directly from the waiting room into a tiny chamber, giving me a button to push and headphones to wear. Then she went into the next room and, through glass, watched me as she directed the test.
When we spoke afterward in her office, I asked if my chronic earwax buildup might affect my hearing. She looked in my ears and didn’t see much wax, but that’s because my internist recently did an ear lavage.
“One of the first things an audiologist should do is look in your ears and check for earwax,” Zapala said.
My audiologist rightly explained that, as we age, hearing loss could lead to social isolation. Some people really do need hearing aids now, not later.
If you’re one of those folks, do a little due diligence rather than rush to purchase whatever model your audiologist sells. Audiologists tend to favor a few brands, but that doesn’t mean they carry the most superior products or the ones most ideally suited to fit your needs. Check reviews from user groups and consumer organizations that do independent product testing before you buy.
