Understanding hearing loss: How do you know if you need hearing aids?

Feb. 10, 2023
UCHealth experts explain hearing loss and how you might know if you need a hearing aid. Older Hispanic man wearing a hearing aid.
Hearing loss affects most people by the time they reach their 50s and 60s. It is best to address hearing loss earlier for your overall health, which may mean you’ll need hearing aids. Photo: Getty Images.

We’ve all been in the home of a person who has the volume on their television cranked very high.

Being unable to hear the television is a common indicator of hearing loss. For the person who has trouble hearing, it’s not only unpleasant and frustrating, it is also a medical problem. The sooner it is treated, the better the chances for an all-around healthier life, according to Dr. David Book, an otolaryngologist or Ear, Nose and Throat specialist at UCHealth.

“As people grow older, especially into their 70s and 80s, those who have significant hearing loss may start to become more socially withdrawn; they have a harder time communicating with friends and family. They also may have a harder time communicating with medical providers,” said Book.

“They may struggle with things that keep them happy such as watching television or listening to music and that can lead to social withdrawal, which can be a significant factor in the decline of cognitive thinking and well-being,’’ said Book, who sees patients at UCHealth Ear, Nose, and Throat Clinic – Chapel Hills and a UCHealth specialty clinic at Pikes Peak Regional Hospital  in Woodland Park.

To gain a greater understanding about hearing loss and how to know if you need hearing aids, we asked Dr. Book and Brandi Greenhouse, who holds a doctorate of audiology and specializes in helping people who have hearing difficulty, ear ringing (or tinnitus) and other types of hearing loss, to answer some common questions about hearing loss.

What is hearing loss?

Simply stated, hearing loss is when someone has difficulty hearing.

Does hearing loss affect one or both ears?

Most of the time it affects both ears, though some people experience hearing loss in only one ear.

Why do more men suffer hearing loss than women?

Men are nearly three times more likely to develop hearing loss than women. While noise-induced hearing loss (NIHL) occurs in both men and women, men are nearly three times more likely to develop it. Hearing loss in men is more prevalent because they are typically working in louder environments and who participate in noisier recreational activities.

Do headphones or earbuds contribute to hearing loss?

Loud noises, in general, are bad for your ears and can cause hearing loss. Turning down the volume while listening through headphones may help reduce the risk of hearing loss.

If you believe you have a hearing issue or hearing loss, what steps should you take?

The first step is to get a hearing test. A hearing test is done by a hearing specialist called an audiologist and is pretty straightforward, according to Book.

“They’re painless and easy to do. It just takes the effort to get out and get them done.’’

What is involved in the audiology test?

Most tests are done in a sound-treated environment, and patients are presented with a series of tones and different volumes. The patient has to respond to the tones at different volumes. Most of the time, there is a test called a tympanogram. It looks at how well the middle ear is functioning and how well the eardrum is vibrating. Testing also involves word recognition, and people are presented with phonetically balanced common American words, and they have to repeat those words. That tests the ability to process sound information.

How long does an audiology test take?

Typically, about 30 to 45 minutes.

How soon does a person receive the results of their audiology test?

Through our clinic, the audiologist reviews the test results with the patient, so they get immediate feedback and then, typically, they receive some advice about hearing conservation. For those who may be candidates for hearing amplification or benefit from hearing aids, our audiologists will talk with them about that.

For those who are candidates for hearing amplification, there’s usually a second visit and it is typically about an hour with an audiologist. It is a free visit, and during that consultation, patients are presented with hearing aid options, running through what products may be most appropriate for a person.

For those who are wishing to consider hearing aids and proceed, most will go home with the ability to test hearing aids for about two weeks. That gives them a chance to decide if the hearing aids are right for them and to make determinations or adjustments of the specific functions on the hearing aids.

Does medical insurance cover hearing aids?

Most insurance companies are starting to cover some or all of the cost of hearing amplification, and that’s a change over the last five or six years. That did not always used to be the case, but now the cost of hearing aids can often be deferred with the insurance plans.  A lot of commercial plans cover hearing aids, and Medicare supplemental plans may have some coverage or discounts available.  Our office will always assist with verification of hearing aid benefits prior to any hearing aid fitting.

We see a lot of advertisements on TV for hearing aids. Why are there so many?

In late summer, Congress deregulated hearing aids. It used to be that hearing aids were required to be dispensed through an audiologist. With deregulation, you no longer have to have an audiologist dispense or prescribe a hearing aid.

Over-the-counter products are starting to become more widely available, and these products are usually less expensive than the more standard hearing aids. Our audiologists are acutely aware of that and it is very likely there will be some terrific products available for less expense. At this point, we as a medical community have not had enough time to evaluate which products are superior. I still recommend that patients, at the least, have a discussion with an audiologist about hearing amplification so that they receive appropriate education about hearing aids and what to expect from them, including what type of functionality may be best for each individual.

Even if they don’t end up getting the hearing aid through the audiologist, at least getting that education is helpful.

If you get the wrong type of hearing aid, can that be harmful to you?

If the hearing aid has been dispensed by an audiologist with appropriate follow-up, I would not expect any harm associated with a hearing aid.

If you purchase an over-the-counter hearing aid, do you have to have a consult with an audiologist?

No, with the over-the-counter products, you don’t need a consult with an audiologist; you can just order them.

Most of these companies have a website with some form of an app to do a hearing screen through your phone. That information gets uploaded to the company, and then they give you options about hearing aid products, and they program it according to the at-home hearing test that you have done.

Is it advantageous to schedule an appointment with an audiologist before getting a hearing aid?

Yes. An audiologist, in their scope of practice, is an expert in determining whether there is something atypical or abnormal on an audiogram. If there is, they are really obligated to counsel patients to seek medical clearance and an appointment with an ENT to assess for anything that may be atypical or abnormal.

At what age do people typically begin to experience hearing loss? 

Most people typically start to see early stages in their 50s or 60s.  For the majority of people, by the time they get into their 60s and 70s, they have developed some form of hearing loss.

Is that due to the aging process?

Yes, we call it presbycusis, and it is just age-associated hearing loss. It is important to realize that hearing loss can begin at any age, however. Any person who feels that they may be experiencing changes in hearing should schedule a hearing evaluation with an audiologist.

Has hearing aid technology advanced? Has the quality improved?

As with any technology, every year there are improvements in not only the hardware but also the software for the functionality in hearing aids. All hearing aids now are digital and most have Bluetooth capability, so you can connect with your smart phone or your computer. You may be able to listen to music or watch TV through Bluetooth connectivity. You can answer your phone. Many of the newer hearing aids are rechargeable with a docking station so they do not require having to change out batteries.

What if I am self-conscious about wearing a hearing aid? And are they hard to wear?

Most hearing aids are essentially invisible, so when a person is wearing them, unless a person is looking carefully, you don’t typically know that a person is wearing the hearing aid.

Using hearing aids is practically no more difficult than putting on eyeglasses in the morning. I see many folks who come in and they are self-conscious about having a hearing aid, but 80% of them are wearing eyeglasses or reading glasses.

People who have vision problems don’t tend to worry about using aids for their vision but, for whatever reason, seem to be turned off by a hearing amplification. Hearing aids are simple to wear and certainly improve quality of life, not only for the person but for the family members and friends.

What kind of feedback do you get from patients after they start wearing a hearing aid?

Most people are happy with hearing amplification because they realize they are no longer missing the things they didn’t know they were missing. It makes communication easier and reduces the frustration of not being able to hear the television, conversations or your phone. It also reduces the frustration for family members and friends.

From a safety standpoint, you want to be sure that you hear things in your environment, so it is beneficial in that regard as well.

For those who feel like they may struggle with hearing aids, in most circumstances, it simply means changing the programming or the settings on hearing aids to maximize the benefits to the person. Our audiologists are always open to follow-ups to make sure that the products are working well for people.

After testing, how long does it take to get hearing aids?

Patients can typically be fitted with hearing aids within 2-3 weeks.

Is hearing loss often associated with tinnitus?

Yes. Hearing loss is often associated with tinnitus, or ringing in the ears. That is often a key complaint that people present with – they hear noise in their ears. We diagnose the hearing loss secondary to that. Tinnitus is endemic. Somewhere between 30 million to 50 million Americans experience tinnitus daily. Unfortunately, we do not have a cure for tinnitus yet, but there are many treatment and management strategies available to help adapt to tinnitus. For many people who suffer from tinnitus, hearing amplification is a way to help people better manage and can be a treatment for tinnitus.

People who have tinnitus, what do they experience?

It is variable. Most people experience tinnitus as a relatively constant sensation of noise. It is often described as hearing a high-pitched sound in the background, a mechanical noise or hissing or humming — and it can be fairly obnoxious.

Is there more to hearing loss than just problems with the ears?

We know that hearing is more than just the hearing organ. Our hearing system performs a lot of processing of sound information. For a person with hearing loss, if they let that go and don’t treat it with hearing amplification, over time our ability to make sense of complex sound information can also diminish.

I tell people not to wait to treat hearing loss. The sooner they get hearing aids, the better they’ll do 10 years down the road, 15-20 years down the road. Those brain connections in the hearing system fall into the ‘use it or lose it category.’ So we found that that earlier people get treated for hearing loss, the better they do in the long run.

Do people do better cognitively in the long run if they get hearing loss treated?

That’s part of it. As we get older, especially into or 70s and 80s, especially for people with significant hearing loss, they may start to become more socially withdrawn, they have a harder time communicating with friends and family. They have a harder time communicating with medical providers. They may struggle with things that keep them happy, watching television or listening to music to the point where that social withdrawal can be a significant factor in the decline of cognitive thinking and well-being. Studies have linked untreated hearing loss to auditory deprivation, fatigue, tension, stress, depression, and avoidance or withdrawal from social interactions.

How do I schedule a hearing test?

It depends upon insurance, but most people can get a hearing test without a referral from their primary care doctor. If audiologists feel like an ENT is needed, then they place the referral. To schedule an appointment with an audiologist or an ENT, call 719-364-4120. You can also schedule an appointment or through My Health Connection, UCHealth’s online patient portal.

About the author

Erin Emery is editor of UCHealth Today, a hub for medical news, inspiring patient stories and tips for healthy living. Erin spent years as a reporter for The Denver Post, Colorado Springs Gazette and Colorado Springs Sun. She was part of a team of Denver Post reporters who won the 2000 Pulitzer Prize for breaking news reporting.

Erin joined UCHealth in 2008, and she is awed by the strength of patients and their stories.