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Hearing aid buying guide

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If you're older than 45, there's about a one in five chance you suffer from some amount of hearing loss--and that rate climbs steadily as you age. Almost one-third of people ages 65 to 74 report difficulty hearing, and the number rises to about half at 75, according to the National Institute on Deafness and Other Communication Disorders.

Hearing loss can wreak havoc with your social life, causing you to avoid activities such as going to restaurants or parties. It can also increase your risk of falls, possibly by making you less aware of your surroundings and impairing balance, and it can make driving dangerous. A recent study at Johns Hopkins University even linked untreated hearing loss to a higher risk of developing dementia.

What causes hearing loss

Most cases of hearing loss in adults stem from damage to the inner ear, where tiny hair cells turn sound vibrations into impulses that nerve cells then carry to the brain. The most common causes of that damage are aging and chronic exposure to loud noises--think rock concerts, sports events, and lawn mowers. A family history of severe hearing loss could signal that you're at increased risk. So does being male.

If you're experiencing signs of hearing loss (or have been told as much by a concerned family member), first see a board-certified otolaryngologist--an ear, nose, and throat physician who will check for impacted earwax and other reversible causes. If none are found, the doctor will probably refer you to an audiologist, a professional who specializes in testing and treating hearing problems.

The new hearing helpers

Once hair cells in the inner ear are dead, there's no bringing them back to life. But hearing aids and other devices can dramatically improve your ability to hear and carry on a normal life. Consumer Reports scanned the marketplace and consulted hearing experts to help you determine which are worth considering.

Digital hearing aids. Unlike older hearing aids, which amplified the volume on everything (including background noise), today's digital models have microphones that transmit sound to a computer chip, which moderates the volume and amplifies the frequencies needed to help improve your hearing. They can be programmed to filter out wind and other background noises, and some can sync up wirelessly with Bluetooth to your smart phone, enabling you to hear calls through the hearing aid and to use your phone to adjust the aid's settings. Some accessories also allow you to stream audio from your MP3 player,

laptop, or TV right to your hearing aid.

Another boon for people with hearing aids is a technology called the Hearing Loop. It provides a magnetic signal that's picked up by a tiny coiled wire in the hearing aid, which transmits the sound into the wearer's ear. It's available in some sports and concert venues.

Smaller size in aids is another innovation. You can find aids that fit in the ear canal and are barely visible--though you may give up some features and power.

How to choose: Depending on the sophistication of the device and where you get fitted, expect to pay $1,000 to $6,000 for a pair of custom-fitted hearing aids. Medicare and most private insurers don't cover hearing aids, but check your health plan. Veterans may be eligible to get free hearing aids at their local Veterans Affairs facility.

Personal sound amplifiers (PSAPs). These over-the-counter products generally have fewer features and less functionality than hearing aids, although some of the technology may be similar. They're sold online and at some mass retailers, and can be a lower-cost solution for people with mild hearing loss who aren't ready to spring for a prescription hearing aid, according to Barbara E. Weinstein, Ph.D. professor of audiology at the City University of New York. The Food and Drug Administration cautions that PSAPs aren't designed for people with hearing loss, but rather for people who want to amplify certain sounds--and they aren't subject to the same safety and effectiveness standards that hearing aids are. So consult an audiologist first if you're considering one.

How to choose: Options range from behind-the-ear models (about $25 to $500) to in-ear models such as The Bean ($375 and more), which claims to amplify hard-to-hear sounds, including soft voices, while lowering the volume on loud noises. Ask your audiologist which type might make sense for you.

Assistive listening devices. If you need just a little help with hearing, there are a number of low-cost listening devices to aid you. They include apps that let you amplify sound with your smart phone and earbuds, and portable wireless devices that let you listen to your TV and other audio devices with earphones. You can also find amplified, flashing, or vibrating versions of basic household items such as telephones, alarm clocks, and doorbells.

How to choose: You can buy listening aids for smart phones and other electronics at many websites. Prices range from about $80 to $900. Amplified or flashing household items cost about $40 to $300.

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