How to choose the right hearing aid for your specific needs

Tired of making people repeat themselves? Is cranking up the volume on the TV no longer enough help?

That's a signal it's time to get your hearing checked and consider a hearing aid. In the last several years, the technology has advanced tremendously, hearing aids have become less conspicuous and insurance coverage has improved.

"This is not your grandfather's hearing aid," yet many people have that outdated view, says audiologist Carolyn Smaka, editor of the website www.audiologyonline.com .

Today, virtually all hearing aids are digital and they do far more than boost volume. They're essentially minicomputers, precisely programmed for each patient, to boost sounds and adjust tones where they need it most, much like the way stereo equalizers adjust various frequencies to produce the best sound, says Smaka.

They're also pricey: Most run from $1,000 to $6,000 each, including follow-up. Nearly everyone needs two, and they usually must be replaced about every five years.

"People should realize that their hearing loss is much more noticeable than any hearing aid will be," says Kim Cavitt, an audiology consultant in Chicago and president of the Academy of Doctors of Audiology.

About 30 million U.S. teens and adults have impaired hearing, often caused by excessive noise at work or leisure, such as loud music. That includes nearly 1 in 10 adults aged 55 to 64; 1 in 4 aged 65 to 74; and half those 75 and older.

Hearing impairment can cause frustration, social isolation and depression, so hearing aids can greatly improve daily life, though they can't completely restore hearing.

With all the available options, selecting a device is complicated, but most manufacturers provide a trial period entitling you to a refund if you're not satisfied.

Here's a roadmap:

• Talk with your doctor. A thorough exam is essential, as about 15 percent of patients with hearing problems are found to have ear infections, medication side effects, benign tumors or other problems hearing aids can't fix, Cavitt says.

• Seek recommendations. If a hearing aid is appropriate, it's crucial to pick a hearing professional who answers all your questions and listens to your concerns. Options include an audiologist, who has a master's or doctoral degree, or a hearing aid dispenser, who may be equally knowledgeable but may not have an advanced degree. Be sure to ask about qualifications and fees in advance.

Start with your doctor, but also ask relatives and friends who have a hearing aid, or search the databases of professional organizations, such as http://www.audiology.org.

• Check insurance coverage. The initial evaluation normally is covered, but until recently the hearing aid, fitting and follow-up were rarely covered, except by the Veterans Administration. Today, roughly 30 percent of plans cover at least some of that, according to Cavitt. Your out-of-pocket costs may limit what options you choose.

• Interview a couple hearing aid providers. Besides an initial evaluation, you'll need a fitting that includes programming the device and training on insertion, cleaning and battery changing, plus two to three follow-ups to fine tune the hearing aid's settings.

• Get tested. At this stage you should receive a 45- to 60-minute test analyzing your hearing loss, such as whether your problem is mainly with low frequencies or high frequencies. High frequencies usually go first as you age, making it difficult to understand children and women.

• Discuss your specific problems. For many, that's trouble talking on the phone and hearing conversations at a party or restaurant. For those still working, it may be difficulty participating in office meetings.

Knowing those details will help your audiologist pick the most suitable device. If it's programmable, you can have multiple settings for specific situations, such as quietly listening to music, trying to hear over all the background chatter at church bingo or carrying on a conversation when you're driving and can't watch the passenger's face.

• Review optional features. If you want multiple settings for different sound situations, you might consider a remote control to switch between settings.

Feedback control, which prevents loud squealing and whistling, is a must.

You likely will want directional hearing aids; they have two or three microphones, which helps you focus on what you want to hear and can reduce annoying background noise.

If you use a cellphone, ask about hearing aid compatibility. For example, there's an iPhone app for that can stream a call directly into your hearing aids.

But you may not need the most advanced bells and whistles. Those include hearing aids that are water-resistant and ones with accessories such as a penlike device that streams TV audio.

• Consider appearance. Options include devices that hook behind the ear, sit in the outer ear, or are in the ear canal and nearly invisible.

• Discuss price options. In general, the smaller and more sophisticated the device, the higher the price.

Beware of "bargains," though. Some hearing aids can be bought online, but most Internet offerings are really just personal sound amplifiers. Although they sell for as little as $100, they're not regulated and are only for people who want volume boosted a bit.

• Review the warranty. Hearing aids typically are covered for one to three years, and the first year may include replacing lost ones - a common problem, since they're so small. An extended warranty might be smart.

More info: www.nidcd.nih.gov/health/hearing/pages/hearingaid.aspx .