Cheaper hearing devices can turn up the volume

Baby boomers, listen up!

Were you born between 1946 and 1964? Do you lack your old get-up-and-go? Spend a lot of time hunting for reading glasses? Can't run so fast anymore? Can hardly run at all?

Maybe none of the above applies to you. But here's another question that probably does: Are you not hearing quite as well as you used to?

If the answer is yes, you're not alone. Nearly a quarter of people age 65 to 74 have a disabling hearing loss, according to the Centers for Disease Control and Prevention. This fraction climbs to over one half for people who are 75 and older.

In most cases, the problem is what doctors call age-related hearing loss, or ARHL, which is caused by the wearing-out of the tiny hair cells in the inner ear that turn sound vibrations into nerve impulses. We're born with a set number of those cells, and anything from everyday noise to a single loud exposure diminishes their number.

ARHL isn't typically experienced as difficulty hearing, but rather as the frustrating sense that others are mumbling. This gets worse over time, often leading people to ask others to speak up or repeat what they've just said. Not surprisingly, ARHL has been linked to isolation, loneliness and depression.

Recent research also shows that people with ARHL have a greater risk of falls and fractures, an increased rate of hospitalization and faster cognitive decline.

The link with deteriorating cognition is not well understood. One possibility is a variant of “use it or lose it”: Social withdrawal leads to less brain stimulation, which leads to a deterioration in mental functioning. Alternatively, it may be a matter of overload: People with hearing loss must devote more brainpower to understanding speech, and so have less cognitive reserve to devote to tasks such as memory.

That's the bad news. Here's the good news: The hearing-device market is in the midst of a profound disruption that is making it easier and cheaper for people with hearing loss to get help.

Gone are the days when the only option was to use an audiologist's office to buy aids that often cost a couple of thousand dollars each, usually not covered by Medicare or other insurance.

Today it is possible to get quality hearing aids online and though big-box stores, bypassing the traditional office-based high markup and “bundled service” model, where consumers often pay for future visits they may not use. Websites and stores employ audiologists and fitters, and sell some of the same brands as private offices. One downside is that the service may not be as attentive or skilled. You'll need some help getting used to your aid. So if you go this route, you may want to get a referral from a friend who was satisfied with service and follow-up.

More significantly, perhaps, there is a lower-cost option that has emerged in the past few years: a personal sound amplifier, or PSAP. These devices, which typically cost $300 to $350, amplify sound directly into someone's ear. They are marketed as consumer electronics and therefore are not regulated by the Food and Drug Administration, as hearing aids are. In many cases, they use much the same sound-processing technology as hearing aids. Some look like in-ear hearing aids, while others look more like a cellphone headset. Some of these gadgets, are adjustable via smartphone apps that allow the user to change the device's sensitivity as background noise changes. PSAPs are sold at some big-box stores, drugstores and online (where you can read reviews). They can be tried at home (there's often a risk-free trial), and they come in various styles. Doctors who work with people with mild to moderate ARHL report that PSAPs can be very helpful for people with mild to moderate ARHL. (For someone with more serious loss, a custom-fitted hearing aid, with sealed ear mold and more involved tuning, is in order.)

If a PSAP is too expensive, consider a free smartphone app that uses ear buds and your phone's microphone to pick up sound. The app can be tuned to fit your hearing loss, and you can adjust settings as the sound environment changes. This solution can be awkward (ear-bud wires can get in the way, for example), but these apps offer a way to experience better hearing for free. For best results, it's important to find high-fidelity ear buds that fit well. For technical reasons, these apps right now run better on iPhones than on Android phones.

These options tend to work best for people with the gradual decline in hearing in both ears that occurs with age-related loss. They're not for people with serious ear problems (for instance, people born with hearing loss or those deafened by disease).

How can you know whether your hearing loss might be serious? Look for these “red flag” conditions, which should lead you to consult a doctor: sudden loss of hearing, rapid decline in hearing, hearing loss that is confined to one ear, ear discharge and/or ear pain, hearing loss accompanied by dizziness, vertigo or ringing in the ears, or excessive wax in the ear.

As more boomers develop hearing loss, policymakers are taking note. In October, the President's Council of Advisors on Science and Technology recommended that the FDA encourage the creation of a new class of basic over-the-counter hearing aids for people with ARHL. These would be sold in pharmacies and similar settings where consumers could try them out, compare them and make choices that fit their needs and pocketbooks — much as nonprescription reading glasses are sold now. The council further recommended allowing manufacturers of PSAPs to advertise that their devices can be helpful for people with AHRL, a claim that they are forbidden to make under current rules. To ensure safety, the council also suggested that these new over-the-counter hearing devices be sold with information about the red flags to encourage people with underlying ear disease to seek medical attention. The FDA — which has been leery of OTC hearing aids in the past, saying they are intended for “non-hearing-impaired consumers” who may need amplification in certain settings — has not commented on the recommendation.

More ideas for change are on the horizon. In 2016, the Institute of Medicine has said, it will issue recommendations to increase affordability and accessibility of hearing health care. On the legislative side, advocates have long urged Congress to provide tax credits to those who buy hearing aids, and a bill to extend Medicare coverage to include hearing aids is now before Congress, though similar legislation has gone nowhere in the past.

Maybe you can no longer boogie till dawn or even finish watching the 10 o'clock news without nodding off. But you can, and should, be able to understand what others are saying to you. So if you're in denial about hearing loss, get out of it. Start by trying an app on your smartphone and see if that helps. Order a PSAP, and take it for a trial run. Or if you'd prefer a professional assessment, make an appointment with an audiologist. There's a lot more at stake than just your ears — there's what lies between them as well.