Tip 1 - Act Now

Hearing loss can be a tough problem to admit. It's often several years between the time that people first identify hearing loss and the time they actually get a hearing aid or other help. That's too long.

Getting help for hearing loss is often viewed as a sign of old age and disability, and few of us want to face that. Balance this viewpoint with another one: Taking action to protect your hearing can have an immediate and positive impact on your quality of life — physically, socially and emotionally.

Hearing loss: The physical costs

Hearing loss can involve disorders of the ear that cause temporary or chronic pain. In addition, hearing loss can be a symptom of a serious disease or condition, such as a tumor, that requires prompt medical attention. Getting treatment for these conditions could restore your hearing, ease your pain and even save your life.

Hearing loss: The social costs

Think about the consequences of living each day with hearing loss. You can't hear what people are saying, so you constantly ask them to repeat themselves. Or, you just nod your head, smile and pretend to understand.

Friends and relatives see you as confused or uncoopera­tive, simply because you don't hear well. At the same time, you feel angry that people seem to mumble whenever they're around you. You wonder why they don't just speak up — or if there's something they don't want you to hear.

You have trouble hearing the TV or the stereo, so you crank up the volume until your family complains.

You want to listen to the radio in the car, but you have to turn it up so high that you can't hear sirens. Given these conditions, it won't take long for you to feel alone, isolated in a world defined by hearing loss. According to the National Institute on Aging, people with hearing loss may become depressed or withdraw from social situations to avoid frustration and embarrassment.

Getting help for hearing loss — now — can heal relationships and get you back in the mainstream of life.

Choose better hearing starting now

Aging often brings some degree of hearing loss. But don't assume that getting older means living in a world of muffled sounds and garbled speech. The choices you make today determine how well you'll hear weeks, months and years from today. The rest of the tips in this booklet explain those choices in detail.

One reason to treat your ears with kid gloves goes beyond good hearing. That reason is to protect your sense of balance. Balance is controlled by signals sent to your brain from several locations. One of those locations is your inner ear. Problems with the inner ear can lead to dizziness, and dizziness can lead to falls — an event that often sends older adults to the hospital.

A lightheaded feeling or mild dizziness has a variety of causes and often goes away by itself. However, there's a more serious condition called vertigo — the sensation that you or your surroundings are whirling. With vertigo, you feel like a pair of pants being tossed around in your dryer's spin cycle.

Ending the spin cycle usually calls for hearing and balance tests. Get your doctor's help.

Tip 2 - Recognize signs of hearing loss

Hearing loss means much more than being deaf. Your ability to communicate is threatened even when you miss parts of words. This can happen with high-frequency hearing loss, when some sounds — such as certain conso­nants — may be hard to hear. For instance,fall may sound like tall, or sell may sound like Jell.

Even people with mild hearing loss can miss pitch, vol­ume and other qualities that speakers assign to words. These qualities communicate a whole world of subtle meaning.

Watch for early signs

To protect your full range of hearing, look for early signs of hearing loss. Start by taking the following quiz from theNational Institute on Deafness and Other CommunicationDisorders (NIDCD). Remember that this quiz is just for general information. Only your doctor can diagnose hearing loss.

• Do you have a problem hearing over the telephone?

• Do you have trouble following the conversation when two or more people are talking at the same time?

• Do people complain that you turn the TV volume up too high?

 Do you have to strain to understand conversation?

 Do you have trouble hearing in a noisy background?

• Do you find yourself asking people to repeat themselves?

• Do many people you talk to seem to mumble or not speak clearly?

• Do you misunderstand what others are saying and respond inappropriately?

• Do you have trouble understanding the speech of women and children?

• Do people get annoyed because you misunderstand what they say?

If you answered yes to three or more of the questions onthis NIDCD quiz, call your doctor and ask about getting ahearing test. (See Tip 5: Get Professional Help)

In addition, go through these questions with your spouseor a close friend. These people might notice signs of hearing loss long before you do. Their answers could prompt you to get help right away.


Tip 3 - Learn about causes of hearing loss

Many conditions can cause hearing loss. Examples are excess noise, foreign objects in the ear, infections, heart conditions, stroke, injuries, cysts and tumors. Below are some of the more common causes of hearing loss in adults.


People over age 50 are likely to lose some hearing each year. The gradual loss of hearing due to aging is called presbycusis (pres-bih-KU-sis), from the Greek presby,meaning "old," and cusis,meaning "hearing."

Presbycusis results from changes that occur over time to the inner ear, including damage to the sound-sensitive hair cells that convert sound vibrations into nerve signals. Presbycusis affects hearing in both ears, especially theability to hear high-frequency sounds.

Hearing loss that results from aging is usually permanentand can't be reversed with surgery or medication. However, hearing aids may help
(Tip 6,) along with simple strategies for better hearing (Tip 8, page 26) and assistive 
listening devices (Tip 9,).


Heredity plays a role in how resilient your hearing is, and several types of hearing loss seem to run in families. An example is otosclerosis(o-toe-skluh-ROE-sis), the most common cause of middle ear hearing loss in young adults. In otosclerosis, an abnormal growth of spongy bone occurs at the entrance to the inner ear, and the stirrup no longer moves easily. Surgery and hearing aids can often treat the problem successfully.

Heredity can also play a role in age-related or noise-related hearing loss. Some families tend to have strong hearing, and others lose hearing at a more rapid rate as they age. Some families have hearing that's more susceptible to damage from noise exposure.


Certain medications can cause hearing loss. These include, for example, aminoglycoside antibiotics (streptomycin, neomycin, others), some chemotherapy drugs (cisplatin, carboplatin, others), loop diuretics (ethacrynic acid, furosemide, including the brand Lasix, others), quinine and high daily doses of aspirin. Hearing loss due to aspirin or quinine is almost always reversible when the drug isdiscontinued.

If you see a doctor about hearing loss, be sure to mention any medications you're taking. And if you experience anysigns of hearing loss, tell this to the doctor who prescribed your medication.

Other conditions

Many other conditions can cause temporary or permanenthearing loss. A few examples follow.

Barotraumaalso called airplane ear, results from changes in air pressure between the atmosphere and your middle ear that cause your eardrum to bulge outward or retract inward. Barotrauma may occur if you fly or scuba dive or if you're at high altitudes in the mountains, especially if you have a nasal allergy, cold or throat infection.

To prevent Barotrauma on long flights, consider takinga decongestant an hour before takeoff and an hour beforelanding, allowing sufficient time between doses as suggested on the product package. During a flight, suck candy or chew gum to encourage swallowing and the equalizing of pressure.

ruptured eardrum can occur after an ear infection or trauma, such as a blow to the ear.

Signs and symptoms of a ruptured (perforated) eardrum are:


  Partial hearing loss

  Slight bleeding or discharge from your ear

If you suspect that you've ruptured an eardrum, see your doctor as soon as possible.Swimmer's ear (external otitis) is an infection of the outer ear canal. It results from persistent moisture in the ear — from frequent swimming, for example — often in combina­tion with a mild injury to the skin in the ear canal. Such an injury can happen from scraping the ear canal when tryingto clean out wax. Hair sprays and hair dyes also can cause infection.

Signs and symptoms of swimmer's ear include:

  Pain or itching

  Temporary hearing loss

  Pus drainage from the ear (rarely occurs)

If the pain is mild and you don't have ear drainageor hearing loss, try the tips below. Otherwise, seekmedical care.

  Place a warm — not hot — heating pad over your ear, but don't lie on the heating pad.

  Consider taking a pain reliever such as ibuprofen (Advil, Motrin, others) if needed (and take it with food).

  Keep water out of your ears.

  Avoid getting substances in your ear canal that might irritate it, such as hair spray or hair dye.

  Clean your ear canal only if a doctor or nurse instructs you to do so

Tip 4 - Put a lid on noise

One  major cause of hearing loss is something you can control — your exposure to noise.

We live in a noisy world. Vacuum cleaners, power lawn mowers, power tools, construction equipment and jumbojets are just a few sources of the racket that assails us each day.

Fortunately, we've found ways to turn down the volume knob on daily life. Compared with previous generations, fewer people today drive noisy tractors or work on assem­bly lines with deafening machines. Even so, people now choose to ride motorcycles that drown out conversation or listen to music at volumes that shake walls.


Sound intensity is measured in units called decibels (db). Normal conversation registers at about 60 db. A loud conversation in a crowded building is about 70 db. Stereos, tractors and power lawn mowers can hit 90 db or more.


Repeated exposure to noise at or over 85 db can be haz­ardous. Even a one-time exposure to loud noise can damage the delicate, sound-sensitive hair cells in the inner ear.


Noise-induced hearing loss can occur so gradually that you're not aware of it. Whenever you're exposed to sources of loud noise, take precautions.

Wear earplugs or earmuffs

If you have to shout to be heard by someone an arm's length away, you're being exposed to too much noise. This guideline applies at work and at home.

Wear protective earplugs or earmuffs. Use commercially made devices that meet federal standards. You can find them at drugstores, hardware stores and sporting goods stores.

Don't use cotton earplugs. They don't dampen noise well, and they could get stuck in your ears.

Hold down the noise at home and at play

Most of us can understand the dangers of work-related noise. But we can easily overlook the racket at home. To protect your hearing, keep your house a haven of peace and quiet:


  • Turn down the volume on your TV or stereo.
  • Choose personal stereos with an automatic volume limiter.
  • Don't turn up the volume on headphones to drown out background noise.
  • Don't run multiple appliances at the same time.
  • Wear earplugs or earmuffs when using power equipment.
  • Place computer mouse pads under noisy small appliances.
  • Choose quieter appliances. Include the insulation package when buying a dishwasher.
  • Install carpeting to absorb sound.
  • Seal windows and doors to block traffic noise.
  • Rest your ears. Alternate noisy activities with quiet ones.


Hearing loss related to recreation is becoming more common. Activities with the greatest risk are shooting guns, driving snowmobiles and listening to extremely loud music. Use hearing protection in all such activities.

Protect children's hearing

If your son or daughter listens to loud music with head­phones, use this simple test to determine whether the soundis too loud: If you can identify the music being played while your child is wearing the headphones, it's too loud. Advise your children to save their ears for a lifetime of music enjoyment.

Tip 5 - Get professional help

Hearing screenings for adults are generally done at theirrequest. If you are exposed to loud noises in the work environment or have a history of exposure to loud noises,or if you suspect hearing loss for any reason, have your hearing checked. The American Speech-Language Hearing Association recommends that adults have their hearing checked every 10 years through age 50 and every three years after that.

In addition, don't buy a hearing aid without seeing yourdoctor first. Sometimes hearing loss results from an infec­tion, tumor or other problem that calls for medication or surgery, not a hearing aid. Your doctor can guide you to the most appropriate treatment.

Specialists you might see

As you seek professional help, you may meet severaltypes of hearing specialists:


  An otolaryngologist (o-toe-lar-in-GOL-uh-jist) is a doctor who specializes in diseases of the ears, nose,throat, head and neck. To investigate the cause of the hearing loss, this doctor typically takes a medical history, asks if other family members have hearing problems, does a thorough exam and orders any needed tests. You may also hear this specialist referred to as an ENT (ear, nose and throat) doctor or otorhinolaryngol- ogist (o-toe-ri-no-lar-in-GOL-uh-jist).

  An otologist (o-TOL-uh-jist) is an otolaryngologist (see above) who specializes in treating ear disorders.

An audiologist (aw-dee-OL-uh-jist) is a health profes­sional who can identify and measure hearing loss.
The audiologist will use a device called an audiometer 
to test your ability to hear sounds at different pitches and loudness levels and to recognize words. These tests are painless. Audiologists often work with otolaryngol-ogists. An audiologist can dispense hearing aids but doesn't prescribe drugs or perform surgery.

Tip 6 - Get the most from hearing aids

Hearing  aids gather sound and amplify it. The amplified sound helps to stimulate hair cells in the inner ear.

You may need a hearing aid for only one or both ears. Too often, people pay for high-priced hearing aids that end up hidden in a bedroom drawer. Complaints usually relate to:

   Performance in situations with background noise

   Performance on the phone
•   Cost

   Size, visibility and physical fit in the ear

   Battery life

   Sound quality, including feedback (whistling)

You can greatly increase your satisfaction with hearing aids by following the suggestions below.

Learn about the choices

Hearing aids come in many makes, models, shapes andsizes. Some are small enough to fit completely in the ear canal, making them almost invisible. Other aids are visible but fit snugly in the ear. Bone conduction hearing aids are another option for conductive hearing loss. Hearing aids on eyeglasses are rarely used.

Most hearing aids now use digital technology. Digital hearing aids offer more ways to adjust volume levels without distorting sound quality. Features such as compression and noise reduction help to reduce uncomfortably loud noises. Advancements in digital technology also make it easier to control feedback.

Completely-in-the-canal aid 

In-the-canal aid 

Behind-the-ear aid 

In-the-ear aid

Sort out your options

To sort out all of the hearing aid options, discuss them thoroughly with your audiologist. Remember these points:

  With all of the options, more than one type of hearing aid could work for you. Make sure you understandwhy a specific type of hearing aid is recommended and how you can expect it to meet your needs.

  Don't assume the latest, most expensive model is bestfor you.

  For the best performance in situations with background noise, ask your audiologist about a hearing aid withdirectional microphones.

  All hearing aids use batteries. Practice putting the battery in and taking it out until you can do it easily. If you find it hard to replace batteries, tell your audiol­ ogist or hearing aid dispenser.

List your priorities

When people buy hearing aids, they typically face a trade-off among three factors — cost, performance and size. If you rank those factors, it will help you and your audiologist or other dispenser in making your selection.

Hearing aids aren't covered by Medicare, and they usually aren't covered by insurance. But if a hearing aid improves your quality of life, it's worth the money. Also ask about costs of repairs and replacement batteries.


Keep expectations realistic
If you expect a hearing aid to give you perfect hearing, you'll be disappointed. Your success with any hearing aid depends on several factors:
• Severity of your hearing loss
• Length of your hearing loss
• Type of situations in which you want to hear better
• Your motivation to hear better
Remember that hearing aids amplify all sounds — including sounds you may not want. Hearing aids don't eliminate all background noise.
Also beware of misleading claims. No hearing aid can restore normal hearing. Don't believe advertisements or salespeople who make such claims.

Learn how to use and maintain your hearing aid
Before you leave the audiologist or other dispenser, get verbal and written instructions for using your hearing aid. Ask how to insert it, turn it on and operate any other controls. If your hearing aid has more than one program setting, ask

Buy on a trial basis
A hearing aid should come with a 30- to 60-day trial period and a warranty. You may need that amount of time to adjust to the aid and determine how much it helps you. Be sure to get the terms of the trial period in writing.
Also ask:
• How long the warranty lasts, preferably one or two years and specifically what is and isn't covered. It should cover bothparts and labor.
• What the return policy is
• How much money will be refunded if you return the hearing aid.


During the trial period, keep a detailed list of what you like and dislike about your hearing aid. Take that list with you when you return to the audiologist or other dispenser.about the most useful situation for each program. Ask how long the battery should last and how to change it.
Also find out how to maintain your hearing aid. Moisture or wax buildup can cause problems requiring maintenance. Feedback can be caused by loose fittings, cracked tubes and similar problems that your audiologist or dispenser can fix.

Finally, ask how long you can expect your hearing aid to last. Many models last five years or more.

Give it time
Getting used to a hearing aid takes time. The sounds that you hear are different because they're amplified. And it takes time for your central nervous system to learn and accept the different sounds that you're hearing.
To begin, test your hearing aid in an ideal situation — for example, listening to a radio or watching TV in a quiet room. Next, try your hearing aid in noisier surroundings. In situations where background noise is loud, you may prefer to turn your hearing aid off.
Finally, follow up with your audiologist to check your progress with your use of the hearing aid and to discuss any problems.

Tip 7 - Learn about other options

When hearing aids don't provide successful treatment for hearing loss, you may still have other options. These include implants that require surgery.
Cochlear implants
A cochlear implant is a small, complex electronic device that can help people who get little benefit from conventional aids or who are deaf or profoundly hard of hearing. The implant includes:
• An external microphone that picks up sounds
• An external speech processor that converts sounds intocoded signals (electrical impulses)
• An external transmitter, held in place by a magnet behind the ear, that relays the coded signals to the receiver
• An internal receiver, implanted beneath the scalp, that relays signals to electrodes inside the cochlea
• Internal electrodes that send sound information to the auditory nerve and on to the brain for interpretation
Cochlear implants and hearing aids are different. Hearing aids amplify sound. Cochlear implants bypass parts of the inner ear that don't work.
Although a cochlear implant doesn't restore normal hearing, it can dramatically improve the ability to hear and understand speech. And the technology is rapidly improving. Most adults with implants can talk on the phone, and after a few months of hearing with the device, many of them describe other people's voices as sounding natural. Most children who are born deaf or become deaf in early childhood and then get cochlear implants can expect to enter regular schools rather than schools for the deaf.
There are many cochlear implant centers with experienced audiologists and surgeons 
who can help you decide if this technology is right for you. If you're an 
appropriate candidate for this procedure, ask your doctor for written information 
about the benefits and risks, and find out if your insurance will pay for it.
Implants for the middle ear
Newer experimental devices that are implanted in the middle ear might provide better  sound quality than conventional hearing aids do. These implants are designed for people with mild to severe sensorineural hearing loss (defined on page 3). Standard hearing aids convert sound into electrical signals and amplify it, but implantable devices work on the principles of mechanical vibration. They conduct  sound by directly vibrating the middle ear bones to stimulate the inner ear.
Most middle ear implants are still in early trials, but they're expected to provide clearer sound than hearing aids do, less feedback, and less feeling of restriction in the ear canal. Discuss your individual situation and risk factors with your doctor.
Hybrid implants
Some people benefit from a combination hearing aid and cochlear implant arrangement called a hybrid device. A cochlear implant with a short electrode helps improve high-frequency hearing, while an in-the-ear hearing aid worn in the same ear assists with low-tone hearing loss.
Auditory brainstem implants
Rarely, auditory brainstem implants (ABIs) are used in individuals who lack a  functioning cochlear nerve. With this device, an electrode is implanted directly on the brainstem, where the auditory nerve would normally enter. An external processor  similar to that of a cochlear implant is used to stimulate the electrode.

Tip 8 - Use simple strategies for better hearing

Medical treatment is just part of better hearing. If you have hearing loss and find yourself in difficult listening situations, additional strategies can help.
Talk face to face
Speak to people on a one-to-one basis or in small groups rather than large groups. Eye contact is critical. Whether you realize it or not, we all read lips when talking to people. So, sit where you can see the speaker and stay close to that person. Distance and physical barriers reduce the amount of sound that reaches the ear.
Control background noise
Find locations with the least background noise. For example, steer clear of noisy restaurants, or go during off-peak times to avoid a crowd. You can also ask for a booth or table in a quiet corner with good lighting.
Apply the same tactics in other locations. In meeting rooms and lecture halls, sit in the front row. At home, turn down the TV or stereo — or shut it off entirely — during conversation.
Ask others to help
One of the best things you can do for better hearing is let other people know how to help you. For example:
•Tell people upfront that you have trouble hearing. This gives them the opportunity to focus on clear communication.
•Ask people to speak clearly, but tell them it's not necessary to shout.
• Let people know if you don't understand what they're saying. Ask them to repeat or reword their statements. Most people will be glad to help in these ways. All it usually takes is a simple request from you.

Tip 9 - Use services and assistive devices

Ask your audiologist about hearing services and devices other than hearing aids. For example, TV programs often offer closed captioning. 
Speech recognition software turns spoken messages into documents you can read on your computer. Text telephones work on the same principle and 
allow you to type in replies to the caller. Real-time captioning and note-taking services also might be available in your community. Assistive listening devices (ALDs) offer another whole range of options. These can be used to overcome background noise and poor room 
•Personal FM systems operate on a special radio frequency assigned by the Federal Communications Commission.They include a microphone and 
 transmitter that's used by the person who is speaking and a receiver that delivers the sound directly to your hearing aid or headset.
•Infrared systems can be used with TV sets. They work much like personal FM systems, using invisible infrared light waves rather than radio 
•One-to-one communicators include a microphone for use by the speaker, and a receiver that amplifies sound and delivers it by a cable or cord 
  directly to your ear via an "ear bud" or headset. Alerting devices use lights or vibrating systems to alert you to sounds such as a ring at 
  the doorbell, a knock on the door, or an alarm from a clock or a smoke detector.

Tip 10 - Reliable information

You can find hundreds of publications, products, services and Web sites devoted to hearing loss and other health issues. But be careful. What 

you'll find ranges from solid research to outright quacker

Surf cyberspace safely

Carefully evaluate any information you find on the Internet. Begin with Web sites that are created by national organizations, universities, 

government agencies, or major medical centers.

Remember these guidelines:

• Look for current information. Search for the most recent information you can find. Reputable Web sites include a date for each article they post.

• Look for documentation. Check for the source of information. Notice whether articles refer to published medical research. Look for a board of 

qualified profes sionals who review content before it's published. Be wary of commercial sites or personal testimonials that push a single point of view or sell miracle cures.

•Double-check the information. Visit several health sites and compare the information they offer. Before you follow any medical advice, ask 

your doctor for guidance.

Check out hearing aid dispensers

Dispensers are audiologists (health care professionals) or other vendors, including companies on the Web, who sell hearing aids. Your local Better Business Bureau, consumer protection agency or state attorney general can be helpful if you're checking out companies that sell hearing aids. These resources may have records of complaints against the