Hearing loss is the most common health condition in older adults,” says Brendan Lennon of the support charity DeafHear.

“By the age of 50, 20% of adults have a significant hearing loss and by the age of 65 it affects one third. That’s a quarter of a million Irish people who need hearing aids in order to be able to converse easily, but only one third of those actually have a hearing aid.”

The explanation lies in the fact that hearing loss occurs gradually, he says.

“For most people, it happens over several years and it’s mainly that they lose hearing at a higher frequency threshold. While the volume is the same, the clarity goes.”

Trouble hearing women’s and children’s voices or having difficulty understanding speech where there is background noise are some of the signs.

“Typically, they will have the TV up louder than others and will have to concentrate seriously to hear in a restaurant, for example. They will also put a lot of effort into listening, which can be very tiring.”

Emotions can be involved too, with those with hearing loss often embarrassed that they can’t hear properly.

“They may blame family members initially for not speaking up but over time they lose confidence, which can lead to social withdrawal and isolation.”

The earlier, therefore, that someone does something about it, the better, he believes.

“The longer we delay, the more difficult it is for us to get used to the hearing aid. Our brains will have got used to a lack of sound (usually at higher frequencies), like birds singing or a door creaking, then when we get hearing aids we will feel uncomfortable hearing those sounds again because our brains may not have been registering those sounds for years.”

Average wait it 10 years before testing

Research shows that the average wait before a person goes for a hearing aid is 10 years.

“Accepting you have hearing loss is a turning point. People typically say: ‘I didn’t do something about it until I had to.’”

Hearing aids are now mini computers and there is great variety and choice available, he adds, compared to the past.

“Lots of people are now wearing them and you wouldn’t know it. If you’re self-conscious, there are in-the-canal aids available as well as behind-the-ear ones – and they are all very discreet.”

How do you choose which hearing aid to buy?

Brendan Lennon believes that it is difficult to get transparency around what exactly you are getting for your money in what is still an unregulated industry.

“We are campaigning to have standards introduced to avoid people being overcharged.”

DeafHear centres also sell hearing aids now.

“We’re a social, not-for-profit enterprise and one of the reasons we got involved in selling hearing aids a few years ago was because we had many complaints from people about being pressurised or ripped off. We wanted to give people choice and a complete service.”

Advice when buying

So what’s the advice from DeafHear.ie when buying a hearing aid?

Further information

See www.deafhear.ie or www.ishaa.ie

ISHAA is the association of private audiologists.

Note, if you pay PRSI or are a dependent of a PRSI payer, you may be entitled to a Treatment Benefit Scheme grant up to a maximum of €500 per aid (or €1,000 for two) every four years. Suppliers must have a contract with the Department of Social Protection. Also, there is tax relief available when you buy hearing aids. See www.revenue.ie and the Form MED 1. Prices generally range from around €1,500 for basic/medium-range aids to €6,000 for top-of-the-range models (all including aftercare). In-the-canal aids can cost more.

Audiologist Leona Kane of Audi-Lab, an independent hearing practice in Dublin, is a member of both the Irish Society of Hearing Aid Audiologist (ISHAA) and the British Academy of Audiologists.

ISHAA represents audiologists in the private sector.

She explains what happens at a full hearing test.

“I recommend a full hearing test – an audiometric assessment – rather than a hearing screening test,” she says.

Checking for wax, debris or any abnormalities is first, then a middle ear function test is carried out to establish if there are any middle ear issues, such as fluid. After that, the focus is on the inner ear.

“There you’ve got what’s called the cochlea which looks a little bit like a snail and if you unravel it there are tiny little clusters of hair cells along the length of the cochlea.

“These hair cells are responsible for the different frequencies (we hear) so in a hearing test we are effectively testing those clusters of hair cells along the length of the cochlea.

“For somebody with a high-frequency sound loss (one cause of which can be exposure to loud noise), you will find that they will hear low-frequency sounds like M, U and B but that they are missing more of the high-frequency ones like F, SH and TH.

“Next, we look at the person’s speech scores. This involves them listening, through headphones, to a word list. The person has to repeat each word they hear.

“We score their response between 0-3 depending on if the person got the word completely wrong or repeated part of or the full word.”

“The test is then repeated, this time through speakers, for a more real-world situation. We then have what we call the person’s unaided speech score. If we fit somebody with a hearing aid we repeat this test with hearing aids to see what improvement they have – are they now repeating a much higher percentage of the words correctly, for example?”

A speech and noise test then follows.

“We use sentences this time, not random words, because we want the ear and the brain working together. The background noise will get progressively louder with each sentence. This test gives us the person’s signal to noise ratio score (SNR).

“This score is important as it indicates how well a patient can expect to hear in noisy environments. Using all of the information from the assessment, the patient can be told what they can expect to achieve from their hearing aid based on their results,” she says.

Lifestyle is important

Lifestyle enquiries come next.

“I’d ask the person to list five areas where they’d like their hearing improved. The first one is usually general strain – not having to put effort into listening to every single conversation.

“Then it could be the TV, the telephone or hearing their grandchildren.”

How busy people are outside the home will be very important in choosing a hearing aid.

“People who don’t have active lifestyles don’t need to buy a hearing aid with sophisticated technology as they won’t be using all the features.

“If a person goes out a lot – to meetings, restaurants, places with different ambient noise – then they will benefit from premium technology features (aids that will adjust automatically when they walk into a pub, for example) to optimise hearing in those challenging environments.”

Staged process - getting used to it

Leona Kane says she doesn’t generally fit someone to a full prescription at the first fitting.

“That’s because they would be going from auditory deprivation to auditory overload. A staged approach, usually over six weeks, is needed to bring them slowly back to what their prescription entails and to let them get used to hearing more again.”

Won't work unless your're ready

She also points out that unless a person is ready to get a hearing aid, it may be a waste of time.

“If I fit a patient because their family or friends are pressurising them, it’s not going to work. The person has to be ready to engage with the process. If they haven’t recognised and accepted their hearing difficulty, there is a possibility that they will not wear them and they will be left in a drawer.

“They are also likely to discourage other people from addressing their own hearing problems.”

Extra advice

It is important to feel very comfortable with your audiologist because you are going to be seeing them on a regular basis, says audiologist Leona Kane: “Remember, a hearing aid is not ‘just a piece of plastic’. It’s how it’s programmed to suit you that’s important. No two people’s scores or measurements are the same. Audiologists measure the individual acoustic properties of the ear canal and then verify the gain and tailor the setting to the person’s prescription.”

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