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Cindy Brody, my sister-in-law, was only 40 when she realized that something bad was happening to her ability to hear. Telephone conversations were a challenge and there were lots of misunderstandings even during one-on-one conversations, including those with her husband at the dinner table.

But the day of reckoning came when she heard a riding instructor say "to hell with her" about a disabled woman who wanted to ride a horse, when in fact the man had said "I'm helping her."

So she went to an audiologist to have her hearing checked. Sure enough, she had suffered a significant hearing loss in her left ear and some loss in the right ear as well. The audiologist said she could be helped by a hearing aid, and after several adjustments she is now using the aid successfully.

Cindy is one of 28 million Americans who are hard of hearing, which makes hearing loss one of the most prevalent chronic health conditions in the United States, a condition that is becoming increasingly common as the population ages.

But while hearing loss occurs most often in older people, with about a third of people over 65 and half of those over 75 affected, 17 children in 1,000 as well as many middle- aged adults like Cindy also have significant hearing loss. In fact, 65 percent of hearing- impaired people are under 65.

Suffering in Silence

But unlike Cindy, some 20 million of those with serious hearing deficits are, in effect, suffering in silence. Either they refuse to acknowledge their hearing difficulties or they are aware of the problem but are doing nothing about it. Many had once tried a hearing aid, but when the initial results were not satisfactory, they quickly gave up and left the aid to languish in a drawer. Others, fearing a stigma, never even tried.

"Hearing loss is isolating," Cindy recalled. "If you can't hear, you shut down, decrease your social activities and atrophy. I found that I easily lost interest in conversations. If you're watching television and blasting it, it clears the room. If you have the radio on in the car, you can't hear sirens. Hearing loss had an enormous negative effect on my day-to-day life."

In addition to difficulty hearing conversations, especially when there is background noise, people with hearing loss may experience fatigue and irritation caused by straining to hear. Some may have tinnitus — hissing, roaring or ringing in the ears — or dizziness and balance problems.

It is not just insufficient volume that makes hearing difficult for people with hearing loss. As Cindy's story shows, it is also an inability to discriminate one sound from another because of a diminished ability to register high frequency sounds, or, in Cindy's case, low-frequency sounds.

Since different letters and diphthongs are said at similar frequencies, one may be confused with another, with the result that people often say they can hear but they cannot understand what is being said. Words like "hell" and "help" or "mass" and "map" sound alike.

Types and Causes

There are two main types of hearing loss. Conductive loss, resulting from a problem in the middle or outer ear, can be caused by a buildup of earwax, an infection or fluid in the middle ear or a punctured eardrum. Such losses are often treatable by drugs or surgery. Cindy's hearing loss, for example, was caused by calcification of a bone in the middle ear and could be treated surgically, which she plans to pursue eventually.

More common is sensorineural hearing loss, which develops when the auditory nerve or the hair cells that line the cochlea in the inner ear are damaged by aging, noise, illness, injury, trauma, toxic medications or an inherited condition. Hearing specialists are already seeing the fallout among baby boomers and their descendants who listened for hours at a time to loud music piped directly into their ears or blaring from amplifiers.

How Hearing Aids Can Help

Sensorineural hearing loss is the type most amenable to correction by hearing aids. Hearing aids do not cure hearing loss any more than eye glasses or contact lenses cure vision problems. Neither do hearing aids restore normal hearing. But when properly fitted to meet the hearing needs and dexterity of the person, hearing aids can reopen the door to a much fuller and rewarding life.

A hearing aid consists of three main elements: a tiny microphone that picks up sound, an amplifier that makes the sound louder and a speaker that transmits the sound into the ear.

The differences between one aid and another involve where the aid is placed, how big it is, how it processes sound and how much it costs. Prices vary as much as threefold and neither private insurance nor Medicare pays for hearing aids.

The latest wrinkle in hearing aids are digital models — in effect, miniature computers — that may cost as much as $3,700. Digital aids can be programmed through a modem to meet individual needs, and they adjust automatically to changing levels of environmental sound.

They may also cause less sound distortion than traditional analog devices and greatly reduce feedback.

But you do not necessarily need a top-of- the-line hearing aid to gain satisfactory improvement. For many people, a $1,000 aid or even one costing $500 works just fine.

The trick in buying and successfully using a hearing aid is to start with a full medical evaluation (you may have a correctable problem, after all), preferably by an otolaryngologist, and then be tested by a reputable audiologist.

Cindy had a bad first experience with an audiologist who told her, incorrectly, that surgery was rarely effective and could make her completely deaf; in fact, it is 90 percent successful in restoring normal hearing for people with her condition. She found another audiologist.

Making It Work

There are three other important criteria: the hearing aid vendor should provide a warranty and a trial period of 30 to 60 days, after which the aid is fully returnable for no more than a small rental fee; your willingness to return as often as necessary for needed adjustments; and your patience and determination to weather the break-in period.

Sometimes you may have to go to a second vendor to have the aid reconfigured. But, in the end, as long as the auditory system has not been completely destroyed, nearly everyone with sensorineural hearing loss can be helped to obtain an aid that fits comfortably and meets that person's hearing needs.

Do not expect miracles. You may have to get used to hearing background noises like the furnace or radiator that you could not hear before getting an aid. Also, loud high- frequency sounds may be more disturbing. Then, Cindy said, there are the insensitive things people might say like "What's that in your ear?" and "How are you going to wear your hair to hide the hearing aid?" as well as people who come too close or talk too loudly and slowly when they notice you have a hearing aid.

Before pursuing the purchase of a hearing aid, you might check several Web sites for further guidance: Hearing Loss: How to get Help; National Institute on Deafness: Hearing Aids.