Now hear this! The ins and outs of buying a hearing aid

Philip Goldstein has a conundrum.

He knows he can't hear as well as he used to, but, like many who are first struggling with hearing loss, he said he doesn't know what to do about it.

His search for a solution stalled after he went to a hearing aid retailer who recommended aids that would cost $1,500 an ear. Goldstein, 76, a retired New York City social studies teacher from Port Jefferson Station, said he balked -- particularly since he's seen ads on late-night television promoting much cheaper alternatives.

"I wondered, being somewhat skeptical, if I send away for it, is it going to be a piece of junk?" he said.

Goldstein's dilemma is common. Consumer Reports magazine last year found that despite the high cost of hearing aids -- $1,800 to $6,800 a pair -- many users were unfamiliar with their aids' features, and almost two-thirds of the aids the magazine reviewed were improperly fit and did not work properly.

This comes at a time when hearing aid technology has made tremendous advances in helping users hear the sounds they want to hear while filtering out noise. While it's possible to take steps to keep the cost down, experts warn that cheap alternatives to properly fit hearing aids do little to help hearing loss.

The first thing to do is the simplest -- get a hearing test from a trained audiologist, said Elizabeth Marcinkus, supervisor of the audiology clinic at Hofstra University's Joan and Arnold Saltzman Community Services Center.

Such tests are available at clinics like the one run by Hofstra, or at ear, nose and throat doctors, Marcinkus said. (Most hearing-related tests and hearing aids are not covered by health insurance.)

She warned that hearing tests given by hearing aid retailers may not be performed by people with graduate training in audiology, and they may not be able to identify medical issues associated with hearing loss, some of which can be cured without hearing aids.

 Importance of a good exam
A good exam also will be thorough, Consumer Reports said. It will include asking you what types of situations give you difficulty hearing, and will test your hearing in settings that simulate background noise or a telephone, for example.

Consumer Reports said veterans should get examined at a Veterans Affairs medical office. Those who responded to the magazine's survey gave the VA high marks.

The magazine, which surveyed hundreds of hearing aid users and tracked dozens of others as they were diagnosed and fitted with aids, also noted that audiologists generally did a better job of making sure hearing aids fit properly.

Once it's determined that hearing aids are necessary, experts say the next step is to get all the features you need - but not more. Consumer Reports said its research indicated the most useful features were the telecoil, which reduces some types of feedback, and the directional microphone.

Consumers also should shop smartly, Consumer Reports said. As with any expensive product, consumers can comparison shop and make efforts to negotiate a lower price.

In addition, ask about the relative advantages of different types of hearing aids, decline costly promotional extras and make sure you understand what the warranty does and does not cover.

 Aids need to be fitted
Because every ear is shaped and hears differently (including a person's left and right ears), each hearing aid must be fitted properly and tuned.

That's part of what makes getting a hearing aid difficult for some, in addition to the cost. Marcinkus noted that although not all hearing aids are custom-made, most of them are, which adds to the expense.

More important, she said, is that almost all hearing aids are digital and must be programmed with a computer for each patient. An audiologist can turn certain sounds up or down, like adjusting the equalization on a high-end stereo system.

 Retraining your brain
Then, once a person starts using hearing aids, it takes some time to get used to them.

"You have to retrain your brain to hear sounds you haven't been hearing for a while," Marcinkus said. For many people, it can be jarring to hear birds clearly again, for example, or to hear a multitude of voices in the roar of conversation in a crowd.

People may still struggle with background noise at first, Marcinkus said. For many, it's one of the more trying annoyances associated with hearing aids.

"After you're fitted with hearing aids, it's not over," she said. Any provider should offer a trial period of 30 to 45 days, to make sure the aids are the right ones and that they are programmed properly.

Users need to do their part during that period by using them in all situations, Marcinkus said, to see if there are any times when they're not functioning as well as they should be.

And users will need to stay in touch with their audiologists, she said. Hearing changes over time.

"It really is a long-term relationship with your audiologist," Marcinkus said. "That's why it's important to find someone you connect with and trust."

Goldstein hasn't done that yet, and that may explain why he feels frustrated.

"I'm in the dark about what to do," he said.