More options for people with hearing loss

Do you miss out on conversations because you’re hard of hearing? Or maybe a friend or a family member is asking you to repeat what you say a lot more often. 

Hearing loss affects millions of people, especially as we age. And, the vast majority of people who are hard of hearing don’t seek help or ever try a hearing aid. 

Last month, the Food and Drug Administration decided to allow hearing aids to be sold over the counter without an exam or prescription. 

MPR News host Angela Davis talked with an audiologist and a researcher about how the ruling could make hearing aids less expensive and more accessible. Plus, changes in hearing aid technology and how to make the most of them. 

Guests: 

• Peggy Nelson is a professor in the Department of Speech-Language-Hearing Sciences at the University of Minnesota. She teaches audiology courses and has researched how to make hearing aids more effective in daily settings. 

• Rachel Allgor is an audiologist with Audiology Concepts, a clinic in Edina. She also uses a hearing aid. 

The following transcript has been edited for length and clarity. Click the audio player above to listen to their conversation.

Angela Davis: Good morning. I'm Angela Davis. And you're listening to MPR news. So glad you could join us today. Now, do you ever miss out on conversations because you're hard of hearing. Or maybe you've noticed that a friend or family member is asking you to repeat what you say a lot more often. Hearing loss affects millions of people, especially as we all age and most people who are hard of hearing don't seek help or ever even try a hearing aid. Now last month, the Food and Drug Administration decided to allow hearing aids to be sold over the counter without an exam or prescription. So today I'm gonna talk about all of this I'm talking with an audiologist and a researcher about how this might make hearing aids less expensive and a lot more accessible. We'll also talk about changes in hearing aid technology and how to make the most of them. And we're taking your phone calls, I want to know your stories. Do you know someone? Is there someone close to you who has hearing loss? How does that impact your life? Do you have hearing loss and how difficult or easy has it been for you to get a hearing aid? I have two guests today. Peggy Nelson is joining us. Peggy is a professor of audiology in the Department of Speech Language Hearing Sciences at the University of Minnesota. She teaches audiology courses and has researched how people can make hearing aids more effective in daily settings. Hello there, Peggy.

Peggy Nelson: Good morning.

Angela Davis: And here in the studio with me I have Rachel Allgor. Rachel is an audiologist with Audiology Concepts, which is a clinic in Edina. She has a four year clinical doctorate in audiology. And she also uses a hearing aid. Rachel, so glad you could come in and join us today.

Rachel Allgor: Yes, thank you.

Angela Davis: So Peggy, I'll start with you. Let's hear more about this decision from the FDA. Where did this push for over the counter hearing aids even come from?

Peggy Nelson: Yeah, great question. We have been talking about trying to improve the accessibility of hearing devices for people for a decade at least and probably longer than that. And it came with a congressional push from Congress, people who said we really need this for our constituents. There are too many people who are living with hearing loss, who have no hearing aids and we'd like to make that more accessible to them. So for the past several years, we've been working on methods, technology platforms, things that might show promise for direct to consumer hearing aids.

Angela Davis: So I have this number from the FDA, nearly 30 million Americans suffer from hearing loss, but only about 20 percent of these people use hearing aids. So what's getting in the way? What's stopping people from choosing to get help?

Peggy Nelson: Yeah, isn't that remarkable? I would say there are several things and that we don't know all of the things that are stopping people. Certainly cost is an issue. Absolutely, people cite that probably most frequently. But we also know that people in countries where they're socialized medicine, where there's really no cost to them, there's still only 30 or 40 percent of the people who are getting them and using them. So there are clearly more barriers than just cost. It might be stigma, it might be just the frustration of trying to get to services that are far from where they live, might be some trepidation about the technology, not being willing to try something brand new and being a little fearful of that. And perhaps people themselves don't always realize how much they need it. It's often their friends and their families that are realizing that and they're the ones that are encouraging people to seek help.

Angela Davis: And I want to talk more about that. Like how do you have that conversation with someone who you think maybe you should go get their hearing checked, but getting back to the stigma. I think when we think of hearing loss and maybe hearing aids, we think of the an older man with this large thing, you know hanging out of his ear. But hearing aids have really changed.

Peggy Nelson: Definitely, we need to change that image and we hope that that's happening. I'm in my 60s, more of us in our 60s have been using earbuds and hearing devices of various kinds for quite a while now. So we're really hoping that that stigma that hearing loss equals aging will change quickly, and that people will be willing to give these new devices a try.

Angela Davis: Now, Rachel, you are an audiologist who works in a clinic. So how do you think the availability of over-the-counter hearing aids will affect you and your colleagues and people who may be curious and really need them?

Rachel Allgor: Yeah, that's great question. So there's a lot of back and forth right now in the audiology community about how this is going to impact just the profession itself. And honestly, I view it as a good thing. There is an average of seven years before somebody comes into a clinic after realizing that they're having hearing difficulty. What I would hope that this direct-to-consumer OTC bill is doing is lessening that timeframe. And so instead of seven, maybe we can shift it down to three even, so that people can start getting help sooner, in an easier way.

Angela Davis: Rachel, you use a hearing aid and tell me how that came about. Because this started as a child for you.

Rachel Allgor: It did. So I had a benign tumor in my middle ear when I was born. And it was removed when I was a toddler. I started wearing a hearing aid in second grade. And I was the hearing aid user that wore it much more off than on.

Angela Davis: And why was it off?

Rachel Allgor: I didn't want to be different, right? Especially as a kid going through things. I didn't want to feel different, I didn't want to look different. And so it wasn't until I was halfway through my audiology degree that I finally started wearing one full time.

Angela Davis: You have hearing loss in one ear, but not the other. Is that typical or common?

Rachel Allgor: Not as common as somebody who has hearing loss in both ears.

Angela Davis: What do you think it's going to do? Because, you know, sometimes I think you hear over the counter you somehow think the quality is not gonna be as good.

Rachel Allgor: That is yet to be determined because it is so new. I haven't had a chance to play around with it myself, either. But from what I've read online, from folks who do have hearing loss and have worn hearing aids for a while, and have tried them out, they're pretty favorable.

Angela Davis: And Peggy, with over the counter hearing aids, people will need to adjust the hearing aids themselves, you've done some research into that, do you think people are gonna be able to do this on their own?

Peggy Nelson: That's right, it's going to be determined. Just as Rachel just said, there are some things we're going to find out over the months to come. Our research that we've done in the lab, we've had, you know, at least 100 people come and try things that suggest people can do it. And they are successful, they can tweak and they can follow the instructions, and they can find settings that they like, and then they use those and they go back to the same settings and they're happy with those, they're pleased with them. But we recognize these are volunteers who are willing to come in for a study and try them. So it's not representative of the people who will buy them from a big box store or online, and may struggle with opening the box and trying to adjust to them. I think that's a big area where we as professionals in the field can try to help people do this. Hearing aids take some adjustment, you don't just put them on and instantaneously things are really different. It does take some time, it takes some effort, it takes some tweaking. And we want to encourage people to really try them, keep trying them, keep tweaking them until they find something they're satisfied with.

Angela Davis: And what about the proper fit because ears are all shaped differently in different sizes, what are the options with that?

Peggy Nelson: Again, we'll see but probably they will have tips that go down into the ear with a tube that goes up to behind the air. And those tips will probably come in small and medium and large sizes so that they could be exchanged. And actually quite a few users right now are using those kinds of tips. But I think that will be one barrier, will they fit well, will they feel okay. You can imagine trying to wear something all day that just doesn't feel good.

Angela Davis: And one more question before we take some phone calls which were already starting to get in. Are they even in stores yet? Because I think they're supposed to come out in mid-October are they out yet?

Peggy Nelson: The White House announcement yesterday said next month, so we'll find out in October exactly when they'll be available.

Angela Davis: Let’s go to Brooklyn Park, where one of our listeners Marika is on the line. Good morning. Marika, what did you want to tell us about hearing aids?

Marika: Good morning, Angela and guests. This conversation is so timely. It really resonates with me because I've been struggling with my mother for the last five years to get hearing aids. And it came to a head this summer finally, because I've been telling her and talking about it with our family. But it took her grandchildren standing right next to her, asking to talk with her, to realize that she really had that significant hearing loss. So she went in and she got some hearing aids. She did a trial period and literally came out of that saying it was like the world woke up. She's like, I could literally hear a skateboarder going down the street next to me, and I didn't know how much I was missing. So we're really excited about the steps she's taking. And then she got the pair. And it's the technology that is challenging her it's the app and the phone and learning how to navigate that, she's in her early 80s very independent. And so like we are still navigating that question about should we go into the store? Because I know she's going to need more support. Or do we invest in the higher product and also the connection with the audiologist because of that hesitancy and the adjusting needs. So it's been a journey, and I'm really just curious, how will people get supported if they do the over the counter method?

Angela Davis: And you mentioned the app and the phone. Okay. Marika, great phone call. Lots of things to talk about with that. But Rachel, I'll start with you as an as an audiologist, as someone who wears a hearing aid, what do you hear in her story, Marika finally got her mom to get her hearing tested?

Rachel Allgor: First, very exciting that we were able to do the hearing test, able to do the trial. And so you can actually hear what you've been missing. Because you don't know what you don't know. And that's the biggest thing when people come into the clinic is oh, I didn't realize I was missing so much. And so that story is familiar to me.

Angela Davis: And describe to me what is it like? How would you describe it to someone to be hard of hearing? What is it like to experience the world that may be different than other people?

Rachel Allgor: Yeah, it is so person dependent for that. It's not quite like glasses, where things just seem a little fuzzy. It could be that your hearing is fuzzy, but it also could be a distortion that's occurring too. And so a common hearing loss is going to be a high frequency one. When you have a high frequency loss, it's the clarity that we're missing. So then it feels like people are mumbling, all day, every day.

Angela Davis: And then also, sometimes sounds that you don't want to hear are really loud and distracting. I've heard that folks will get hearing aids, but then they're hearing everything.

Rachel Allgor: Yes, because the brain is suddenly getting reintroduced to sound. And so it has to learn how to filter things out again, which is hard, particularly if it's been years since you've heard it all.

Angela Davis: Marika described her mother talking to her grandchildren. And then that's finally what got her to go in to get tested. Is that a story you often hear with as an audiologist helping people through these tasks and getting fitted that while I was because I realized I was missing out on a lot.

Rachel Allgor: Yes, that's a very common thing for me to hear. Either they're with their friends or they’re with their family. And they realize they're just smiling and nodding through the conversation because they don't catch everything or they're scared or embarrassed to say something wrong.

Angela Davis: And Marika, a final question she had was about the technology. She's got her 80-something-year-old mom on the phone using an app. What support is available to help people actually be able to be independent as they have, you know, higher quality hearing aids?

Rachel Allgor: Apps have been so helpful to hearing aids for most users, because it gives you a visual of what's going on. So you can see the volume, instead of just pushing a button on the hearing aid. It gives the control back to the patient. And so they can see what's happening, they can know exactly what's happening. Or it can be in the hands of the caregiver so that they can see what's going on too.

Angela Davis: Peggy, as you heard Marika’s excellent phone call covered a lot of issues. What stands out to you about the story she shared about her mother getting a hearing aid and having the world opened up to her again?

Peggy Nelson: Yeah, I was cheering. And I completely agree with Rachel and on what she said yes, it's finally realizing what you're missing. It happens so slowly and so gradually, especially as we age. A friend who recently got hearing aids described getting them as not really hearing better, he said, but hearing fully. He had, you know, better quality of hearing and realizing things that he was missing. I recognize the app can be a challenge. But I recommend that Marika go back to the audiologist and work to simplify things. And perhaps they can use the app just for one or two things and get things set pretty standard on the hearing aid so she doesn't have to use it all the time. Some people on the other hand will want to change things all the time, they'll want to be playing with the app and adjusting this and that. But I think somewhat, it pretty much stays the same, just one or two times when they turn it up or down. And I think that the audiologist can help her simplify that.

Angela Davis: But before we get to more of our listeners, let's talk about money. Peggy, how much does a hearing aid cost? If you're going through, you know, if you're not buying it over the counter. Does insurance cover it? Like what what are we talking about in terms of money here?

Peggy Nelson: Yeah, hearing aids, a pair of hearing aids will cost thousands. There's a wide range that might be perhaps $2,000 for a pair or perhaps up to $8,000 for a pair, perhaps Rachel's got other information about that. We're hoping that over the counter devices will be priced at under $1,000 a pair. What we've seen in startups and glimpses have been at $800 for a pair or something like that. I imagine, again, there will be a wide range.

Angela Davis: And one more question. How about hearing loss in isolation. Does hearing loss make people more isolated? And I know that this is something you looked at in the pandemic.

Peggy Nelson: Hearing loss gradually causes more and more isolation, and especially among older people. And so that cuts them off from their family and friends and activities. And it cuts them off from things that would otherwise keep them healthy, they actually become more lonely, more sedentary more, you know, all the things that are bad for us about getting older, the hearing loss can exacerbate that. So we want hearing devices to help people stay active, involved, engaged playing bridge, whatever they love to do. We want the hearing devices to be used in that way, and that keeps us all healthier. And you asked about the pandemic and we did study the isolation of people in the pandemic with hearing loss. And I would say there were two polar different outcomes. Number one, everyone wearing masks is just terrible for a person with hearing loss. It's really frustrating to go out in public. They cannot read lips and it’s muffled even more. It's still a problem because we're still masking in quite a few places. But that was just a horrendous response from people with hearing loss of how difficult that was. On the positive side, many people with hearing loss learn to use remote communications, telemedicine, tele-friendship tele-families that had clear signals and even live captioning. And so there are some people with hearing loss who are loathing to go back to in person appointments for things because they were so successful doing that with technology that provided a really nice audio signal and live captioning.

Angela Davis: In Stillwater, Nancy is on the phone. Hi, Nancy, thank you for waiting. What did you want to share with us?

Nancy: Hi, thanks for having me. I just wanted to comment on that statistic that you mentioned a minute ago about on average people waiting up to seven years, which is kind of an astounding one. And I think I might have been in that category. When in my mid- to late-50s, I realized I had hearing loss. But I think I thought well, I'm at the young end of this or I don't want to wear hearing aids. But what convinced me was my brother-in-law's ear, nose and throat surgeon and he mentioned the point that I think you amplified earlier on your show, the longer you wait, the less effective the hearing aids are going to be that they'll still collect the same information. But by then, when you wait, your brain has already remapped its way around the noise trying to figure it out. And they become less effective over time. And, you know, that really nudged me to get in. And then I, you know, only to learn when I got in that my hearing loss was exactly in the range of my daughter's voice. And she also sings, does vocal performance. And I thought, wow, if I missed that band of time and and missed that going on in the future, I would have missed out on a lot.

Angela Davis: Thank you, Nancy, for calling in and sharing that. Rachel, what can you tell us about the longer you wait and how your brain kind of adjust to not being able to hear very well?

Rachel Allgor: And so with that, as your brain learns to hear without the full spectrum, it's missing those components. And so those pathways within your brain actually get reprioritized to something else where it is more use, because it's not getting that information anymore. So when you start wearing hearing aids, we're not only having to get used to sound again, but it's actually the brain trying to bring that pathway back to what its original purpose was.

Angela Davis: So as an audiologist, walk me through this process. How do you start a hearing test? What happens?

Rachel Allgor: First thing we do is a case history. So I'm asking a bunch of questions about you and your life and your lifestyle, trying to figure out right off the bat, okay, what is going on for you? How is this possibly impacting you? Next thing we do is a full blown hearing test. And so I want to see how you're hearing at different pitches. I want to see how you're doing with understanding words, I want to see how you're doing in background noise. Because that's telling me all the information I need to know to make a good recommendation for you.

Angela Davis: So what does that look like you put headphones on me or you put me in a room and you play sounds?

Rachel Allgor: Typically, you're in some kind of sound-treated room. So it feels soundproof and then headphones go on, you're given a button, or you can just raise your hand. So whenever you hear those beeps, kind of like when you were a kid in elementary school, you'd have a hearing test, very similar premise there for that part of the testing.

Angela Davis: And then and then what happens?

Rachel Allgor: And then we switch to doing word tests. Because we know that beeps aren't our everyday life. We want to know how you're hearing with words, especially words that you don't know what's coming. Because that gives us a really good snapshot of how you do in just understanding when you're not expecting.

Angela Davis: When we talk about aging, what do we know about that?

Rachel Allgor: I don't know if Peggy knows a little bit more about this, but we've seen the average age start to drop, especially in kids using earbuds where we're damaging hearing a lot earlier than what we used to see.

Angela Davis: Peggy, a researcher, what do we know about aging and hearing loss?

Peggy Nelson: It tends to start mostly in our 60s. And then there's a greater proportion in our 70s and 80s. By the time we're in our 80s, probably half of us have hearing loss. But you realize that means half don't have very much hearing loss, too. So we've got some, some pretty healthy older people as well. You can inherit from your parents and grandparents, your susceptibility to noise and other things like that, too. So we should look carefully at our parents and grandparents. Interestingly, we have fewer people that are working in exceptionally noisy environments, like mines, or old time printing presses. But we still have millions of workers in the United States who are working in noisy environments. And so we try to help protect their hearing as well, because they could stay in those careers for 30 or 40 years and that could be very damaging.

Angela Davis: As we look to the future, we now have toddlers, children, elementary school, high school kids, wearing earbuds, headphones, listening to music, podcasts, many hours of the day, you have concerns about what these young folks will be confronted with when they're in their 60s and 70s.

Peggy Nelson: We’re keeping our eye on it. They're not listening at levels that we would call 'breaking the law' as according to the occupational safety and health. For example, they're not listening like a miner or printer would be listening to levels, but we're keeping our eyes on what the effect is. If they're listening for hours per day, for example, at fairly high levels. There's no data yet that say it's a terrible thing. But we'll just have to wait and see because they're not older yet.

Rachel Allgor: What I'm usually telling patients is a good rule of thumb is 60 percent or less of the volume on your phone, you're pretty much in the clear. If you're doing 60 percent or more, do it under 60 minutes a day.

Angela Davis: In St. Paul, let's talk to Wendy, what's going on with you?

Wendy: Hi, I'm calling about one of those genetic hearing issues. It's called auditory processing disorder. I and my son had been diagnosed with this. And it was not easy. In my son, it perhaps delayed his social-emotional learning. And I look back over my life. And it's created social difficulties for me as well, but I've navigated them. My brains adjusted. Hearing aids are a treatment for this, but you have to go to a specialist. I've tried a regular audiologist and they could not adjust the levels correctly. So this is not just for old people. It's also hearing loss in different ways. The genetic kind can affect any age and if someone uses hearing aids, but does not find they're successful, I would urge them to go see a specialist and consider auditory processing disorder.

Angela Davis: All right. Thank you, Wendy. And this is a new term for me. What is this? Can it affect all ages?

Rachel Allgor: Yeah, it can. And it often shows up when you're younger, because you're struggling in school. So what an auditory processing disorder is, is when the information going into your brain is healthy. And so your ears don't show any form of hearing loss oftentimes. But once it gets into your brain, information scrambles a bit. And so you're not understanding things clearly. Even though on a hearing test, you should be.

Angela Davis: Is this rare?

Rachel Allgor: It’s probably more common than we realize, but testing just isn't prevalent, like what Wendy said.

Angela Davis: So what does a hearing aid do?

Rachel Allgor: A hearing aid helps amplify just a bit in the regions that are most helpful, especially for speech. And so I am not somebody who specializes in it. I believe there are two, maybe three providers in the cities or the state.

Angela Davis: Peggy, anything you could add about auditory processing disorder?

Peggy Nelson: I hear the frustration, it's really tricky. And the other thing that a person might try is a system that has a remote microphone where the microphone could be near the teacher or the speaker, and then feed that to the hearing aids directly so that the person with auditory processing is not hearing everything at once. But they can hear more selectively the voice that they need to attend to at the time, but it's a tricky situation very difficult to handle.

Angela Davis: Let's go to Onamia and talk with Robert. Hi, Robert, thank you for calling in. And what did you want to tell us?

Robert: Good morning. Hi. Yeah, I want to say a few things about over-the-counter hearing aids. I wear two hearing aids. And I got my hearing aids through Medicare at no cost. And about two years ago, the hearing aid for my left ear was damaged and couldn't be repaired. And I was told by my audiologist that I wouldn't be able to replace it until 2024. So it's been, you know, pretty difficult, not having that hearing aid in my left ear. And a few weeks ago, I was in Walmart, and I saw over-the-counter, FDA-approved hearing aid. So I bought one. And I thought I would try it out. And it has a built in battery, it looks almost exactly like my other hearing aid. It's a little bit more bulky, it's a little bit more unsightly, I think, because of the tube that runs between the ear plug and amplifier.

Angela Davis: So Robert, you have one of the new over-the-counter hearing aids, and how was it like getting it set up. Because you're just going on directions from the box? Right?

Robert: Well, it was really easy. I mean, all I had to do was recharge the battery and put it into my ear. And they do give you like, the one I have has three different ends on the earplugs. But the one that was already in it fits my ear pretty good. And there's just two volume controls on it. One is for a higher volume, and then there's one for lower volume. And so you press the button hear, a little beep. And when you hit to get up to two beeps, that means you've reached the maximum of the volume. So I don't know, it works really good.

Angela Davis: Can I ask you how much did it cost? How much did you pay for the this over-the-counter?

Robert: Yeah, I paid $90 for it. And so I think for that price, it was a good deal. I see it mainly as something that's temporary.

Angela Davis: Because the quality is not the same as the one that you had that you went to a professional to get?

Robert: It's pretty close to that quality. But I'd rather have, you know, one from my audiologist rather than the over-the-counter. I mean, I think the over-the-counter works really good. Of course, I can't recommend them for other people.

Angela Davis: Thank you, Robert. What are you hearing in his story, Rachel?

Rachel Allgor: Yeah, I mean, that one sounds like it's a very simple one. I'm not sure if there was an app component involved, which is involved in all of the newer OTC products. And so there's a difference between a personal sound amplification product.

Angela Davis: So there's, there's a range of products that will come out over-the-counter. So some will be much more advanced and some will be more simple. Okay, and Peggy, anything you can add to what he just shared about having over-the-counter ones? It sounds like a more simple one.

Peggy Nelson: Yeah. And that was good clarification. I think there will be confusion about the product. So again, we'll wait and see. And I would guess also this was a personal sound amplifying product, but I love his approach of using this temporarily. And that might be hopefully with access, people will try them and even if they only use them for months or a year or short time, whatever it might be. And it brings them into realizing the potential, they think that will be a great thing.

Angela Davis: Let's take up more phone calls. In Topeka, Kansas, we have Kate on the phone calling in. Good morning, Kate.

Kate: Good morning, Angela. I've known for four years I've lost hearing, I noticed mostly in group settings. And because my mother has dementia that may be related to hearing loss. And my husband's always been a bit of a mumbler. So it's led to a lot of irritability at our house when I make him stand in front of me while he talks. But the audiologist confirmed I have about 20-25% percent loss in both ears, especially in the high tones, as you've described. I lost that clarity, and it feels like everyone's mumbling. But they warned me, both of them, that it probably would only do a little bit of good if I got a hearing aid because the mumbling would just be amplified, as well as all the other noises around me. I'm wondering if these new FDA OTCs will be better, that they will be able to sort out the sound and help me in a way. I'm willing to gamble like Robert’s $90. I wasn’t willing to gamble $8,000.

Angela Davis: So Kate, since you know, she doesn't want a hearing aid that’s just gonna make the mumbling louder. She wants something that's going to bring her clarity. So what do we know about the technology that the ability to do that with the over the counter, the ones and the ones that you would get from a professional audiologist?

Rachel Allgor: Well, I expect that that clarity piece will be similar. The audiologist fit will have more capabilities, like streaming and directionality, directional microphones that will focus hearing a little better. But I want to clarify one thing about the mumbling and maybe the advice that you got there. If I mumble, the hearing aid will help with that, because it will sharpen the pitches, it will sharpen up the high pitches. And so while it won't be lots louder, and I think that advice that you got was good, it's not going to be night and day, it's not going to be a switch that flips for you and everything's going to be so much better than it was yesterday. But as Rachel said, if you give it time to help your brain relearn those high pitched sounds, within some time, you'll realize things are clearer. It's not just mumbled anymore, it will be clear, it will not knock out all the background noise. The background noise will still be there. It'll still be audible, but the speech itself should become clearer over time.

Angela Davis: Rachel, what can you tell us about how a hearing aid can help bring clarity, if someone sounds like they're mumbling?

Rachel Allgor: Yeah. And I think it's tricky, especially with this caller. Because she doesn't have a lot of hearing loss. So really low pitches to really high pitches, but she mentioned that she has more of a high pitched hearing loss. And this is where I can see the over-the-counters coming into play a lot more. Because it gives the control in the patient's hand or in the person's hand where you can tweak things and see how it sounds for you. Because I can do that as best I can in the office. But I know my office is not your life. And so that's where I can see some benefit of control. It's a lot less cost and more control in your environments.

Angela Davis: I've read that people who are experiencing hearing loss, that often it's children's and women's voices that they have the hardest time hearing. That's the first indicator. Is that true?

Rachel Allgor: It is to an extent. Because there's typically higher pitched voices. And so more of their speech sounds are found in those higher frequencies. I think men often project more and kind of have been taught that as a gender.

Angela Davis: Let's take another phone call in Minneapolis. Chris is on the phone. Hi, Chris. What did you want to share with us about hearing loss and hearing aids?

Chris: Hey, thank you. I'm so grateful to be listening to this excellent conversation on my Bluetooth hearing aids, which I've worn for about two years. Unfortunately, I waited decades to get them. You know, I acquired verbal proficiency pretty early in life, read widely from a young age and also unfortunately, I began abusing my hearing at a fairly young age to and I damaged profoundly the upper range of my hearing in both ears. One thing that I've read and have certainly experienced for myself is the amount of bandwidth it requires for me to process other people's speech. And because of my verbal proficiency, I'm able to sort of reconstruct what people are saying, because people do tend to speak in, you know, fairly standard syntax. So I can kind of assemble a second or two after something is spoken what's being said. I had a boss who, ironically, once said to me, interpolation is 90 percent of meaning. And he had a way of sort of reversing syntax, because he was very well read. And so he could be creative with how he put sentences together. He also had Parkinson's disease. And he spoke very softly, I didn't have hearing aids at that time. And I really struggled to make out what he was saying to me. And the amount of bandwidth that we devote to that really detracts from the ability to just let the sound come into our ears, and allow our cognitive powers to process meaning rather than to try and tease out constructions. And I just think it's really important for people to see hear and to know that.

Peggy Nelson: This is something that we're studying. It's not only about repeating and understanding the words and sentences, (it’s) about how much effort it takes how much fatigue over the course of the day, how much they are not able to concentrate on two things at once, because of the effort that it takes to, to listen, and we really hope and anticipate that getting hearing devices will reduce that effort, it is something that we're studying as well. So that really hit a lot of notes for me that, that perhaps one of the things we could notice about getting used to new hearing aids is that a person can relax more, can be not quite so tired at the end of the day, to relax and enjoy a conversation, you know, the give and take of a conversation, rather than really having to focus and struggle. I really appreciate that viewpoint.

Angela Davis: Let's take a phone call in Minneapolis, Mary's on the phone. Mary, thank you for waiting, what do you want to ask or share with our guests about hearing loss?

Mary: Hi, I've heard so many positive things today. And I just want to ask for some advice for the obstinate 80 year old who does not feel like it's something he wants to undertake. He did undertake it once and he didn't like it. But he's become increasingly isolated from friends and family who don't want to sit around with the TV blaring in the background, trying to have a conversation with him. Or even having a phone conversation with him. It's just become so difficult to to kind of continue the relationship when he's not a fully part of a conversation.

Angela Davis: Mary, I think you speak for a lot of people with this question. And so Peggy and Rachel helped me with this conversation. One of the words to use how do we have a conversation with someone who is reluctant to get help or doesn't believe that they need help? Peggy, could you begin?

Peggy Nelson: Well, one thing I do is ask people directly what's important to you? What do you miss? Or what would you like to see and then try to figure out how that could be achieved, perhaps especially in this case, where he tried something before and didn't like it. And that does happen. Perhaps we need to go to simpler technology. There are some, you know, boxes, to pocket talkers and things that might be a simpler solution that would allow him to have the high-priority conversations that he wants. And then to to say clearly, we miss talking to you. What can we do to try to make it easier?

Angela Davis: Rachel, anything you'd add?

Rachel Allgor: Yeah, I think it can be really powerful coming from family and friends saying, we miss talking with you. We miss engaging with you. So hitting on that emotional side of things, or like we see that you're not paying attention during dinner anymore, and you missed this part of the conversation, or you missed your grandkids trying to get your attention because they need you. Like we need our grandparents.

Angela Davis: And then there's some words that we should not use with people who have hearing loss I have in my notes here. You want to talk about people saying, ‘nevermind.’ How does that come into conversation?

Rachel Allgor: That comes from asking for repetitions. So as a person with hearing loss, there have been many times in my life where I've had to ask for repetitions. And if people say "oh, nevermind" it is one of the most hurtful things for me to hear that from somebody else. Because I'm genuinely interested. And I want to know what's being said, I just can't figure it out. Even with my hearing aid, I still have trouble sometimes. And so understanding that it's my responsibility to repeat back what I did here, so that you only have to fill in the blanks. And then sometimes it's your responsibility, instead of saying the same thing, rephrase it.

Angela Davis: Could you describe what your hearing aid looks like?

Rachel Allgor: So I have one that is a speaker in my ear canal itself. And then it has a wire going and sitting to like the main component of the hearing aid behind my ear. I have long hair, it is hidden more. But I have a purple, white and sparkly ear mold also. Because I love having something fun with my hearing aid.

Angela Davis: And Peggy in the last 30 seconds here, where do people go? What do you advise folks do or go to get more information about the over the counter hearing aids and hearing aids that you will get from going to see an audiologist, what are some resources?

Peggy Nelson: There are some good resources online from the National Institute on Deafness and Other Communication Disorders. We also have the Minnesota Commission for the Deaf, Deafblind, and Hard of Hearing that have resources available, and the Minnesota Academy of Audiology will and the university clinics will as well. We're all discovering this together. And we want to work with people to figure out what's best for them and sometimes it will be stick with your audiologist and go back but sometimes, like some of your callers, they want to give it a try. So let's help them give it a try.