Age-related hearing loss has long been thought of as an inevitable part of getting older, more a nuisance than a life-altering medical condition—at least by those not experiencing it.

But that’s all changing.

In the past two years, the President’s Council of Advisors on Science and Technology (PCAST) and the National Academy of Sciences (NAS) have published reports calling untreated hearing loss a significant national health concern­, one that’s associated with other serious health problems, including depression and a decline in memory and concentration. Several studies even suggest a link between hearing loss and dementia.

The estimated 48 million Americans affected by hearing impairment didn’t need that memo.

More than 100 years ago, Helen Keller, who was deaf and blind, described the isolation caused by hearing loss aptly when she said: “Blindness separates people from things. Deafness separates people from people.”

Lise Hamlin, director of public policy for the nonprofit Hearing Loss Association of America (HLAA) echoes that sentiment. “We’re social creatures," she says. "When you shut down the ability to talk and interact with people, that isolation affects your health and your ability to participate in society.”

Recent research shows that the number of Americans of working age with hearing loss has declined slightly, but it continues to be a problem for seniors, affecting 28.6 million Americans ages 60 and older.

Despite the prevalence of hearing loss and the negative impact it can have on health and quality of life, relatively few people seek treatment. Almost half of the 131,686 Consumer Reports subscribers surveyed for our 2015 Annual Fall Questionnaire reported having trouble hearing in noisy environments, yet only 25 percent had their hearing checked in the previous year. And according to research published in the Archives of Internal Medicine, just 14 percent of those who could benefit from hearing aids actually use them.

People don’t seek help for several reasons. A common one, according to NAS, PCAST, and others, is that they can’t afford it. NAS reports that hearing aids cost an average of $4,700 per pair in 2013 and can climb to almost twice that price. And they’re usually not covered by health insurance or Medicare.

No wonder the market for less expensive, over-the-counter hearing helpers known as PSAPs (personal sound amplification products) is growing.

We dug deep to find out why hearing aids and treatment for hearing loss can be so costly, and what’s being done to bring solutions within reach. We also tried several PSAPs to determine whether they’re an affordable alternative to hearing aids for some people.

Here’s what we uncovered.

Great Strides in Treating Hearing Loss

Though most of us take our hearing for granted until we begin to lose it, the ability to perceive and make sense of sound is a marvel. In simple terms, sound waves travel through the air to the inner ear. There, microscopic hair cells convert them into electrical signals that are shuttled to the brain, which interprets them as meaningful sounds, language, music, and more. But a constellation of abnormalities in the auditory system can cause this process to malfunction.

For those who have mild to severe hearing problems (see “Degrees of Hearing Loss”), hearing aids have traditionally been the solution. These prescription devices contain a microphone that picks up and converts sound waves into electrical signals and an amplifier that makes the signals louder. The amplified sounds are directed by a speaker to the inner ear, where hair cells detect them and send them to the brain.

Worn in or behind the ear, hearing aids have come a long way since the handheld ear trumpets of the 19th century, particularly in the past 20 to 30 years. (See our hearing aid buying guide and ratings of brands and retailers.)

Today’s aids are smaller and, thanks to digitization, better at amplifying sound specifically in the frequencies where it’s needed. Most aids can now be adjusted by wearers for a variety of environments, from quiet rooms to loud parties. Modern hearing aids are also better at reducing unpleasant feedback and background noise. They often have telecoils, small copper wires that improve sound clarity by picking it up directly from phones and public-address systems. At the higher end, hearing aids may have features such as Bluetooth connectivity, allowing users to stream music and take phone calls through them.

A result of this progress is that 46 percent of our survey respondents reported that they were very or completely satisfied with their aids. Just 3 percent of those who reported trouble hearing but don’t use hearing aids noted that they had tried the devices and found they didn’t work.

Despite the advances, experts say that even the most sophisticated devices can’t fully normalize impaired hearing. As Marvin M. Lipman, M.D., Consumer Reports’ chief medical adviser, notes: “No hearing aid can match the efficiency and function of the human ear. There’s nothing like the real thing.”

And some people benefit more from hearing aids than others.

“You can have two people with identical audiograms who have very different functionality,” says Debara Tucci, M.D., a professor of otolaryngology at the Duke University Medical Center, referring to a commonly used hearing test.

In many cases, people don’t think their hearing loss is severe enough to warrant treatment or they simply don’t want to wear aids. Then there’s the image problem: Hearing aids are still sometimes viewed as a sign of faltering health.

“There’s much more of a stigma about wearing a hearing aid than there is for wearing glasses,” says James C. Denneny III, M.D., CEO of the American Academy of Otolaryngology—Head and Neck Surgery.

Priced Out of Treatment Options

You can buy the newest smartphone, a far more complex device than any hearing aid, for less than $1,000. But hearing aids typically cost $3,300 to $8,000 per pair—and prices continue to rise. (Check our advice on how to save on hearing aids.)

Groups such as NAS and PCAST say that hearing aids are more expensive than they should be. The PCAST report cites a 2010 study that found that the cost of hearing-aid components could be purchased for less than $100.

The professionals who sell hearing aids, most of whom are audiologists with doctoral degrees, note that the price also covers many services. Todd Ricketts, Ph.D., director of graduate studies in hearing and speech sciences at the Vanderbilt University Medical Center, explains that evaluating people and then selecting, fitting, and adjusting hearing aids to ensure that they work as well as possible is exacting and time-consuming.

But “bundling” the price of the product and services together makes it more difficult for people to know exactly what they’re paying for. According to the NAS report, this lack of transparency also forces consumers to pay for services they may not need.

What’s more, neither Medicare nor a majority of commercial insurance plans—which often follow Medicare’s lead—cover the cost. Nor do they offer coverage for an additional fee, as many plans do with dental and vision care.

Given the established link between hearing loss and other serious health problems, why don’t private insurers or Medicare pay for hearing aids?

“I don’t know why we don’t cover the cost of hearing aids,” said a spokesman for Aetna, Matthew Clyburn, when we asked. “Medicare doesn’t cover them either, so it doesn’t seem to be highly out of the ordinary,” he added.

None of the representatives of the six large health insurers we spoke with could pinpoint reasons for this lack of coverage. (A few states require such coverage, and some insurers offer discounts on hearing aids.) The National Association of Insurance Commissioners said it’s a business decision.

In response to our questions, a Medicare spokeswoman sent an email explaining that she couldn’t address why hearing aids are excluded from its coverage. She suggested that we refer to the Congressional Record of 1965—the year Medicare was signed into law—for an answer. From the outset, Medicare specifically excluded hearing aids from coverage. They were far more affordable when the program was created, and hearing loss wasn’t viewed as a significant health concern.

As Kim Cavitt, Au.D., an audiologist and adjunct lecturer at Northwestern University, says, “You don’t die from hearing loss.”

But the continued lack of coverage has not gone unnoticed by certain members of Congress. They, like lawmakers who tried before them, are pushing to make hearing aids more affordable and easily available.

“We know now that 70 percent of all seniors between 65 and 84 who need a hearing aid simply do not get one, many times because they can’t afford it,” says Rep. Debbie Dingell, a Democrat from Michigan, who introduced a bill in 2015 that would require Medicare to pay for the devices. “People with untreated hearing loss are cut off from their communities,” she says. “They feel isolated and depressed. We must get agreement in Congress that people need to hear.”

Dingell’s bill failed to get traction, but she says she plans to reintroduce it this year.

In December, Sens. Elizabeth Warren, D-Mass., and Chuck Grassley, R-Iowa, introduced legislation that would make simple, more affordable hearing aids easier for consumers with mild to moderate hearing loss to obtain. The legislation would allow such devices to be sold over-the-counter and eliminate the requirement that consumers have a medical exam or sign a waiver before purchasing them. The latter is still on the books. But the Food and Drug Administration recently announced that it would no longer enforce the medical exam or waiver requirement.

Affordable Over-the-Counter Solutions

Given the high cost of hearing aids, it’s no surprise that we’re seeing a growing array of less expensive OTC products, such as wireless headphones for TV watching and phone apps that amplify sound.

But PSAPs, which range from about $10 to $500 each, are the most common OTC option. They sit in or behind the ear and have some of the same components as hearing aids: a microphone, an amplifier, and a receiver. In theory, they should boost the volume of the sounds you have trouble hearing. Some may reduce background noise, as many prescription aids do.

Most PSAPs are fairly basic, offering few or no adjustments for varied environments—say, outdoor spaces or movie theaters. And unlike a majority of hearing aids, PSAPs are generally analog, not digital, so they’re usually less able to reduce annoying feedback and to consistently target only the frequencies in which users really need amplification.

“That’s a big difference,” says Cavitt, who co-authored a 2016 study comparing PSAPs with hearing aids. “When the sound comes in, does it merely amplify it, or can it also suppress feedback or extraneous noise?”

These differences may be challenging for consumers to discern. PSAPs aren’t regulated by the FDA as hearing aids are, and manufacturers aren’t permitted to call them hearing aids or claim that they improve impaired hearing. (In fact, according to the FDA, the devices aren’t meant to compensate for hearing loss but are “intended for non-hearing-impaired consumers to amplify sounds in certain environments.”)

And because PSAPs are so loosely regulated, their manufacturers aren’t held to the same safety or efficacy standards as hearing-aid manufacturers.

“Consumers have no way of knowing whether one PSAP is better manufactured than another,” says Neil DiSarno, Ph.D., chief staff officer for audiology at the American Speech-Language-Hearing Association (ASHA).

Experts agree that people who already have moderate to severe hearing loss won’t benefit from PSAPs.

To see how well they work for those with mild to moderate hearing loss, Consumer Reports had three volunteers who fit that definition test four devices.

We found that the higher-end PSAPs helped some of our volunteers hear better, especially while watching TV. (Get details on the results of our tests at “Are OTC Hearing Helpers Any Good?”)

Ricketts urges consumers to see a hearing professional to determine their level of hearing loss and which frequency ranges need amplification most. A hearing specialist can also diagnose more easily remedied conditions such as earwax buildup or more serious problems such as ear-canal tumors.

A majority of audiologists don’t sell PSAPs or adjust those that consumers buy on their own, although this might soon be changing.

“Even if PSAPs are not perfect,” Denneny says, “they may give people a relatively simple entry point into the healthcare system at a markedly reduced cost.”

Types of Hearing Loss

There are two main types of hearing loss; some people have a mixture of the two.

Sensorineural hearing loss, the most common, is usually caused by the destruction of hair cells in the inner ear. The damage to hair cells can be due to aging, certain medications, heredity, exposure to loud noises, and nerve damage from illnesses such as mumps. This is the type of hearing loss that most often affects people over 60. It's treated with hearing aids or cochlear implants. These devices send sound signals directly to the auditory nerve, which then carries them to the brain.

Conductive hearing loss occurs when a physical block such as earwax or a malformation of the ear stops sound from traveling through the ear canal. Removing the blockage or corrective surgery usually restores hearing.

Degrees of hearing loss
Illustration: Thomas Porostocky

Degrees of Hearing Loss

Hearing loss is measured by degrees ranging from mild to profound. Although the best way to know whether you have a hearing impairment—and to what degree—is to see an audiologist or other hearing professional, this can give you an idea of where you may fall on the scale.

1. Mild
Difficulty hearing soft speech or quiet conversations, or sounds such as a babbling brook.

2. Moderate
Trouble hearing conversations amid background noise; inability to hear the hum of a refrigerator motor.

3. Moderate/Severe
Difficulty understanding group conversations or hearing sounds such as a running shower or an air conditioner.

4. Severe
Inability to hear speech at normal volumes and sounds such as a toilet flushing or a garbage disposer.

5. Profound
Difficulty hearing or total inability to hear even the loudest of noises, such as a revving motorcycle engine.

Editor's Note: This article also appeared in the March 2017 issue of Consumer Reports magazine.