Consider these facts:

* 28 million Americans are believed to have hearing loss. That's 10 percent of the population, and one out of three people over 65.

* Only one in five people with hearing loss use hearing aids. Three out of five people over 65 with hearing loss and six out of seven middle-aged Americans with hearing loss do not use hearing aids.

* A study conducted in 1999 by the National Council on Aging documented the effects of hearing loss on older people. Seniors who do not wear hearing aids are more likely to experience depression, anxiety, paranoia and emotional turmoil, compared with those who do wearing hearing aids.

* According to the study, most hearing aid users report significant benefits in family relationships, mental health and other areas that affect the quality of their lives.

For Marion Caldwell and Pat Cook of Caldwell & Cook Hearing Services in Danville, these statistics are more than dry facts on a page: they represent both the frustrations and the joys of their profession.

The frustrations, because they know there are a lot of people in the community who are not getting help with their hearing difficulties.

"I look forward to the day when hearing loss is treated like any other sense loss," said Caldwell, who has a doctorate in audiology and has worked in the field for many years.

Family physicians don't routinely check patients' hearing

One of the reasons hearing problems go undetected and uncorrected is because family physicians don't routinely check their patients' hearing and refer them for further tests, she said, adding that she and Cook have worked to build local doctors' awareness.

The problem remains largely "invisible," she said. "People aren't aware of how significant it is.

"People become isolated and depressed and angry. You need to be aware of hearing loss and how it affects your life and your environment."

Caldwell said she is encouraged that screening for hearing loss has been included in the recently adopted "Welcome to Medicare" preventive physical exams and that interest has been shown locally in the importance of students hearing well in the classroom.

"It would help a lot if it were a health issue that would be checked along with other things," Caldwell said.

Caldwell and Cook, who is a certified hearing instrument specialist, said, generally, people are referred to them by their employers, encouraged by a family member to come in or just decide on their own that they are not hearing well.

"I had a lady whose mother had moved in with the family," Cook said. "When the child becomes the caregiver, you see a lot of frustration when they can't communicate."

After the parent was fitted for a hearing aid, the daughter was very pleased, Cook said. "She said it made life just wonderful. She said, 'Now we can communicate in restaurants.'"

The joy of being able to hear again

Many people who try hearing aids experience that kind of joy, Cook said, the joy of being able to hear again. "The older person who puts them on appreciates them," Cook said.

"If they come in with the attitude that they want to hear, half of the battle is won," Cook said. "I tell them they're going to hear more about hearing aids than they ever want to know."

People will either say, "I'm not going to be able to do this" or "I wish I had done this five years ago," Cook said.

One reason that the correction of hearing problems with hearing aids is not as widely accepted as the correction of eyesight problems with glasses or contact lenses may be that it is a more complicated process.

Stories abound of people who obtain hearing aids, wear them a few days and then leave them in drawer. That's why Caldwell and Cook stress counseling and follow up. They like to see people four times a year to make sure their hearing aids are properly adjusted.

Some people just put their hearing aids on and never have a problem with them, but others find that their hearing aids need adjustment. "Just like a car, they need to be tuned up," Cook said.

Caldwell and Cook offer a service agreement in which they supply the hearing aid batteries for five years. That gives them opportunity to see people regularly. "If people don't come in for their batteries, we contact them," Caldwell said.

"With glasses, you put them on and your vision is corrected," she said. "With hearing loss, it's an ongoing process. When the environment changes, hearing aids have to be adjusted."

Another issue is cost

Another issue with hearing aids is cost. Entry-level instruments that are not customized to the individual start at $495 while digital, high-end, customized aids start at about $2,500.

"We try to fit them to a person's lifestyle," Caldwell said. "A lower-end hearing aid may not work for them. Or they can get an entry-level one and next time get a better one when they realize the issues involved."

Caldwell said the cost of hearing aids is falling some while their effectiveness has improved greatly since digital devices came on the market in 1995.

The Cable News Network (CNN) recently ranked modern hearing aids among the top 25 innovations of the past 25 years. The new digital hearing aids are actually a tiny computer in the ear that can be customized to each person.

"Since each person's hearing loss is as unique as his or her fingerprint, the ability to digitally break down incoming sounds and reconfigure them to enhance an individual's ability to hear sounds was a major breakthrough," Caldwell said.

The first voice-activated hearing aid, which was able to prioritize human voice over other sounds in the environment, became available in 2001 and within the last year, hearing aids using "artifical intelligence" have been released. The new technology further enhances the ability of hearing aids to screen out background sounds and improve hearing even in noisy environments and other areas such as busy streets, social gatherings and crowded restaurants.

"There's no reason why a person should go without a hearing instrument in this day and age," said Cook, "not if they have a need for it."

By John T. Davis