To hear or not to hear is no longer the question for many people.

But buying a big ticket item like a hearing aid -- small enough to be barely noticeable, yet powerful enough to make a lifestyle difference -- can be confusing for consumers. Digital hearing devices cost $400 to $4,000 each.

Utilizing sophisticated computer chips, the more advanced instruments can help people make up for their loss in ways that were unheard of when all aids did was amplify sound.

Still, it's hardly a case of one size or kind suits all. Government and industry experts caution that unless consumers get the right instrument for their needs from someone competent and reliable who provides good follow-up services, an expensive aid might end up in the drawer rather than in the ear.

In Florida, hearing aids can be purchased from either audiologists or licensed hearing aid specialists.

Audiologists are health care professionals who typically have six years of college education, culminating in a master's degree in audiology. Their training includes clinical experience and graduate course work in such areas as anatomy, physiology, communication, assessment and treatment of hearing loss. Some audiologists go on to earn doctorate degrees in their field.

Licensed hearing aid specialists don't need to attend college. The state requires them to have high school diplomas and six months of on-the-job training before being tested for a license. In addition, they have to take continuing education courses. Some also receive certification from a national board of hearing instrument specialists.

Hearing aid centers run by audiologists and licensed hearing aid specialists abound locally. Over the past few years, however, a multinational hearing aid company has expanded its network in Volusia and Flagler counties, and now the majority of local hearing aid retailers here -- audiologists and hearing aid specialists alike-- are affiliated with Sonus or its Italian-based parent company, Amplifon.

Until recently, the nonprofit Easter Seal Society of Volusia & Flagler Counties also sold hearing aids. But that agency discontinued hearing services to adults this year, and callers are now referred to three area audiologists.

Debi Zarajczyk is one of them. An audiologist for 25 years, she worked for Easter Seals before opening her own practice in Ormond Beach 12 years ago, which remains independent.

Though approached by Sonus, she said she opted not to join the network because she didn't want an outside corporate entity influencing her business practices or "giving me my marketing tools."

Zarajczyk said she gets many of her referrals from two local ear, nose and throat physicians, who rely on audiologists to do evaluations.

Business has been so brisk at her office she recently hired a part-time hearing aid specialist to help with fittings and follow-up visits, although she does all evaluations herself.

It's important, Zarajczyk stressed, for those experiencing hearing loss to first have their ears checked by a doctor, "to make sure there's nothing medically wrong." People also may have a build up of earwax that could prevent proper testing.

Audiologists -- unlike hearing aid specialists -- are allowed to remove the wax, although Zarajczyk said she prefers to have a physician do it.

But for most people it's simple wear, tear and aging of the delicate inner workings of the ear that cause hearing loss. One of the major culprits is loud noise, which over time can cause sensory-neural damage. People who've worked around loud machinery may be vulnerable. And some members of the original rock 'n' roll generation are now starting to pay the price in middle age for liking their music extra loud.

"I do see a lot more of them," Zarajczyk said of baby boomers.

"The stigma (of getting a hearing aid) is not as great as it used to be," she added.

The kind of device a person ultimately decides upon depends on his or her "hearing loss, lifestyle and pocketbook," according to the audiologist, who notes that for most people it's an expense not covered by insurance.

Dan Allen of Allen Hearing Center in Daytona Beach, said keeping prices as low as possible while providing good service has given him an edge over centers affiliated with big corporations. The business is "unbelievably competitive," noted the independent licensed hearing aid specialist. But "the little guy can sometimes beat the big corporation," he said.

Allen also contended that licensed hearing aid specialists are just as qualified to sell hearing aids as audiologists.

"It all comes down to the individual," he said. "We all use the same testing techniques, the same equipment, the same manufacturers."

Audiologists, however, counter that their professional education makes them best qualified to evaluate hearing loss and offer the most knowledgeable service.

"There are a lot of good and honest hearing aid specialists," conceded Joe Luckett, a practicing audiologist for 28 years. And it's "legal and honest to carry a hearing aid license." But the difference in training is evident, according to Luckett, who has eight years of college education, including a doctorate in audiology from the University of Florida. "It makes sense," he said, for consumers to seek out people with the "maximum amount of training, expertise and experience."

The Daytona Beach audiologist doesn't object, however, to being part of the same corporate network as hearing aid specialists. Six months ago Luckett became one of 1,600 Sonus affiliates in the United States and Canada in order to take advantage of its discount purchasing from manufacturers and other benefits.

In 2002, Sonus was acquired by the Italian-based Amplifon Group, the largest distributor of hearing aids in the world. Amplifon also owns Miracle Ear, a hearing aid brand sold in Sears stores.

"The thing I tell people is you can get a good hearing aid just about anywhere," said Robert Morrison, a licensed hearing aid specialist with Audio Arts Hearing Aid Centers, which has offices in Ormond Beach and New Smyrna Beach, and is now also part of Sonus. "Find a person you can trust to deal with," he said.

"People should go to a couple of different vendors, audiologists or hearing aid specialists," suggests Allen. "They should shop around."

For Bill DeNoon, who splits his time between Ormond Beach and Ohio, just acknowledging he had a hearing problem was the biggest step.

"My wife was saying you better get a hearing aid. My kids were saying it. My grandkids were saying it."

He ended up getting a high-tech model from Zarajczyk that's so tiny it's virtually invisible when it's in his ear.

But he knows it's there.

"I can hear fairly well," DeNoon said during a recent check up and adjustment in the audiologist's office. "I notice a difference."

donna.callea@news-jrnl.com

LISTEN UP

The Federal Trade Commission, Food and Drug Administration and state law all play a role in how hearing aids are dispensed in Florida. The state also mandates minimum testing procedures and equipment used. The following are some government suggestions for consumers and requirements for dispensers:

· A person selling a hearing aid in Florida must give the buyer a 30-day trial period and money-back-guarantee. Cancellation fees can't exceed 5 percent of total charge of the hearing aid.

· The FTC can take action against companies that mislead or deceive consumers.

· The FDA requires that dispensers obtain a written statement from the patient that his or her ears have been medically evaluated by a licensed physician and that the patient is cleared for fitting with a hearing aid.

· The National Institute on Deafness and Other Communication Disorders (part of the National Institutes of Health) recommends that people with hearing loss first see their own physician, who can then refer them to an otolaryngologist (ear, nose and throat specialist) or audiologist.

TYPES OF AID

There are several types of hearing aids, offering different advantages, depending on size, levels of amplification and design.

· In-the-Ear, or ITE, hearing aids fit completely in the outer ear and are used for mild to severe hearing loss. The case, which holds the components, is made of hard plastic. ITE aids can be damaged by earwax, and their small size can cause adjustment problems and feedback.

· Behind-the-Ear, or BET, hearing aids are worn behind the ear and are connected to a plastic piece that fits inside the outer ear. The components are contained in a case behind the ear. A poor fit or buildup of earwax or fluid can cause feedback or whistling sounds.

· In-the-Canal, or ITC, hearing aids are customized to fit the size and shape of the ear canal and are used for mild or moderately severe hearing loss.

· Completely-in-Canal, or CIC, hearing aids are concealed in the ear canal and used for mild to moderately severe hearing loss. Because of their small size, canal aids may be difficult for the user to adjust and remove. Canal aids also can be damaged by earwax and ear drainage.

The inside mechanisms of hearing aids can vary among devices, even if they're the same style. The types of circuitry used include:

· Analog/Adjustable. The laboratory builds the aid to meet certain specifications. This type of circuitry is the most basic and usually the least expensive.

· Digital/Programmable. The hearing aid is programmed on a computer and sound quality and response time can be adjusted. Digital hearing aids use a microphone, receiver, battery and computer chip. Those that provide the most flexibility for computerized adjustments are typically the most expensive.

From The National Institute on Deafness and Other Communication Disorders