Do you find yourself confusing words or making silly mistakes? Do voices sound blurry - like static? Do you understand men's voices better than women's or have trouble hearing birds or the wind in the trees? Do you have trouble understanding conversation within a group of people? Do you avoid group meetings, social occasions, or family gatherings where listening may be difficult or where you may feel embarrassed about misunderstanding what is being said? If you answered yes to more than one of these questions, you may be one of the approximately 20 million Americans who have a hearing loss. Age-related hearing loss will ultimately happen to almost everyone, it just affects some of us earlier than it does others. Our ears have a tendency to be like the family car - sometimes they just don't work, they get damaged, or they simply wear out.

For most of your life hearing has been as natural as breathing, yet little by little some things may have changed. Hearing can be damaged gradually or suddenly and at any age. Most often a hearing loss is gradual and painless, and in many cases it may develop so slowly it is barely noticeable. It is normal for people not to realize that they have lost some of their hearing, even though family and friends may be quite aware of it. People with hearing losses often complain that they can hear others talking but do not understand what is being said.

What should a person do if they suspect that they may have a hearing loss? Hearing problems are serious. But remember, there's something wrong with your hearing, not with you. It is a real mystery why people hardly think twice about correcting their eyesight with glasses, but find it difficult or impossible to admit they don't hear as well as they used to. Hearing loss is not a sign of senility and it certainly doesn't mean that your life is over. If you suspect a hearing loss, you should talk with your family physician about seeing an audiologist for a hearing test. The following are 10 Important Questions to Ask Your Doctor About Hearing Loss: 1) What type of hearing loss do I have? 2) Is it likely to get worse? 3) Would a hearing aid help me? What types are available? 4) How can I use my hearing aid to my best advantage? 5) Are there any surgical options that might help me? 6) What can I do to protect my hearing? 7) Are there precautions I should take in my daily activities (driving, etc.)? 8) Are there other techniques that I can use to compensate for my hearing loss (like speech reading)? Would an audiologist be of help to me? 9) Is there anything that my family and friends can do in order to communicate better with me? 10) Are there any clinical trials I could participate in?

How is Hearing Loss Diagnosed? Early detection and treatment of hearing loss is crucial. The following tests are typically part of the hearing evaluation.

- Audiometric Testing - A special machine (audiometer) is used to measure the softest tones you can hear. You will be asked to raise your hand or press a button when you hear the tones. The audiologist will determine, based on your responses, the softest tones you can hear at each frequency and record them on an audiogram, which helps identify the type and degree of hearing loss you may have.

- Immitance Testing - These tests measure the middle ear's ability to conduct sound. They may detect fluid buildup in the middle ear space, a perforation of the ear drum or other problems in the middle ear.

- Speech Testing - During your evaluation, you will be asked to listen to and respond to speech, either in the form of words or sentences. This provides information regarding your ability to detect and discriminate speech.

What treatments and devices can help? Your treatment will depend on your hearing problem, so some treatments will work better for you than others. Here are the most common ones:

- Hearing aids are tiny instruments you wear in or behind your ear. They make sounds louder. Things sound different when you wear a hearing aid, but an audiologist can help you get used to it. To find the hearing aid that works best for you, you may have to try more than one. You and your audiologist can work together until you are comfortable.

- Personal listening systems help you hear what you want to hear while eliminating or blocking out other noises around you. These systems may make it easier for you to hear in a crowded room or group setting. Others are better for one-on-one conversations.

- TV listening systems help you listen to the television or the radio without making the TV too loud for others in the room. These systems can be used with or without hearing aids.

- Telephone amplifying devices. Some telephones are made to work with certain hearing aids. They allow you to listen at a comfortable volume and help to lessen background noise. You can also buy a special type of telephone receiver and other devices to make sounds louder on the phone.

- Auditorium-type assistive listening systems. Many auditoriums, movie theaters, churches, synagogues, and other public places are equipped with special sound systems for people with hearing loss. These systems send sounds directly to your ears to help you hear better. Some can be used with a hearing aid and others without.

- Cochlear implants are for people whose hearing losses are more severe. They require surgery to implant the internal portion of the device. The external portion of the device is worn just behind the ear where it picks up sound and sends it to the speech processor. The speech processor converts the sound into a special signal that is sent to the receiver. The receiver, a small round disc about the size of a quarter that a surgeon places under the skin behind one ear, sends a sound signal to the brain. Cochlear implants are most often used with young children born with hearing loss. However, older adults with profound or severe hearing loss are beginning to receive these implants more often.

Can my friends and family help me? Yes! You and your family can work together to make hearing easier. Here are some things you can do:

- Tell your friends and family about your hearing loss. They need to know that hearing is hard for you. The more you tell the people you spend time with, the more they can help you.

- Ask your friends and family to face you when they talk so that you can see their faces. If you watch their faces move and see their expressions, it may help you to understand them better.

- Ask people to speak louder, but not shout. Tell them they do not have to talk slowly, just more clearly.

- Turn off the TV or the radio if it does not have to be on.

- Be aware of noise around you that can make hearing more difficult. When you go to a restaurant, do not sit near the kitchen, doorway, or near a band playing music, because background noise makes it more difficult for you to hear and understand people when they talk.

- Remember, the most effective communication distance is three to six feet from the speaker, if the person is using a normal conversational voice and the background noise is low.

- Tell your family and friends to speak to you only when they are in the same room and have your attention.

- Determine as soon as possible what the topic of conversation is, even if you have to ask.

- Pay close attention with your eyes and ears to the speaker.

- Do not be over-confident. Do not fake or pretend to understand. Ask for clarification of a missed thought or idea rather than repetition of each missed word.

- Do not get bogged down on one difficult word or phrase. If you keep up, repetition and context will help to fill in the gaps.

- Look and listen for key words and phrases. Each small individual word need not be identified.

Working together to hear better may be tough on everyone at first. It will take time for you to get used to watching people as they talk and for people to get used to speaking louder and more clearly. Be patient and continue to work together. Hearing better is worth the effort.

By Pam Pippenger