"My co-workers would have to speak up. I found I was reading lips," said Cage, now 59 and interim director of the economic development partnership at N.C. State University.

With a family history of hearing problems, Cage had her hearing tested. The tests showed she had lost 40 percent of the hearing in both ears.

The baby boom generation is finding that their parents were right: Rock 'n' roll was bad for them. Now they are expected to pump up the number suffering hearing loss from 32.5 million to 40 million by 2025, according to the National Institute on Deafness and Other Communication Disorders. And because people have continued to listen to loud music through small devices (think ear buds), those numbers are only expected to go up.

All of that is music to the ears of those who sell hearing aids. Sales now total about $4 billion annually, according to the Better Hearing Institute, a nonprofit educational group. Fitters are rushing to open new offices to keep up with demand. And manufacturers are scrambling to make products more appealing in style (snakeskin) and size (too small to be seen) and with better technology.

But the high-style look comes with high prices. Retailers -- audiologists and licensed fitters -- routinely add 100 percent markups to manufacturers' prices, said Don Schum, vice president for audiology of Oticon, a Danish company that is the world's second-largest hearing aid manufacturer. Many of the devices retail for $2,000 to $3,000 each.

Manufacturers and retailers say prices reflect expensive research, quality improvements and overhead costs. That offers little solace to wearers who must pay the cost themselves: Hearing aid purchases generally aren't covered by health insurance or Medicare.

Clayton retiree James McGrath spent $3,400 for a pair of hearing aids to correct hearing loss he traces to Navy duty next to a five-inch cannon during the Korean War.

"It certainly was a hardship," said McGrath, 75.

Government policymakers have been reluctant to require more coverage or provide it though Medicare. With prices of hearing aids showing few signs of coming down and the numbers of sufferers rising, more people will face a difficult choice: Ante up big bucks for a hearing aid or keep screaming "What?" into the telephone.

"I don't want to create an alarm, but it is a big issue," said Sergei Kochkin, executive director of the Better Hearing Institute.

Much of the increase in hearing loss can be attributed to population growth. Older Americans' hearing loss often could be traced to industrial sources and service during WWII or the Korea war. Though Occupational Safety and Health Administration rules have reduced workplace noise, recreational sources such as amplified music have joined firecrackers, hunting and construction din as potential causes.

Boomers are "the first generation where rock and roll has had a negative impact on hearing," Kochkin said. "But an iPod is louder than a stereo. They're probably in more danger now than when you were a child." Already, one in 14 of those age 29 to 40 have hearing loss, according to the Better Hearing Institute.

Jerry Hatfield-Berrang owns five Audibel hearing aid centers, including locations in Raleigh, Cary and Durham. His business is up 15 percent to 20 percent in the past two or three years. Sales totaled $1 million during the first half of 2007, he said, adding that many of the new customers are baby boomers.

Wearers "used to be Grandma Jones sitting in the rocking chair, but now people want to stay in the game of life, and hearing is vital," Hatfield-Berrang said.

Mark Walser of Raleigh opened eight Avada Audiology & Hearing Care centers this year, including offices in Fuquay-Varina, Graham, Roxboro and Wake Forest. He already had 42 stores in North Carolina, including in Cary, Garner and Raleigh.

"Demand has gone up, and in the first six months of this year, it's been phenomenal," Walser said. A new digital hearing aid that comes in 51 finishes, including ostrich and snakeskin, caused much of the increase, he said.

In the old days, hearing aids were noticeable, large and unattractive. Now one new model that can cost as much as $3,000 each resembles a small guitar pick, fits behind the ear and matches hair colors. Walser also offers a $295 "Vocal Modesty" entry-level device.

Like other vendors, Walser declined to discuss profits, but said prices reflect overhead, including malpractice insurance, employee training costs, fitting and testing, and free follow-up visits every three months for life. If buyers don't want the features of expensive models, they can get the cheaper version.

"It depends on what you want," he said. "If you want really good noise reduction, it costs more, and if you just want sound amplification, it costs less."

Schum, the Oticon executive, said upgrading technology was expensive. Older aids had only one microphone to pick up sound. Newer models have multiple microphones and circuitry that separates speech from background noise.

In 2006, Oticon sold 8 million hearing aids worldwide. Revenue was $900 million and net income was $153 million, but the company spent $80 million on research and design. "There's a tremendous amount that goes into them besides materials," Schum said.

But with aid prices averaging $1,800, according to the Better Hearing Institute, some are calling for more coverage by insurers or the government.

"It's a travesty," said Johnnie Sexton, an audiologist and president of the N.C. State Hearing Aid Fitters and Dealers Board. "When you get into that pricing world, I don't know how to make it any easier without public assistance."

Little help in N.C.

North Carolina doesn't require insurers to cover hearing aid costs.

Blue Cross and Blue Shield of North Carolina, the state's largest health insurer, pays $250 or 25 percent of the manufacturer's suggested retail price, whichever is higher, said spokesman Lew Borman.

"It's not a medical necessity," Borman said. "It's like glasses and lens prescriptions."

Ten other states require insurers to help pay the costs of children's hearing aids, but only Rhode Island requires adult coverage, according to the Hearing Industries Association. A bill pending in Congress would offer a $500 tax credit per hearing aid every five years, but the proposal has been made several times before and never passed.

More than hearing lost

Kochkin, the Better Hearing Institute director, said there's more at stake than just better hearing. Studies show people that with untreated hearing loss can make $12,000 less than their counterparts who have hearing aids.

"They get passed over for promotions. They're messing up their lives and the quality of life for their entire families," he said.

Cage, the NCSU official, said life hasn't been the same since she spent $5,000 for two hearing aids.

"I was beginning to doubt my own intelligence because of mishearing everything," said Cage, who has a master's degree.

"I didn't know the birds sang all day long, I thought they only sang when I took the dog out in the morning. I couldn't hear my friends' children," she said.

"It's made a huge difference in my life, professionally and personally," she said.

By Dudley Price
http://www.newsobserver.com/business/story/645479.html