I Said What Three Times

My grandson told me a story at dinner in June. Nine years old and already a talker, that kid.

I said “what?” Then I said it again. The third time, he just looked at his plate and said “never mind, Grandpa.”

Never mind, Grandpa.

I’d been blaming the restaurant. Bad acoustics. Too many people. My wife mumbles. The TV volume creeping up two clicks a year for a decade, and I never once thought that was about me.

But a nine-year-old giving up on telling me his story? That got through.

So I went looking. And what I found was messier than the headlines let on.

Search this topic and you’ll get hit with the same claim from every direction. Hearing loss causes dementia. Hearing aids prevent it. Get yours today.

The claim isn’t made up. It comes from real research. Observational studies have linked hearing impairment to roughly double the risk of developing dementia. And the Lancet Commission, which is about as serious as it gets in this field, estimates that 8% of dementia cases worldwide are attributable to hearing loss — making it the single largest risk factor we can actually do something about.

Hearing loss is also common in a way most guys don’t realize. It shows up in about 65% of adults over 60. Two-thirds of people past 70.

And almost nobody treats it. Fewer than one in five Americans who could benefit from hearing aids actually wear them.

Those numbers are solid. But there’s a gap between “linked to” and “prevents,” and that gap is where the marketing lives.

Observational studies tell you two things happened together. They can’t tell you one caused the other. To get that, you need a trial where you treat some people and not others and see what happens.

Somebody finally ran it. The ACHIEVE trial. 977 adults, ages 70 to 84, all with untreated mild-to-moderate hearing loss, none of them showing signs of dementia at the start. Half got hearing aids and proper audiology support. Half got health education instead. Then researchers tracked their thinking for three years.

Here’s the part the headlines skipped. Across the whole group, the hearing aids made no measurable difference to cognitive decline. That was the primary result. No effect.

But the trial had pulled its participants from two different pools. One group came out of a long-running heart study — older, more health problems, higher risk of losing a step mentally. The other group were healthy volunteers who signed up on their own.

In the higher-risk group, hearing treatment slowed cognitive decline by 48%. Cut it roughly in half over three years. In the healthy volunteers, nothing. A later analysis went further: among the participants at the very highest risk, decline was about 58% slower.

So the honest version is this. If you’re in good health with mild hearing loss, hearing aids will probably not protect your brain. If you’ve already got some risk stacked up — age, blood pressure, weight, low activity — they might help a lot. The researchers themselves say more trials are needed before anyone treats this as settled.

Forget the dementia argument for a minute. It’s the wrong reason to act and it’s not proven anyway.

Here’s the real cost of not hearing well, and you don’t need a study to confirm it. You stop going to restaurants because they’re exhausting. You nod along in conversations instead of joining them. You skip the family reunion because eight people talking at once is work now. You laugh a beat late at jokes you didn’t catch.

And the people who love you start editing themselves around you. Shorter sentences. Simpler stories. Never mind, Grandpa.

That’s the thing that gets you. Not a lab result. The slow shrinking of your own life while you tell yourself the restaurant was loud.

If the number in your head is four thousand dollars, your information is out of date. In October 2022 the FDA created a whole new category: over-the-counter hearing aids, sold to adults with self-perceived mild-to-moderate loss. No prescription. No audiologist appointment. No exam required.

That broke the pricing open. Here’s roughly where things sit now.

▸ Over-the-counter. Runs about $200 to $2,500 a pair, with the solid full-featured models clustering around $800 to $1,500. One survey of buyers put the average actually paid at just over $500.
▸ Warehouse clubs. Costco and similar run roughly $1,000 to $1,700 a pair for prescription-grade devices, with a hearing test and fittings included. Buyers there reported saving around 65% versus comparable technology at traditional clinics.
▸ Prescription through a clinic. Generally $2,500 to $6,000 a pair, bundled with testing, fitting, follow-ups, and warranty work. Premium tiers go higher.
▸ The one that surprised me. Apple’s AirPods Pro 2 — $249 — are FDA-authorized to work as an over-the-counter hearing aid with a compatible iPhone. Not a gimmick. A cleared medical device that also plays music.
▸ What Medicare does. Original Medicare covers none of it — not the aids, not the fitting exam. Many Medicare Advantage plans include a hearing benefit, but the allowance and the approved vendor list vary a lot. Check your plan before you shop, not after.

Get a real hearing test first, even though the law no longer makes you. Plenty of places do them free, and a full evaluation in a sound booth runs $100 to $250 at most. It tells you what kind of loss you have and how much. It also catches the easy stuff — a good chunk of muffled hearing turns out to be earwax, and that gets fixed in one appointment.

One important exception. If your hearing dropped suddenly, or it’s clearly worse in one ear than the other, or it came with ringing, spinning, or pain, don’t shop online. Call a doctor this week. Sudden hearing loss is treated as urgent and the window for treating it is short.

If the test says mild to moderate, start over the counter. Buy from somewhere with a real return window and use it — wear them in a restaurant, on the phone, at a family dinner, not just around a quiet house. Give it a few weeks. Your brain needs time to stop treating amplified sound as noise.

If the test says severe, or your loss is uneven between ears, or you tried over-the-counter and it didn’t take, go see an audiologist. That’s where the money is worth spending — not on the hardware, on the person who tunes it to your actual ears.

I got tested in July. Moderate loss in both ears, worse in the high frequencies. Which is exactly where consonants live — the sounds that tell you the difference between fifty and fifteen, or between cat and hat. That’s why my wife sounded like she was mumbling. She wasn’t.

I started with a pair of over-the-counter aids. Eleven hundred dollars. First few days I hated them — my own chewing sounded like gravel in a bucket. Around day ten my brain caught up and they mostly disappeared.

Two weeks ago the whole family came over. My grandson sat next to me and told me a long, winding story about a kid at camp with a slingshot.

I got every word of it. Didn’t ask him to repeat a thing.

I still don’t know whether these things will do a single thing for my brain twenty years out. The research isn’t there yet and I’m not going to pretend otherwise.

But I got the story about the slingshot. That was worth eleven hundred dollars by itself.

— Walter