Helene Rosenthal’s day starts when she gets out of bed and puts in her hearing aids, something that’s as natural as brushing her teeth. It ends when she climbs into bed and says to her husband, Jim, “Is there anything else you want to say? Because I’m about to not be able to hear you.”

Nearly a decade ago, the New York City couple had very different conversations. Jim found himself often repeating things Helene had missed in social gatherings and shouting at her so she could understand him.

One day, when she asked why he was screaming, he said simply, “Because you don’t hear.”

“That was what really nailed it for me,” Helene recalls. “I said, ‘Oh God, I’ve got to get this taken care of.’”

And she did. She had her hearing evaluated at the Center for Hearing and Communication (CHC), a nonprofit in lower Manhattan that helps everyone from infants to older adults with audiology, speech-language therapy, speech-reading training and emotional health and wellness.

Eight years later, Helene’s moderate-to-severe hearing loss no longer prevents her from living a conversation-filled life.

Her epiphany wasn’t quite as straightforward as it sounds, however. Jim says it took him a couple of years of ongoing prodding to convince her to get tested, even though their daughter, Zooey (who’s now 25), was born with hearing loss and received services at CHC. In fact, hearing loss runs in Helene’s family, so you might think she’d be the first person to recognize the importance of hearing health.

“I was still very reluctant to get hearing aids,” Helene says. “I think it was just because I didn’t see myself as someone who was hard of hearing; I guess I deluded myself into thinking I was very high functioning when in fact I really wasn’t.”

It’s important to focus on how hearing loss is affecting relationships with loved ones.

What’s more, she points out, hearing loss can sneak up on you, unlike vision problems. “You don’t know when you’re not hearing right,” she says. “When you don’t see, you are very aware of what you’re missing out on.”

Six Suggestions for the Conversation

If you have loved ones in denial about their hearing loss, here are six suggestions from the Rosenthals and from CHC audiologist Ellen Lafargue, who serves as co-director of the Shelley and Steven Einhorn Audiology and Communication Center and director of the Berelson Hearing Technology Center:

1. Be Observant. People with hearing loss aren’t the only ones who can be in denial. Their loved ones can be as well. Consider your last big family gathering. Did someone who’s usually engaged in conversation seem withdrawn?

“People just sort of rush by and don’t notice that the person with the hearing loss is not participating anymore,” Lafargue says. “It sort of just passes them by, and the person with the hearing loss withdraws and becomes this silent partner. But they’re, in fact, not a partner at all, because they’re just not participating.”

2. Be Specific. Although Jim broke through his wife’s denial by telling her she couldn’t hear, most of their previous conversations about her problem dealt with specific incidents. “I think it’s important to have specific examples of when the person with hearing loss missed things,” he says. That can focus the conversation on what really matters: relationships.

3. Be Personal. Helene says it’s important to focus on how hearing loss is affecting relationships with loved ones.

“You need to say, ‘I love you, and I want to have a relationship with you — but I need you to hear as well as you possibly can.’ To me, it’s no different than a couple having an issue and going to therapy. It’s something you do to make your relationship better,” Helene says.

4. Be Persistent. Jim acknowledges that it can be frustrating to constantly bring up your loved one’s hearing loss, but he thinks persistence is important. “Don’t feel like it’s a one-conversation thing and you either get it right or give up,” he says.

After all, had he not been persistent over many months, he and his wife might still be shouting at each other. “Eight years later, we are still married and no longer arguing — well, at least most of the time,” Helene says.

5. Be Prepared. Do your homework before broaching the subject. Understand that hearing aids are just that — aids to hearing, not a cure — and that the technology has come a long way since Aunt Millie flushed her hearing aids down the toilet in frustration.

“You need to say, ‘I love you, and I want to have a relationship with you — but I need you to hear as well as you possibly can.’”

Compared to the past, today’s hearing aids are much more adjustable, do a better job of suppressing background noise and often come equipped with Bluetooth, which lets you take phone calls (with microphones on the hearing aids) without reaching in your pocket. (That feature alone might convince your loved one that hearing aids aren’t just for the very old.)

You should also understand cost. Hearing aids can be quite expensive, depending on the brand and quality. The average cost of a single digital hearing aid ranges between about $1,000 and $6,000, according to ConsumerAffairs, a consumer news business. Americans pay an average of about $2,300 per pair, according to MDHearingAid, a hearing aid services company in Southfield, Mich.

While private health insurance plans don’t typically cover hearing aids, Lafargue says it doesn’t hurt to check. Medicare doesn’t cover the cost of hearing aids, but it is possible to find financial assistance for hearing aids through a number of national and community nonprofits, professional associations and colleges.

“It varies state by state, but in New York state, if you qualify for Medicaid, you can get a hearing aid through that program,” Lafargue says. “People who have served in the military, if the hearing loss was caused by their noise exposure in the service, can qualify for hearing aids at no cost.”

Over-the-counter (OTC) hearing aids to treat mild-to-moderate hearing loss will soon be on the market,  possibly in 2020. And Lafargue thinks they might cost as little as $500 a pair.

But can inexpensive OTC hearing aids be of decent quality? Lafargue says to think about them as sort of like reading glasses; they can help a person get by for a couple of years before transitioning to prescription glasses. She also says some audiology centers will help people get their OTC hearing aids configured.

An important distinction to keep in mind: If you see products marketed as OTC hearing aids now, they’re actually personal sound amplification products, or PSAPs, which aren’t regulated by the FDA.

6. Be Dishonest (sort of tongue in cheek). If all else fails, Lafargue says, you could tell your loved one that you’re the one with the hearing problem and that you should both get tested. If you do go that route, however, be prepared for a surprise.

“More often than not, the person who was the instigator has some amount of hearing loss themselves and had no idea that they did,” she says.