Mrs N is a 75-year-old Latina woman evaluated for a 2-to 3-year history of hearing loss, more bothersome to family members than to herself. Mrs N lives with her husband of 49 years in their own home. She previously worked as a private tutor of Spanish and English at a language school. She is independent in activities of daily living. Although she denies having significant hearing problems, when pressed, Mrs N acknowledges having to increase the television volume, often choosing subtitles for greater comprehension, and having some difficulty with telephone conversations. It is difficult for her to understand speech in group settings. Her husband and daughters have noticed that she sometimes completely misunderstands what they are saying and must ask for clarification.Medical history is significant for varicose veins, hypercholesterolemia and hypertension both controlled by diet, and recent herpes zoster. She is taking no medications. On review of systems, she states that she does not have headaches, visual disturbances, or balance problems. She wears eyeglasses.On physical examination, the pinnae, canals, and tympanic membranes appear normal. Two years ago, audiometry documented bilateral symmetric moderate to severe sensorineural hearing loss, more pronounced in the higher frequencies, meeting criteria for bilateral hearing aid augmentation. Although her audiologist recommended a hearing aid evaluation at the time of examination, Mrs N and her sister did not think she needed it, so she did not undergo the evaluation. One year later, the audiologist again recommended a hearing aid consultation, but it was only after Mrs N's daughters pressured her repeatedly that she agreed to proceed with a hearing aid fitting.Mrs N and her daughter were interviewed by a Care of the Aging Patient editor between January 5 and 11, 2011. Perspectives Mrs N: To be truthful, I didn't notice anything [at first about hearing difficulties]. My daughters started telling me that I See also pp 1147 and Patient Page. CME available online at www.jamaarchivescme.com and questions on p 1207.