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By LaGuinn Sherlock, M.A.
"I don't have a problem hearing. If everyone would stop mumbling, I would hear everything just fine." I have heard variations on this statement numerous times during my career as an audiologist.
I also know firsthand the frustration of not hearing speech clearly. I have a mild-to-moderate hearing loss, caused by chickenpox when I was a young child. At that time, hearing aids were not recommended for fear that I would become "dependent" on them. And I have heard that same fear expressed by patients. But the so-called dependency comes from being able to hear better . . . you can bet I'm dependent on them now!
I know the benefits and limitations of hearing aid use. Without hearing aids, I can hear people talking, but I cannot understand what is being said. It sounds like they are mumbling. Without hearing aids, I cannot hear birds and crickets. The absence of these sounds detracts from the pleasure of spring mornings and summer evenings. Without hearing aids, I cannot hear my children calling me from another room. What if they are injured and need my immediate assistance? With my hearing aids, I can hear and understand in each of these situations.
By contrast, trying to listen in a room that echoes, or in a very noisy restaurant, or near a crying baby . . . these situations are generally more unfavorable with hearing aid use. Unfortunately, these are the kinds of situations that prevent potential and unsuccessful hearing aid users from using them. One must consider, however, that these situations probably account for only 10 percent to 15 percent of all listening situations for older people. But that's what the on-off switch is for!
Hearing loss is an "invisible" disability. The invisibility of the condition and the stigma associated with hearing aid use leads to poor use of hearing aids. Individuals with hearing loss who do not use hearing aids report higher rates of depression, sadness, anxiety, and paranoia. Furthermore, they become less socially active and experience greater emotional insecurity. I have encountered many patients who reported that they stopped attending social events and avoided family gatherings, simply because it was too difficult to hear and understand conversation.
The onset of age-related hearing loss is insidious and is therefore often not recognized as hearing loss. You'll frequently hear individuals with age-related hearing loss say to others, "My wife talks too softly," or "Everyone is always mumbling." Age-related hearing loss can be harder to treat with hearing aids than hearing loss related to other causes because not only is there loss of audibility, but there is loss of clarity for speech. Furthermore, overall sound-processing ability slows down. Hence, older individuals who use hearing aids but will continue to say, "What?" contribute to the perception that hearing aids do not help hearing loss.
For many older individuals, other strategies, in addition to hearing aid use, are necessary to improve communication. These strategies include use of
Collectively, these strategies are referred to as aural rehabilitation. This may be provided on an individual basis by the dispensing audiologist, or in a group setting.
Ideally, the hearing aid fitting process includes the following steps:
The steps listed above contribute to hearing aid success. Success is also dependent on daily use as well as acceptance that hearing aids cannot provide normal hearing.
There is no doubt that hearing loss alters lifestyle. While we have not reached the age of reversing all hearing loss, we are in an age of technology that enables better hearing than ever before.
LaGuinn Sherlock, M.A., is assistant director of audiological services at the University of Maryland Medical Center in Baltimore.