October 21, 2024

In Praise of Hearing Aids

Reading Time: 15 minutes

Millions of Americans Could Improve Their Lives With a Simple, Miraculous Device. What’s Stopping Them?, Millions of Americans who could benefit from them don’t use them. Why not?, When I suddenly lost my hearing, I had to confront the truth about hearing

One morning this past March, I stirred from slumber convinced that someone had snuck in overnight and packed my ear with Jell-O. Still drowsy, I registered that the fullness seemed to extend horizontally toward the window, some six feet away. I sat up, thinking this would bring some sense to the situation. It did not.

I later learned that I had experienced ‘unilateral sudden sensorineural hearing loss,’ commonly known as sudden deafness. There are an estimated 66,000 new cases in the United States each year; its cause is rarely identified. In around half of those cases, people will recover their hearing spontaneously or with timely medical care. For the rest of us, the hearing loss will be permanent.

I was doing research overseas, on sabbatical from the law school where I teach, when my case of sudden deafness struck. The hearing loss wasn’t total: I could still hear loud noises clearly, like a ringing phone or a police siren, but I struggled to make out speech. Unless I was in a quiet space, with a single person speaking directly to my face, conversations involved a lot of guesswork.

It would be five months before I’d be back home and able to access the follow-up treatment needed to get hearing aids. In that time, I developed some adaptation strategies and began, to a degree I was unaware of, to normalize moving about in a world where my brain got only part of the auditory input that those around me were receiving. This has given me a glimpse into a few of the reasons why just 16 percent of Americans between the ages of 20 and 69 years who would benefit from hearing aids ever use them. Some 20 million go without.

Untreated hearing loss generates a cascading set of consequences. Hearing is vital to communication. As communication becomes more difficult, social isolation increases, which in turn can cause or exacerbate loneliness, anxiety, and depression. Social isolation also limits opportunities for cognitive functioning, and navigating the world in the face of hearing loss depletes cognitive resources that would otherwise be used to maintain brain function.

Among older adults, the data on the relationship between hearing loss and cognitive decline is clear. Even mild hearing loss is associated with doubling the risk of dementia. As Professor Jan Blustein at NYU School of Medicine puts it, ‘Hearing better helps you think better.’ Nonetheless, for American hearing aid users there is, on average, a 10 year time lag between when they need support and when they start using hearing aids. Why?

Most hearing loss happens gradually. That’s part of the explanation for our widespread failure to adopt hearing aids. Humans are extraordinarily adaptable and with that comes the ability to normalize almost any situation we find ourselves stuck in. Even in my outlier case of overnight hearing loss, the adaptation process began its work and soon took on a life of its own.

Some of the adaptation was doable and, in fact, healthy. When my 11-year-old yelled out a question from upstairs, I would tell him that I couldn’t answer unless he came downstairs to speak to me directly. Calling out to people from a different room was a habit he needed to break anyway.

I told my colleagues at work what had happened, and their efforts to look at me directly when they spoke made one-on-one conversations manageable. Still, when visitors came and a group conversation ensued, I soon got lost. Only occasionally did I feel confident that my need to understand the specific words that they were saying was important enough to interrupt the flow of a lively discussion. Mostly, I rationalized that it was enough to get the gist of what everyone was talking about—I could always follow up with a colleague for the details later on.

But, often, getting what I needed required more effort than I could muster. There are periods in any given day when my kids have the energy of pucks flying across an air hockey table. Asking my 6-year-old twins to stop midslide in order to stand still long enough to speak their words clearly to my face could be achieved once, maybe twice, in an afternoon.

In other situations, straight-up embarrassment got the better of me.

One night my husband and I were having drinks with another couple, close friends that I had told about my hearing loss. We had been talking about different conflicts we had worked on, and one friend, David, made a passing reference to one of those conflicts—I just didn’t catch which one. His wife then launched into a story about a mutual friend who had worked there and everyone laughed, including me. But I still had no idea whether we were in Gaza, Darfur, or Ukraine.

I waited for a pause in the conversation that would enable me to introduce a new topic. That way, I would know what we were talking about. (I later recognized this was a tactic I’d seen my mum adopt on FaceTime with my kids, whenever she wasn’t wearing her hearing aids.) But before I got my topic-changer in, David asked me what I thought about the International Criminal Court’s latest decision in the situation.

I was sitting beside my husband, glass of wine in hand, with two dear friends who knew I had lost my hearing. There could hardly have been a more forgiving scenario in which to simply admit the truth—that I didn’t know what we were talking about. But doing so would have required me to acknowledge that I had been faking my way through the prior 10 minutes of conversation.

Instead, I froze. I looked at my husband, wondering if he knew I was lost. There was a silence that probably felt longer to me than it actually was.

‘You go first, babe,’ I said, hoping that his answer would give me enough of a hook to guess which conflict everyone had been discussing.

When we went to bed that night I tried to explain, to myself as much as to him, how I had managed to isolate myself so fully, while in the company of people who love me and would be mortified to learn that I was unable to ask them for the smallest of help.

I booked an appointment with an audiologist for the morning after we arrived back in the United States. The test results were as sobering as I expected. The window for hearing loss recovery in cases like mine is short; steroids should be administered within a matter of days. The audiologist told me I would need to wear hearing aids for the rest of my life, as I knew he would.

I spent the following days puzzling, intently, over my conflicted reaction to the prospect of wearing hearing aids. I wanted to hear clearly again. I knew hearing aids would help me do that, and at the same time, I didn’t want hearing aids. I oscillated between not wanting to be the only parent with hearing aids at my kids’ elementary school and not wanting to be put off hearing aids because of embarrassment. I vented to my husband about the irrationality of a society that stigmatizes something that helps rectify hearing loss. Then I asked him if he would still love me if I had to wear hearing aids. (Answer: Yes. Also, you know that’s a ridiculous question, right?)

At my follow-up appointment a week later, the audiologist walked me through the contract to purchase hearing aids. I stopped him right before the signature line.

‘How sure are you that I really need these?’ I asked him.

Hadn’t I managed to get by for the past five months without hearing aids? Had it really been that bad?

The audiologist smiled kindly. Presumably I wasn’t his first patient to have made a last-ditch effort to deny reality. Then he pulled up my audiology results. I looked at the plunging slope of crosses, marking out the decibels at which my left ear could detect sound. Even my good ear couldn’t make it into the shaded section where normal hearing resides.

‘I know, I know,’ I said, and signed the contract.

Hearing aids and glasses are superficially similar; they are both forms of technology designed to address a sensory deficit, and at some point in life, most people will need to wear them. Socially though, they are curiously distinct.

It is true that for some adults, glasses are something they would rather not need. Those people, along with some athletic types, are catered to by the contact lens market. Still, my sense is that for most people glasses are a necessity that just becomes part of daily life, noticeable mainly by the annoyance of forgetting where you last left them. At the other end of the spectrum, glasses can be a form of self-expression; one can try out innumerable choices of color, size, and style. Celebrities sport them. They are as much about fashion as they are about function. What they are not is a significant source of embarrassment or shame. Nor are they uniformly read as a sign of aging (even though in plenty of cases they are exactly that). By contrast, consider how, when most people encounter a neighbor or colleague who has just begun to wear hearing aids, they studiously avoid acknowledging the presence of a piece of plastic newly appended to their acquaintance’s ears. Virtually no one looks at a pair of hearing aids and thinks, How fabulous!

The vast majority of hearing aids suitable for moderate-to-severe hearing loss seem to be fighting against their own existence. They literally cannot hide themselves, since they attach to the outside of the wearer’s ear. Nonetheless, they try.

As the audiologist walked me through the catalog of options for the type of hearing aid I needed, my stomach tightened. Descriptions like ‘nearly invisible’ and ‘discreet’ appeared on each page. They came in a small range of colors: sand, terra cotta, chestnut. Maybe I wasn’t thrilled at the prospect of hearing aids. But since they were a non-negotiable part of my future, I wanted to at least walk out of there with a pair that proclaimed they were nothing to be ashamed of.

‘I don’t suppose you have any hearing aids in bright yellow do you?’ I asked the audiologist.

A look of bemusement flickered across his face. I would wager most of his patients are not asking for a way to project ‘fuck you’ to the socially constructed stigma around hearing aids. But then most of his patients are probably burdened by the compounding problem of ageism, which I am not (yet) having to battle.

‘Um, I’m afraid not,’ he said, with a tone that suggested he wasn’t entirely sure if I was serious.

‘If you’re interested in something a bit more, individual, there is an ‘Atlantic green.’ ‘

I looked at the picture. I would have called it moss green myself, but at least it wasn’t beige by another name. I took them.

Stigma does not bear the sole responsibility for the abysmal uptake of hearing aids among those who need them. Cost has long been prohibitive, with good quality hearing aids averaging $4,600 for a pair. The move, in August 2022, to allow hearing aids to be sold over the counter is positive in this regard, with OTC options ranging from $99 to $3,000. Apple is the latest mover in the OTC market, with software being launched later this month that will enable its AirPods Pro 2 to be used as hearing aids—at least for people with mild-to-moderate hearing loss. For those who are already Apple users, this software will give them access to hearing aid technology for $249. (Although, the AirPods’ current battery life of just five to six hours will limit its utility). But affordability alone cannot solve our widespread underuse of hearing aids, which we should be discussing as a black spot in American public health.

Another piece of this puzzle stems from the way that hearing aids work. Despite superficial similarities, glasses and hearing aids are meaningfully different when it comes to how they function. Glasses are a quick fix; hearing aids require time and effort by the user before there is any clear payoff. And the failure to communicate this to the public can inhibit the successful adoption of hearing aids. One of the reasons I know this is that I experienced it a couple of years ago, before the sudden deafness, the first time I tried hearing aids.

During that appointment, I was just like most novice visitors to an audiology office—I had been worried about my hearing for years before finally going to get tested. There were a few factors behind my reluctance to seek out treatment. In my teens, fear of getting questioned about my living arrangements had stopped me going to the hospital after my boyfriend’s fist had left my ear throbbing for days. Later, it took surgery to remove the cluster of debris that had accumulated behind my eardrum—something that can happen after eardrum damage occurs. I also hadn’t done my hearing any favors by working the graveyard shift at a nightclub during college—eight uninterrupted hours at a stretch of noise exposure that vastly exceeded safe levels. So, for a long time, I assumed my hearing was not as good as other people, but I also felt it was partly my fault. And anyway, audiologists were expensive, and my hearing didn’t seem to be stopping me from doing everything I needed to do—at least, for many years.

Then, I became a law professor, entrusted with teaching a new generation of lawyers. At the start of a teaching career, detailed notes resting on a podium at the front of the room are a vital safety net. But they also lead new professors to become glued to that position in the room, reifying the power imbalance that already exists: professor as oracle, center-front at the microphone. I was determined to foster a different kind of classroom. And while I didn’t draw the connection at the time, my subpar hearing was an ally in this effort.

Women’s voices are, in general, harder to hear than men’s. From behind the podium I could reliably hear every question my male students asked. The same was not true with my female students. If I wanted to be sure to catch every word, I had no choice but to move out from the safety of the podium and walk up the aisles to where they were seated. Of course, it would have been weird to spend my lectures walking up to female students only, so I developed the habit of doing it across the board.

In the beginning, this worked for both me and my students. But as class sizes grew bigger each year, I found myself spending more and more time walking the aisles between students. It was starting to become obvious to me, if not yet to them, that avoiding the podium was more about accommodating my hearing loss than it was about constructing an optimal learning environment. So I finally made an audiology appointment.

At that point my hearing loss was still fairly mild, and I was buoyant at the prospect of testing out trial hearing aids—mostly because I thought they would bring instant gratification, much like the first time I wore glasses. (Some 25 years later, I still remember the euphoria of suddenly being able to see individually differentiated leaves on a distant tree.)

I put the hearing aids on for my first lecture of the week, fully expecting to experience the joy of a regular soundscape. The reality could hardly have been more different. I was so flummoxed by the artificiality of the noises entering my ears that I couldn’t concentrate on what I was saying, let alone what my students were asking. I took the hearing aids out the minute the lecture finished. I did try them once more, for my second lecture of the week, with similarly disappointing results. I returned them the next day.

This time round my (soon-to-be long-suffering) audiologist began with a game-changing explanation: ‘People think you can treat hearing aids like glasses; put them on when you need them and take them off when you don’t,’ he said, adding that hearing aid users repeatedly report putting on their hearing aids when heading out to a noisy restaurant, then taking them off again as soon as they get home. ‘But that’s not the right way to think about hearing aids. Think of it more like entering a relationship with a physiotherapist.’

I had been navigating the world for five months with less than half the auditory input I needed. Rebuilding the connections between the external soundscape and my brain would mean relearning how to process the auditory input that I had been missing, much like how physiotherapy can teach you to reuse a muscle. Adjusting to hearing aids takes consistent, daily work.

When you first put on hearing aids, you are hit by a tinny, artificial sound. You cannot recognize your own voice. If you are lucky enough to be able to afford an audiologist, instead of the over-the-counter approach, you will have a specialist who can, in the appointment where you are given your hearing aids, start to tailor the settings to something that feels closer to what you remember as the sound of the world you used to know. (Some OTC hearing aids come with settings prefixed for an average user, while more expensive versions, as well as Apple’s new product, allow users to adjust the settings themselves based on instructional guides that come with their purchase.) But even in an optimal scenario, the best you start out with is a degree of ambivalence. (For this reason, I hope Apple will extend its regular 14-day return policy before launching the AirPods Pro 2 for hearing aid use.)

‘We recommend that people wear their hearing aids for all waking hours,’ my audiologist had told me. ‘You may think you’re in a quiet room, but even if no one else is around, there is still sound. Give your brain the chance to experience it.’

I put ‘All Waking Hours’ on a Post-it note and stuck it to my laptop. From the minute I penned my signature to that sales contract, I was determined to fall in love with my hearing aids. If I was to have any shot at that, I needed to actually follow the advice I had been given.

Shortly before I lost my hearing, I had begun training for an open water swim marathon—eight miles from Switzerland to France across Lake Geneva, no stopping, no assistance. I had never swum anything close to eight miles before, and the reasons for trying exceed the scope of this essay. But when I lost my hearing, the hours of early morning training became a refuge. When I was underwater, my hearing loss no longer mattered. No one was speaking. I didn’t need to listen. I got to reclaim all of my cognitive resources the minute I began my first stroke.

When, a few hours into a training swim, my right shoulder muscle would insist that it couldn’t do the catch, pull, release of one more stroke, I would rebuff its claim, replying that there was no place on earth that I would rather be. And I meant it. Perhaps my shoulder muscles were exhausted, but my entire auditory processing system was reveling in the equivalent of a luxurious Sunday morning sleep-in. I wasn’t conscious of any of this though, until I got my hearing aids. I had chalked up the rapture of swimming for three, four, five uninterrupted hours at a stretch solely to the joy I have always felt being alone in a body of open water.

Over the course of five months I had gradually lost awareness of the degree to which my brain had been working overtime to allow me to continue to function, as a parent, spouse, friend, and colleague. Awareness only returned on the third day after I got my hearing aids.

I had done an early morning swim at our local pool in D.C. Though committed to wearing my hearing aids for ‘All Waking Hours,’ I was drawn into the kids’ breakfast routine before heading upstairs to shower, change, and put in my hearing aids for the day.

‘What do you want on your toast?’ I asked my 9-year-old daughter.

‘–utter an– –e–e–ite,’ I heard in reply.

For the first time in five months I realized what I had been doing. I heard the fragments of words and, a split second later, tranMediaDownloaderd them into what my daughter had actually said. (‘Butter and vegemite.’) This whole process had been occurring without me realizing it. No wonder I had started going to bed before my kids. Getting through any given day had been exhausting.

In late August I returned to my normal teaching schedule at American University. I was scared. I should start with that. I was scared about whether, even with my hearing aids, I would be able to keep up with the quick-fire exchanges that fill my classroom as I engage law students in the Socratic method. What I tried really hard not to be, though, was embarrassed or ashamed.

So far, I’m doing pretty well. I no longer flinch at the crackly sound my hearing aids make when I first put them on in the morning. My own voice is starting to sound, if not normal, at least not distracting. I no longer struggle to figure out where in space a noise is coming from. And speech in a range of settings is legible once more. The biggest benefit, however, is that I am no longer living in a constant state of disgruntled fatigue.

Adjusting to hearing aids is not easy. I understand why people give up, or treat them as a nuisance to be tolerated on an occasional basis. But not adjusting to hearing aids is worse. One of my twins summed it up after I had explained that I would be getting hearing aids: ‘So what you’re saying is that getting hearing aids sucks, but it’s better than not being able to hear us?’

That is, in fact, exactly what I had been trying to say. But what I would also say now, nearly two months into this journey, is that getting hearing aids could (and should) feel a whole lot better than it currently does.

Especially as we move into the era of OTC hearing aids, medical professionals and OTC salespeople, backed up by public education campaigns, should routinely describe hearing aids the way that my audiologist introduced them to me. Managing the expectations of new users and explaining the logistics of the adjustment period can help preempt the early rejections and persistent underuse of hearing aids.

More fundamentally, imagine if we approached the adoption of hearing aids as something to be publicly embraced, rather than something to wish away? Segments of the audiology community are working to push out exactly this kind of messaging—to reframe the use of hearing aids as an empowering decision that reflects a commitment to cognitive well-being. And there are a precious few public figures, NPR host Mary Louise Kelly comes to mind, who speak openly about the benefits of wearing hearing aids. But it is hard to succeed with those messages when both the design and marketing of most hearing aids are working to conceal their own existence.

Of course hearing aids manufacturers will say they are giving the market what it wants; most people want to make their hearing aid use as ‘discreet’ as possible. But disentangling this chicken-egg arrangement must start somewhere. Maybe it is time for a few of the leading hearing aid manufacturers to rethink the assumptions upon which their design choices and marketing materials are based. I noticed that the green hearing aids I went for were on back order, while the bland brigade of other offerings were all immediately available. I don’t believe I’m the only person out there who is interested in having the option of making my hearing aids a visible part of my identity.

As with all social change, each of us can contribute. In the absence of a glorious canary-yellow pair of hearing aids that would alert other people to the fact that my hearing is different to theirs, I’m taking on that work myself. I’ve told my students I am wearing hearing aids, although I could have avoided them knowing if I just stayed behind the podium. I’ve told my colleagues, although I could have avoided it by positioning myself at the back of faculty meetings. I’ve taken these steps because it gives other people the chance to make minor adjustments to their behavior, like turning to face me when they speak, that all people with hearing loss benefit from, whether they wear hearing aids or not.

I’m making my hearing loss visible to people I interact with as one small contribution to the task of dismantling shame around the use of hearing aids. And, in writing this, I’m hoping to reach others who will join me in an enthusiastic rejection of the stigma our society has constructed. The ability to hear each word your child, student, or partner says is a treasure that perhaps only those of us who have lost it can fully appreciate. The existence of a technology that can help us work to reclaim some meaningful part of that ability is magical. If only we would celebrate it as such.

Reference: https://slate.com/technology/2024/10/hearing-aids-loss-sudden-deafness-apple-airpods.html

Ref: slate

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