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- Herausgeber: John Wiley & Sons
- Kategorie: Fachliteratur
- Sprache: Englisch
Improve your hearing, enhance your life
With new advice on just-released over-the-counter hearing aids
Hearing loss can be frustrating, but in fact it’s common and treatable. Hearing Loss For Dummies, written by top experts in the field in collaboration with AARP, walks you through how to get the help you need to clearly hear the sounds of life—whether you’re at home, at work, or out and about. And hearing health is critical: Hearing loss can increase your risk of falls and injuries, isolation and depression, and even cognitive decline and dementia.
Authors Frank Lin and Nicholas Reed at the Johns Hopkins School of Medicine lay out the steps to hearing health:
- Understanding how hearing works—and how it changes as we age
- Finding specialists you can trust
- Determining whether you need testing and, if so, where to turn
- Using your Hearing Number™ to monitor how your hearing changes over time
- Learning practical solutions for hearing better at home, at work, on the phone, and in restaurants and theaters
- Choosing the right hearing aid, including just-approved over-the-counter hearing aids, and getting them adjusted to work for you
- Exploring the pros and cons of cochlear implants and other surgical options
- Covering the costs of hearing health care
If you’re concerned about your own or a friend or relative’s hearing, this is the one book you’ll need. For what can seem like a complicated, stressful and lengthy process, Hearing Loss For Dummies tackles the topic head-on and provides you with expert guidance to put your mind at ease on the path to better hearing.
* ™ Johns Hopkins University
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Veröffentlichungsjahr: 2022
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Hearing Loss For Dummies®
Published by: John Wiley & Sons, Inc., 111 River Street, Hoboken, NJ 07030-5774, www.wiley.com
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Library of Congress Control Number: 2022941589
ISBN 978-1-119-88057-8 (pbk); ISBN 978-1-119-88058-5 (epdf); ISBN 978-1-119-88059-2 (epub)
Hearing Loss For Dummies®
To view this book's Cheat Sheet, simply go to www.dummies.com and search for “Hearing Loss For Dummies Cheat Sheet” in the Search box.
Table of Contents
Cover
Title Page
Copyright
Introduction
About This Book
Foolish Assumptions
Icons Used in This Book
Beyond the Book
Where to Go from Here
Part 1: Understanding Hearing Loss
Chapter 1: Cheers to Your Ears!
Understanding Why Hearing Loss Happens
Putting Hearing Loss in Context
What You Can Do about Hearing Loss
Getting the Support You Need
Chapter 2: Understanding How Hearing Works
What Is Sound?
To Hear, You Need Your Ear!
Hearing with Your Brain
Pinpointing Where the System Can Break Down
Experiencing Trouble Hearing
Chapter 3: Looking at Types of Hearing Loss and Minimizing Risk
Discovering Why Hearing Gets Worse Over Time
Knowing the Causes of Hearing Loss Over Time
Minimizing Your Risk for Hearing Loss
Considering Other Conditions That Affect Hearing
Causing Tinnitus
Chapter 4: Realizing What You Lose When You Can’t Hear
Communicating Is Like a Game of Catch
Watching for a Reduction in Social Interaction
Monitoring Mental and Emotional Health
Losing Physical Abilities
Dealing with a Decline in Cognitive Function
Part 2: Evaluating How You Hear
Chapter 5: Recognizing Hearing Loss
Missing the Signs of Hearing Loss
Sussing Out Whether Your Hearing Has Declined
Knowing When to Get Your Hearing Tested
Shrugging Off the Stigma of Hearing Loss
Chapter 6: Seeing a Hearing Loss Professional and Getting Tested
Getting to Know the Hearing Care Team
Preparing for the Assessment
Knowing What to Expect during the First Part of the Diagnostic Hearing Test
Checking Out Other Hearing Assessment Measures
One and Done or a Regular Occurrence?
Chapter 7: Making Sense of Your Hearing Test Results
Understanding the Importance of Reading Results
Introducing the Audiogram: What Does That Graph Mean?
Defining Hearing Loss with the Audiogram
The Hearing Number: An Easier Way to Make Sense of Your Hearing
Guiding Your Hearing Health Journey with Your Results
Part 3: Taking Charge of Your Hearing
Chapter 8: Fine-Tuning Your Life to Hearing Loss
Discovering Where Adjustments Can Be Made
Finding No-Tech Communication Strategies for Everyday Situations
Optimizing Your Listening Environment
Using Everyday Technology Strategies
Speaking Up for Yourself
Seeking Out Support Groups
Chapter 9: Looking at How Hearing Aids Work
Understanding Hearing Aids
Checking Out the Different Styles of Hearing Aids
Chapter 10: Understanding Your Hearing Aid Options
Discovering Where to Start for Your Needs
Knowing Two Ears Means Two Hearing Aids
Choosing a Prescription Hearing Aid
Navigating the Over-the-Counter Hearing Aid Pathway
Choosing Basic or Premium Hearing Aids
Chapter 11: You’ve Got Hearing Aids: Now What?
Setting Expectations Is Key
Getting Used to Your Hearing Aids
Adjusting and Manipulating Your Hearing Aids
Caring for and Maintaining Your Hearing Aids
Knowing When It’s Time to Upgrade Your Hearing Aid to a New Generation
Chapter 12: Technology That Boosts Hearing and Hearing Aids
Captioning Your Life
Outfitting Your Home with Hearing-Friendly Tech
Talking about Integration Technology
Checking Out Hearing Aid Accessories
The Mighty Telecoil: Getting a Direct Connection to Sound Signals
Sounding Out Personal Amplifiers
Chapter 13: Medical and Surgical Treatment of Hearing Loss
Looking into Medications That Treat Hearing Loss
Checking Out Different Surgeries for Hearing Loss
Part 4: Supporting Hearing Needs
Chapter 14: Helping Those with Hearing Loss
Noting How Hearing Loss Influences Relationships
Understanding Hearing Loss from the Other Side
Discovering How to Be a Good Communication Partner
Figuring Out Hearing and Communication Needs
Supporting People on Their Hearing Care Journey
Chapter 15: Paying for Hearing Care
Paying for Hearing Services
Breaking Down Hearing Aid Costs
Chapter 16: Your Rights as Someone with Hearing Loss
Looking into Disability and Hearing Loss
Understanding the Role of the Americans with Disabilities Act
Navigating the Social Security Administration Disability Benefits
Advocating to Advance Your Hearing Rights
Part 5: The Part of Tens
Chapter 17: Ten (Plus One) Considerations When Purchasing Hearing Aids
Paying More Does Not Guarantee Better Outcomes
Selecting from the Many Styles
Choosing a Brand
Seeking Hearing Aids with Telecoils
Powering Your Hearing Aid with Rechargeable Batteries
Deciding on Open or Closed Fit
Insuring Your Hearing Aids with a Trial Period Warranty
Customizing and Supporting Your Hearing Aids
Monitoring Health with Hearing Aids
Accessorizing Your Hearing Aids
Setting Expectations and Practicing
Chapter 18: Ten Everyday Strategies to Hear Better
Get Close and Face-to-Face
Recognize the Hearing Needs of the People You’re Talking With
Turn Down the Background Sounds
Don’t Just Ask “Huh?”
Choose Good Listening Environments
Use Closed Captioning
Wear Headphones When Listening to Music or Watching Media
Use Video Calls or VOIP When Calling Others
Customize the Hearing and Sound Features on Your Smartphone
Know Your Hearing Number
Chapter 19: Ten Myths about Hearing Loss
Hearing Loss Is Just Part of Getting Older so It Can’t Be That Important
My Hearing Is Fine; It’s Just That Everyone Is Mumbling
Trouble Hearing? Just Have People Shout!
I’ll Wait to Get My Hearing Tested Until I Notice a Problem
I’ll Address My Hearing Loss Later When It Gets Really Bad
I Have Hearing Loss. Now I Need Hearing Aids?
Hearing Aids Fix Your Hearing
I Can Just Put in My Hearing Aids and They’ll Work Fine
A Cochlear Implant Is Only for People Who Are Completely Deaf
I Should Keep My Hearing Loss to Myself
Index
About the Authors
Advertisement Page
Connect with Dummies
End User License Agreement
List of Tables
Chapter 7
TABLE 7-1: Categories of Hearing Loss
Chapter 9
TABLE 9-1: Hearing Aid Styles Pros and Cons
List of Illustrations
Chapter 1
FIGURE 1-1: Prevalence of hearing loss in the United States.
Chapter 2
FIGURE 2-1: Visual spectrogram of ten seconds of a Bach piano concerto.
FIGURE 2-2: Visual spectrogram of the phrase, “I’ll see you Sunday.”
FIGURE 2-3: Visual spectrogram of the phrase, “I’ll see you someday.”
FIGURE 2-4: Diagram of the external, middle, and inner ear.
Chapter 6
FIGURE 6-1: An otoscope, which is used to look into the ear.
FIGURE 6-2: Taking a hearing test in a booth.
FIGURE 6-3: Earphones (left) and over-the-ear headphones (right).
FIGURE 6-4: Air conduction.
FIGURE 6-5: Bone conduction.
Chapter 7
FIGURE 7-1: A blank audiogram.
FIGURE 7-2: The audiogram with categories of hearing loss.
FIGURE 7-3: The audiogram with hearing assessment results.
FIGURE 7-4: The audiogram of familiar sounds with an overlay of hearing loss re...
FIGURE 7-5: Average hearing number by sex for American adults from ages 20–80 y...
Chapter 9
FIGURE 9-1: The basic parts of a hearing aid.
FIGURE 9-2: Dynamic range.
FIGURE 9-3: Earmolds versus domes.
FIGURE 9-4: Traditional behind the ear (BTE) hearing aid.
Note: All components
...
FIGURE 9-5: Slim tube hearing aid.
Note: Like the traditional BTE, all componen
...
FIGURE 9-6: Receiver-in-the-canal hearing aid.
Note: In this model, the speaker
...
FIGURE 9-7: In-the-ear hearing aid.
Note: The amplifier and processor are encas
...
FIGURE 9-8: Completely-in-the-canal hearing aid.
Note:
The amplifier and proces...
Chapter 11
FIGURE 11-1: The hearing aid battery door.
FIGURE 11-2: Pulling the ear back with your opposite hand and inserting with yo...
FIGURE 11-3: Image of a toggle switch on a hearing aid.
Chapter 12
FIGURE 12-1: The portable remote microphone being held while at a party.
FIGURE 12-2: The one-on-one remote microphone in action during a lecture.
FIGURE 12-3: The table remote microphone during a meeting.
FIGURE 12-4: The TV connector plugs into the TV and sends a direct signal to yo...
FIGURE 12-5: The streamer is worn around the wearer’s neck.
FIGURE 12-6: A sign with the universal symbol indicating an area is telecoil co...
FIGURE 12-7: Induction loop system in a large classroom.
Chapter 13
FIGURE 13-1: A cochlear implant.
FIGURE 13-2: An osseointegrated implant.
Chapter 17
FIGURE 17-1: Styles of hearing aids displayed in and out of the ear. On the lef...
FIGURE 17-2: Image of an open and closed dome.
Guide
Cover
Title Page
Copyright
Table of Contents
Begin Reading
Index
About the Authors
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Introduction
You’ve arrived on the first page of the first edition of Hearing Loss For Dummies. When AARP and For Dummies asked us to write this book about hearing loss for adults, we jumped with excitement. We, your authors (Frank and Nick), have dedicated our lives to addressing hearing loss through public health research, advocacy for solutions through public policy, and the clinical management of hearing loss. To us, the need was obvious, but perhaps you may be wondering why an entire book is necessary.
Hearing loss among adults is startlingly common. Nearly half of all adults over the age of 60 years have hearing loss. Scientists and clinicians are just now understanding that treating hearing loss is important for our emotional, cognitive, and even physical health. In fact, recent research suggests hearing loss is a risk factor for social isolation, loneliness, falls, cognitive decline, and dementia.
Yet very few people recognize they have hearing loss, and fewer still seek treatment.
In our opinion, the reasons hearing loss is so overlooked and hearing care neglected include these:
Hearing loss sets in so slowly and subtly over time that many people don’t even realize what they’re missing.
Society has painted hearing loss as an inconsequential aspect of aging with, until recently, little understanding of how it impacts our overall health.
Hearing care, such as hearing aids, can be a costly and timely endeavor that isn’t covered by most insurance, including Medicare.
Hearing aids get a bad rap. People think it’s a sign of aging, when in reality, addressing hearing loss keeps you vibrant and engaged.
Hearing loss is complex and confusing. For example: What’s mild hearing loss, and is it important? What’s a high-frequency or low-frequency hearing loss? What do all those graphs and numbers from a hearing test mean? What hearing aids and other treatments are available?
But so much has changed in just the past decade or so that the time is now right for this book.
Given the explosion of research on the importance of addressing hearing loss, Congress has approved a new category of more affordable over-the-counter hearing aids intended for sale directly to adults without the need for a professional. At press time, these new hearing aids, aimed at people with mild to moderate hearing loss, are slated to be available in late 2022. In addition, new public health initiatives have emerged to move away from vague terminology and graphs when explaining hearing loss to simple and actionable numbers that are easier for people to grasp and more clearly show how hearing changes over time.
That’s a lot of change in a short time period, and Hearing Loss For Dummies is here to break it all down for you and provide a road map for your hearing health journey.
About This Book
If you’re feeling overwhelmed with where to start in understanding how hearing loss happens and what can be done about it, you’ve come to the right place. This book is intended to act as an easy-to-read reference guide, giving you practical knowledge and actionable solutions to address hearing loss and how it affects your everyday life.
This book focuses on hearing loss in adults that develops over time. (We do not cover the complex nature of hearing loss in children, nor do we go into rare and complex medically related hearing loss in adults.) Simply put, the inner ear was not made to last forever. Every single person on this planet experiences a decline in hearing ability as they age, and most over a certain age (around 60) develop a level of hearing loss that is sufficient to begin interfering with their daily lives and is linked with an increased risk of poorer health, falls, social isolation, cognitive decline, and dementia.
To help you navigate what occurs with hearing loss, we cover risk factors for hearing loss and touch on types of hearing loss for adults. We also walk you through the process of taking a hearing test and reading your results as well as give helpful information on purchasing hearing aids — either prescription hearing aids through a professional or over-the-counter hearing aids — and seeking support as you manage your hearing loss.
Foolish Assumptions
This book assumes you know nothing about and have no prior knowledge of hearing loss. Nothing. Nada. Zero. We explain terms and concepts in plain language. But even if you already know a lot about hearing loss, we think you’ll find this book helpful as we take some deeper dives into concepts and offer practical advice from years of clinical care and research.
If you find yourself answering “yes” to any of the following, you’ll find information in this book for you:
Do you suspect you have hearing loss but don’t know where to start?
Have you heard about the new (at the time of this book) category of over-the-counter hearing aids and want information to make an informed decision on your purchase?
Do you have a loved one or friend with hearing loss and want to support them?
Are you new to hearing aids, and do you want a reference book with practical tips and tricks for using them?
Have you recently learned you have hearing loss and are looking for a guide to your options in hearing care?
Do you think you may need hearing aids but are reluctant to start the process?
Do you just want to know more about hearing loss?
Icons Used in This Book
You’ll see various icons throughout this book. They’re meant to complement the material and are our way of pointing out what is essential information versus what is nice to know but can be skipped without affecting your ability to get the right message. Here’s what each icon means:
This icon refers to fundamental and important information on hearing loss that shouldn’t be ignored.
This icon raises awareness of potential misunderstandings or easy-to-make mistakes in hearing care such as avoiding certain predatory situations in purchasing a hearing aid.
This icon marks important and practical advice and insights.
If you see this icon, it means that what follows is probably just your authors giving you scientific details you don’t absolutely need but we find super interesting. Feel free to ignore information with this icon without sacrificing take-home knowledge.
Beyond the Book
In addition to the content in this book, we’ve created online Cheat Sheets for quick access to important information in this book, including hearing loss basics, guidelines for testing and care, communication tips, and major Dos and Don’ts of hearing aids. The Cheat Sheets can be found at www.dummies.com by typing “Hearing Loss For Dummies Cheat Sheet” in the Search bar.
Where to Go from Here
This book was never intended to be read cover to cover. Don’t get us wrong; feel free to do so if you are inclined, but you won’t hurt our feelings if you don’t.
We wrote this book as a reference guide using plain language and plenty of examples to present advanced concepts. The book is designed for each chapter to stand alone so you can jump in at any place to find information you need at that moment. We also understand that sometimes reading one section can create new questions, so we regularly point you to other places in the book for related topics. Of course, you’re always free to check out the table of contents or the index. Start wherever suits your needs. For example:
Need a broad overview of everything? Start with
Chapter 1
.
Concerned you may have hearing loss? Skip to
Chapter 5
for some signs of hearing loss.
You already know the basics of hearing loss, have already had a hearing test, and now are thinking about hearing treatment? Start with
Chapters 8
and
9
.
Want some tips on hearing better at work, at home, in social settings, and in public places? Turn to
Chapter 12
.
Want to find out more about whether you’re a good fit for the new over-the-counter hearing aids? Check out
Chapter 10
.
Want some help navigating insurance and government benefits related to hearing loss? Jump to
Chapters 15
and
16
.
You bought this book because a friend or loved one has hearing loss and you want to find out how to support them?
Chapter 14
is for you.
Part 1
Understanding Hearing Loss
IN THIS PART …
Learn how hearing naturally declines over time and why it matters to recognize hearing loss and the role it plays in everyday life.
Uncover how the ear and brain work together to recognize sound.
Review causes of hearing loss.
Discover the link between your hearing and your health and well-being.
Chapter 1
Cheers to Your Ears!
IN THIS CHAPTER
Discovering how hearing loss happens
Realizing how common hearing loss is and the many ways addressing it benefits your health and well-being
Looking at different strategies to hear and communicate better
Cheers, indeed! It’s not often that we take a moment to appreciate what our ears — and more importantly our ability to hear — allow us to do!
From the clink of two wine glasses coming gently together to the word “Cheers” itself, your ability to hear allows you to process and understand the world around you. Enjoying a conversation over dinner, appreciating the melody and voices of a choir, pulling to the side of the road at the sound of a fire engine … it’s all made possible by your hearing!
For all of us, though, our hearing will gradually and subtly decline over time. By the time we’re in our 40s, 7% of us will experience some hearing loss. By our 60s, that number grows to 27%, and by our 80s and older, 82%. Hearing loss is inevitable even for those of us who didn’t attend loud concerts or crank up the volume in our earbuds. Yet all too often, people perceive hearing loss as a relatively inconsequential aspect of aging.
Scientists now know that nothing could be further from the truth. Addressing hearing loss may be one of the most important things you can do to keep your body and brain healthy and to keep you engaged with life. This chapter takes you on a tour of why we all develop hearing loss, why it matters, and most importantly, what you can — and should — do about it. Hearing loss isn’t about growing old. Rather, addressing hearing loss is one thing we can do to keep us engaged with our families, friends, and colleagues in our everyday lives. This book is all about understanding hearing loss, what you can do about it, and the joys and benefits to health and well-being that hearing brings to your daily life.
Understanding Why Hearing Loss Happens
Knowledge is power! If you’re reading this book, you may be concerned about what you should know about hearing loss and what can be done about it. This chapter gives you an overview of the information you need to understand what’s happening and the steps you can take to hear better.
Hearing takes place over two steps
The sounds we hear every day — like someone’s voice, a piece of music, or a fire engine — are complex and made up of a mosaic of thousands of individual sounds of different pitches and intensities. The first step in being able to hear is that your inner ear (the cochlea) converts this mishmash of different sounds with perfect precision into a signal that is transmitted to the brain. (For more on how your ears and hearing work, turn to Chapter 2.)
Imagine recording a symphony with a fancy microphone and a computer. The microphone picks up the complicated, rich music in the symphony hall and encodes it into a stream of data that can be analyzed and recorded on the computer. Your cochlea is basically doing the same thing as the microphone in picking up the sounds that come to your ear and encoding these sounds into electrical signals (data) that are transmitted to your brain.
The second step of hearing occurs when your brain receives the signal (or “data”) from the ear and decodes it into meaning. Your brain can nearly instantaneously decode the signal into whether the sound you just heard was someone saying your name, a melody in your favorite piece of music, the fire engine roaring down the street, or perhaps all three at the same time! To do this, your brain relies not only on the data sent from your ear but also additional cues as well. For example, when decoding speech sounds, your brain also relies on knowing the context of the conversation and seeing the movements of the speaker’s lips.
Hearing loss happens as the inner ear wears out
There are many different types of and causes of hearing loss, but in this book, we’re covering the most common type of hearing loss that all of us will develop to some degree over time. This type of sensorineural hearing loss (see Chapter 2) develops over time as parts of the inner ear wear out gradually. The inner ear is made up of highly specialized cells responsible for converting sounds into a neural signal. Unfortunately, unlike other cells in the body, these specialized cells of the inner ear (called sensory hair cells) can’t regenerate once they wear out and have become damaged. In contrast, cells in other parts of your body, like your brain, liver, and heart, can all gradually be replaced over time by new cells.
As these cells of the inner ear wear out over time and are lost, the inner ear becomes less effective at accurately encoding the sounds entering your ear into a precise neural signal. In this case, your brain still receives data from the ear, but instead of being crystal clear, the data comes across as garbled and unclear. That’s why for anyone with hearing loss, it sounds as if other people aren’t speaking clearly or are mumbling. You may not even notice that your hearing is getting worse over time, because it can happen very gradually and subtly. Certain sounds may just sound a little fuzzy or garbled, but you may not realize it’s due to hearing loss.
Factors that affect your hearing over time
Lots of different factors can affect your hearing over time (we detail these in greater depth in Chapter 3), and they can generally be divided into those that are non-modifiable (those you can’t control) versus those that are modifiable (ones you can control).
Here are some key non-modifiable risk factors:
Age:
This is the strongest risk factor for hearing loss. The cells in your ears responsible for hearing degrade over time.
Sex:
Compared to men, women in general have better hearing. This may be related to women having increased estrogen that scientists think could protect the inner ear. Women may also have less exposure on average to loud sounds than men.
Skin color:
Individuals with darker skin on average are at a lower risk of hearing loss. The amount of melanin in your skin determines your skin color (the more melanin you have, the darker your skin color is), and there’s a corresponding amount of melanin in your inner ear. Scientists believe this inner ear melanin helps protect the inner ear over time.
The most important modifiable risk factors for hearing loss include these:
Noise:
This is by far the most important risk factor you can control. As a general rule of thumb, if you’re in an environment or situation where you consistently have to raise your voice to be heard, you should move away from the noise if you can or consider using some form of ear protection such as earplugs or over-the-ear noise-canceling headphones or earmuffs. You’ll also want to avoid listening to music through headphones or earbuds for too long or too loud. See
Chapter 3
for tips on how to use headphones safely and information on how noise affects hearing.
Cardiovascular risk factors:
There are myriad risk factors for cardiovascular disease such as smoking, hypertension, and diabetes, and all these can also increase your risk for hearing loss by damaging the small blood vessels that go to your ear. Head to
Chapter 3
for more information.
Putting Hearing Loss in Context
Everyone loses some hearing with age. What we want to stress is just how common it is; how it can impact your physical, emotional, and cognitive health; and what you can do to hear better.
Hearing loss happens to everyone
If you’re concerned about hearing loss, you are most certainly not alone!
The number of people who experience hearing loss is staggering, as Figure 1-1 shows.
In this figure you can see that the percentage of people with hearing loss nearly doubles with every decade of aging. The figure also gives an indication of the relative severity of the hearing loss divided into those with mild and moderate or worse hearing loss. These concepts are covered in more detail in Chapter 7.
How hearing loss impacts our health and well-being
Scientists didn’t always understand much about the consequences of hearing loss for adults. The general impression among even doctors was that since everyone developed some hearing problems over time, it couldn’t possibly be that bad for health.
That period has now passed.
Source: Johns Hopkins Cochlear Center for Hearing and Public Health
FIGURE 1-1: Prevalence of hearing loss in the United States.
Research over the past decade has increasingly demonstrated the adverse effects that hearing loss can have on our health. Key areas where scientists now believe that hearing loss increases our risk for adverse health events include cognitive, emotional, social, and physical areas of health:
Cognitive impairment and dementia:
Research suggests that of all the known treatable risk factors for dementia, hearing loss may be the single largest contributor to dementia risk. Scientists think this is because hearing loss makes it harder for our brain to process sound, and individuals with hearing loss are less likely to remain engaged in social and other stimulating activities that are critical to cognitive health.
Loneliness:
Feeling withdrawn and detached from others is strongly linked with poor health outcomes like early mortality, heart attacks, and cognitive decline. Hearing loss contributes to loneliness because it makes it harder for people to socially engage with others.
Falls:
Hearing is one of several systems — including our vision,
vestibular
(balance), cardiovascular, pulmonary, and
proprioception
(sense of touch) systems — that allow our brain to maintain our body’s balance.
Importantly, while scientists now understand that hearing loss likely contributes meaningfully to all these adverse outcomes, they don’t know yet whether our current treatments for hearing loss (for example, using hearing aids) may lower this risk. Studies are ongoing, and scientists are hopeful.
The benefits of addressing hearing loss
The important thing to keep in mind about hearing loss is that it comes on so slowly that many people aren’t even aware they’re struggling to hear (despite everyone else noting the struggles the person is having!). The single most important reason to address your hearing loss — with the strategies and technologies detailed in this book — is so that you can fully engage with others and the world around you. Scientists and doctors have long known the positive benefits that addressing hearing loss can have on relationships and personal well-being. Importantly, researchers are also now just beginning to understand that these strategies to address hearing loss may have even bigger long-term implications for keeping our brains healthy and free of disease as well!
What You Can Do about Hearing Loss
Besides avoiding loud noises and protecting cardiovascular health, what can you do about hearing loss? It can’t be cured, but it most certainly can be addressed with a range of strategies to allow individuals with hearing loss to communicate and hear optimally. When it comes to hearing loss and how it affects you, you are the master of your own destiny. You don’t have to sit back and just let hearing loss adversely impact your life. There are strategies and technologies to combat these effects so you can remain fully engaged with the richness of the world around you (see Chapters 8 through 13 for details on these).
Know your hearing
This may seem obvious, but to address hearing loss, you first need to know whether in fact you have hearing loss! In many cases, as you can tell from Figure 1-1, you may have a pretty good idea already based purely on your age (nearly two-thirds of everyone over 70 has hearing loss) and the symptoms you may be experiencing. Subjective impressions of your hearing can be helpful, but in most cases, you’ll be far better informed if you have an objective hearing test.
Get your hearing checked
Hearing tests are most commonly performed by an audiologist or a hearing instrument specialist. Ideally, you want to start with an audiologist since these are health professionals trained to diagnose and treat hearing loss, and health insurance will nearly always cover the exam. Depending on your insurance, you may need a medical referral. An audiologist can perform a comprehensive hearing exam and then discuss your evaluation and possible options to address any hearing or communication problems you may be experiencing.
Hearing instrument specialists can also assess your hearing. They are licensed by the state to sell hearing aids and to conduct hearing tests expressly for the purposes of possibly fitting a hearing aid. Hearing instrument specialists often offer these hearing tests for free, but their ultimate hope is that you’ll then buy a hearing aid from them. There’s nothing wrong with these tests, but just be forewarned that they may also come with a sales pitch.
You may also want to consider having your hearing evaluated by an ear, nose, and throat (ENT) physician (also called an otolaryngologist), particularly if you have any medical concerns about your hearing. An ENT is trained in the medical and surgical management of hearing loss and often works with an audiologist in the office. The audiologist performs the hearing evaluation, and the ENT then examines your ears and evaluates whether you have any medically or surgically treatable issues related to your hearing loss. Consult an ENT if you notice any of the following:
Drainage from your ears
Ear pain
Asymmetrical hearing between your ears
Sudden or fluctuating hearing loss (see an ENT immediately if your hearing loss comes on suddenly)
Dizziness or vertigo
Hearing loss that has not been significantly helped by using hearing aids in the past
Turn to Chapter 6 for a full rundown on hearing professionals and tests.
Get your hearing number
One of the best ways to get a better grasp and understanding of your hearing is to know your hearing number. The hearing number — known clinically as the speech-frequency pure-tone average — indicates how loud on average speech sounds have to be for you to hear them. The larger your hearing number, the worse your hearing is.
You will get this number from your hearing test. You can also calculate it from a hearing test yourself using your own smartphone (see Chapter 7).
You can find more details about the hearing number — how it’s calculated and what it means — in Chapter 7 and at www.hearingnumber.org, part of an effort by the Johns Hopkins Bloomberg School of Public Health, where both authors are based, to increase public awareness and knowledge around hearing loss.
In general, the greater your hearing number is, the more communication strategies and technologies you’ll want to consider using to allow you to hear and communicate optimally.
Using communication strategies
The most important way for you or a loved one to optimize hearing and communication is with some basic communication strategies. These strategies can help with communication because they focus on getting a clearer sound to your ear.
“How does this help with hearing?” you may ask. The cells in the inner ear break down over time, as we mention earlier in the chapter, and the inner ear can no longer convert sound into the signal that goes to the brain as accurately as it once did. As a result, the signal that reaches the brain sounds garbled or fuzzy; you may complain that people are mumbling.
In a situation where the incoming sound was very clear to begin with, some slight garbling in the encoding process in the inner can still lead to a fairly clear signal reaching the brain that is easily understandable. In contrast, say the incoming sound was already fuzzy to begin with (imagine trying to hear someone over the din of a loud cocktail party). The inner ear with hearing loss then further garbles the sound during the encoding process, and the resulting signal to the brain may be completely unintelligible.
The communication strategies summarized here and covered in greater depth in Chapter 8 can enhance the quality of the incoming sound and/or provide the listener with additional cues to help their brain understand sound. Important communication strategies to keep in mind are
Get close to (within arm’s length) and face-to-face with people you’re talking to.
Turn down or move away from any background noise whenever possible when talking to others.
At restaurants or other indoor places, choose rooms that are smaller and have lower ceilings and lots of soft surfaces (such as curtains and rugs), which reduce the amount of reverberation that can markedly degrade sound quality.
Instead of saying “Huh?” or “What?” when you can’t understand what someone has said, be specific about what you did and didn’t hear. For example, “I heard you say something about meeting for dinner but missed the rest.” This takes a bit longer but cues the speaker into exactly what to repeat and shows that you were listening (so you aren’t accused by your spouse of never paying attention!).
Hearing technologies
Yes, technology can indeed be a huge help when it comes to optimizing your ability to hear and communicate with hearing loss. But the most important thing is to manage your expectations. Hearing technology — such as hearing aids and cochlear implants — can improve your hearing, but no matter how much you pay, it can never completely fix your damaged inner ear and its degraded ability to accurately encode sounds.
That being said, when these technologies — such as hearing aids and cochlear implants — are appropriately used and programmed for your hearing loss, they can make a huge life-changing difference in your ability to navigate your day with ease. Keep in mind, though, that when using such technologies, the benefits aren’t always noticeable immediately. It often takes a few months for your brain to get used to and benefit from the new sounds that a hearing aid or cochlear implant provides. Think of using a new set of hearing aids like learning to ride a bike for the first time. You may not like it at first, but over time as your brain gets used to the sounds from the hearing aids and learns how to use them, the benefits can be remarkable.
Hearing aids
Hearing aids are the foundational technology for many people with hearing loss, and prescription hearing aids are typically purchased through a hearing care professional who will provide you with support services to ensure you’re able to benefit from the hearing aids. This model of hearing care delivery where you have to get your hearing aids through a hearing care provider works well for some people but is not necessarily ideal for everyone.
A new and exciting development is happening, though, as this book goes to press in 2022. Beginning in late 2022, hearing aids in the United States will soon be available not just as prescription but also as over-the-counter (OTC) devices.
OTC hearing aid regulations at the time of publication are just being finalized by the U.S. Food and Drug Administration (FDA). Once these regulations are enacted in late 2022, manufacturers will be able to develop and sell OTC hearing aids that meet specific acoustic performance criteria to ensure that these hearing aids are both safe and effective for consumers without the need for an audiologist or hearing instrument specialist. These OTC hearing aids will be specifically for adults with mild to moderate levels of hearing loss, which is what the vast majority — over 90 percent — of people with hearing loss have. (When purchasing OTC hearing aids, you may still want to consult with a professional to best understand which devices to consider and how to best use them.)
In contrast, prescription hearing aids will still continue to be available through an audiologist or hearing instrument specialist. People who have greater severity levels of hearing loss, who have other ear or audiological issues, and who need a much more customized hearing aid because of their listening needs will still need prescription devices.
Thriving with hearing aids means setting appropriate expectations for what hearing aids can and can’t do (hint: they don’t restore hearing to normal), practicing with your hearing aids to get used to them, and creating good care and maintenance routines. Your actions can make all the difference in whether or not you succeed with hearing aids. Understanding this is especially important when pursuing OTC hearing aids without the guidance and input of a professional.
To get more information and answers to your hearing aid questions and tips for thriving with hearing aids, check out Chapters 9 through 12.
Cochlear implants
Cochlear implants are indicated for adults who have hearing loss in the severe range and no longer find adequate benefit from using a hearing aid. A cochlear implant is a surgically implanted neuroprothesis that converts sounds into electrical signals that are then directly sent by the cochlear implant to the brain via the hearing nerve (see Chapter 13 for more information). In this way, the cochlear implant takes the place of the cochlea, and thus, is a prosthesis.
Cochlear implants have been around for more than 30 years and are a routine outpatient day surgery for any ENT who specializes in ear surgeries. (Nearly all academic medical centers and large private-practice ENT groups offer this surgery.)
As a general rule of thumb, if you or a loved one still struggle with communication despite using hearing aids and have a moderately severe or greater hearing loss (with a hearing number somewhere in the 60s or worse — see Chapter 7), you may want to consider being evaluated to see if you’re a candidate for a cochlear implant. This evaluation is routinely covered by insurance and is generally offered by any academic medical center or larger private-practice ENT group.
In the past, the FDA approved cochlear implants only for individuals with severe hearing loss in both ears. Recently, that changed. Cochlear implants are also now indicated for individuals with severe or greater hearing loss in just one ear (also called single-sided deafness, or SSD). Not all insurance plans, though, cover a cochlear implant for SSD.
Getting the Support You Need
Addressing hearing loss may at times may seem like it’s solely the responsibility of the person with hearing loss, but nothing could be further from the truth! When a person struggles with communication, it’s as much the individual’s concern as well as the other people they’re trying to speak with.
Surprisingly, most people never learn what to do to help others with hearing problems despite the vast number of people with hearing loss. Chapter 14 explains how a person’s hearing loss can have cascading effects on others and the various strategies that can allow people to support them. Options for covering hearing care either through insurance or out-of-pocket (Chapter 15) and a person’s legal rights under the Americans with Disabilities Act and other federal policies (Chapter 16) pertaining to hearing loss are also covered in Part 4 of the book.
Chapter 2
Understanding How Hearing Works
IN THIS CHAPTER
Defining what sound is
Discovering how you hear sounds with your ears and brain
Understanding why you may not be able to hear well
Every day, everywhere, and at any time, you’re surrounded by sounds that you may not even be consciously aware of — the hum of the refrigerator in a seemingly quiet kitchen, your footsteps hitting the ground on a walk, or the rustle of the sheets as you shift in bed. These sounds are layered onto the ones that may be more obvious, such as a family member’s voice or music from the radio. All these sounds combine to keep you in touch with your surroundings.
If your ability to hear certain sounds begins to disappear, the world becomes a different place. Sounds are used to cue you in to your environment and allow you to communicate. If these sounds become distorted or fade away, the way you perceive and interpret things changes.
In this chapter, we show you how your hearing works and why being able to hear and communicate effectively is critical to your health. This knowledge will ultimately empower you to best address any hearing challenges you and others you care about may be facing.
What Is Sound?
At its simplest, sound is just the vibration of air molecules hitting one another all around you and creating sound waves that move through the air. Consider the sound of a piano: A felt-covered wooden hammer strikes a metal string, which then vibrates the surrounding air. Likewise, the sound of a fork dropped on the kitchen floor comes from the vibrations in the air created by both the fork and the ceramic tile it hits. Similarly, your friend’s voice is created when the air exhaled by the lungs passes through the vocal cords in the throat.
Why is this important, you may ask? Well, if you’re having trouble hearing, you need to first understand what it is that your ear is indeed trying to hear. Namely, understanding what makes up sounds will let you have a better idea of what your ear is trying to do and why the hearing devices and strategies that we discuss later in this book can help.
How sound gets its sound
Two factors define a sound:
Frequency of the vibrations:
How fast the air molecules vibrate gives sound its pitch — the more rapid the vibrations, the higher the pitch (or frequency) of the sound.
Intensity of the vibrations:
How hard the air molecules hit each other gives sound its loudness — the greater the strength of the collisions, the louder the sound.
The frequency of a sound is indicated by hertz (abbreviated as Hz), where one hertz indicates one vibration per second. Humans can hear sounds ranging from 20 Hz to 15,000–20,000 Hz. (In contrast, a dog’s hearing extends from ~60 Hz to 45,000 Hz.)
For perspective about what these frequencies sound like, the lowest note on a standard 88-key piano is about 30 Hz while the highest note is about 4,000 Hz. Sounds in the 10,000–15,000 Hz range are like the brilliant sounds that a cymbal produces.
The intensity or loudness of a sound is measured in decibels (abbreviated dB), which is a unit of sound pressure. The greater the pressure, the greater the intensity and hence the loudness of the sound. Sounds that we commonly encounter in daily life range generally from 0 dB (barely audible to someone with great hearing) to 120 dB (an ambulance siren up close). In general, every 10 dB increase in a sound’s intensity will be perceived as being twice as loud. For example, a 30 dB whisper will be perceived as being twice as loud as a 20 dB soft whisper.
We cover sound frequency and intensity again later in this book, particularly in Chapter 7
