Has the Pandemic Affected Your Hearing?

Katherine Bouton hearing loss and isolation

Captions have become ubiquitous during these many months of isolation. Is that an unmitigated good for those with hearing loss? For me, at least, maybe not.

When I watch TV or streaming video, it’s captioned. I set the volume so I can hear the spoken words to supplement the captions, but it’s the other way around. The captions fool me into thinking I’m hearing.

My phone is captioned, and again the captions seem to clarify the sound.  

Meetings online are captioned. Thank goodness.

This is all very convenient, but is it good for my hearing?

Are you really listening?

I see family and friends in person, and after a brief adjustment period, I’m usually okay. Familiar faces, familiar voices. No masks. I read lips to supplement. I sometimes use Otter captions.

But lately I’ve noticed that I’m not hearing what I used to. I have trouble understanding people I used to be fine with. I’ve always been able to follow my Pilates teacher if she’s wearing my companion mic, but now her words, muffled by a mask, are lost to me.

Unfamiliar voices, masked or not, are more difficult than they used to be.

Routine cash register comments?  If it’s the pharmacy, it’s probably, “Date of birth?” But the other day one stumped me. The masked supermarket clerk behind her plexiglass shield repeated her question three or four times. Finally, I took a stab at “No, thanks.” It was only when I was out of the store that I realized she was asking, “Do you want to use reward points for this?”

Like many of us during the pandemic, I‘m alone much of the time. I don’t feel isolated, because I keep in touch with friends and family by FaceTime, email, and phone calls. Most days I exchange routine greetings with people on the street, or with the guy I buy my newspaper from, or from other dog walkers. But exchanging pleasantries doesn’t require real hearing.

It’s possible the problem is that I’m just out of practice. Or maybe I’ve gotten lazy with my hearing: I don’t try to distinguish sound because I don’t need to in my captioned world. I’m hearing but not listening. A few years ago I wrote about “mindful listening” in a post on auditory rehabilitation. I may not be following my own advice.

Is this a pandemic side effect? Has isolation affected my hearing? Or, maybe, has isolation affected my listening? I’ve made an appointment with my audiologist to check my heairng, both with and without hearing aids. If it turns out my hearing is unchanged, I’ll have to chalk it up to lazy listening.

Readers, have you had a similar experience? Did you have your hearing checked? Was it your hearing or your listening that was causing the problem. Please share in the comments.

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For more about living with hearing loss, read  Smart Hearing, available on paper or as an e-book at Amazon.com, or Shouting Won’t Help, available in both formats at Amazon and other booksellers.

Holiday TLC, Redux

Katherine Bouton Healthy Hearing

This Thanksgiving may be the first time we’ve seen family and friends since the beginning of the Pandemic. I’m both excited and a little nervous. Holidays can be difficult for the hard of hearing. Here are some ways you can make it a little easier on yourself.

T is for Technology

Assistive Listening Devices. Use them! These can be something as simple as a Williams Sound PockeTalker or as sophisticated as a Phonak Roger system with multiple microphones.

The PockeTalker is an amplifier with a microphone. The speaker talks into a mic, the listener uses earbuds or a headset. It won’t allow you to hear the conversation at the other end of the table but you will hear at least one person better. The Williams Sound PockeTalker is available at many outlets. Amazon lists them at $184, batteries included.

Your smart phone can act as an assistive listening device, using a detachable mic and wired headphones or earbuds with a downloaded app. Try a few headphones and see what works best for you. If your phone is connected by Bluetooth to the hearing aids, you don’t need headphones. Both Android and iPhones have an app called Sound Amplifier. I haven’t tried either. Consumer reviews are mixed. Please add a comment if you have used either of these. There is a charge for Sound Amplifier. [Addendum: The IOS Hearing Aid-Sound Amplifier offers one month free, then $4.99. Readers seem confused about whether there is a charge — even though I say there is. I don’t have an Android phone so cannot check their charge.]

If you’d rather have instant captions, try Otter.ai, an iPhone app, or Google Live Transcribe for Android phones. You can also use systems like Dragon Dictation. I use Otter and have used Live Transcribe. I recommend both. They are free.

Don’t forget the most basic tech fix of all: a pen and paper.

L is for Location.

The best location for a person with hearing loss depends on the nature of their hearing. I hear better from my right ear, for instance, so I try to position myself with at least one strong voice to my right. That way I can ask that person what was said. For others, sitting at the center of the table may allow them to hear the whole table better.

If there’s background music, sit as far from the speakers as possible, or ask the host to turn the music down — or, preferably, off.

If you end up in a particularly noisy spot, ask if you can change seats with someone. Often the easiest time to do this is between courses, or before dessert. Some hosts move guests around at a dessert as a matter of course, a social tradition that can be useful for the hard of hearing.

C is for Care.

Take care of others. There a few things more emotionally rewarding than doing for someone else. Volunteer to serve dinner at a homeless shelter. Invite friends who may not have anywhere else go. I always like to include people newly arrived in America, who don’t know much about Thanksgiving. Often these are friends of my children’s, whose social network is much farther flung than mine.

There are lots of ways the word Care should be part of your Thanksgiving TLC.

First, take care in how you listen. I think of this as mindful listening. As I wrote in an earlier post, “Watch the impulse to say What? or ‘Huh? Think before you respond. What’s the context of the conversation? What parts of the sentence did you get? Is there a logical missing word? We always tell people with hearing loss not to pretend they’ve heard, not to guess. But guessing can be an effective strategy for getting someone to repeat in a way that makes the whole sentence comprehensible.”

In other words, when asking what was said, you’ll get a much more helpful response if instead of “What?” You ask “Did he say this butter is acid free?” That way the speaker knows you’ve missed “lactose free.” [And for those with lactose intolerance, check out Green Valley lactose-free butter.)

Take care of yourself. When it gets too noisy, take a break in another room. Trying to hear is exhausting. Help serve and clear the table. Wash some dishes. Play with the baby. Go home early if you have to.

The T could also stand for Thankful. I hate to sound sentimental, but remember to be thankful for what you do have, rather than making yourself miserable about what you don’t, like good hearing.

This post is adapted and updated from a previous post. For more about living with hearing loss, read  Smart Hearing, available at Amazon.com, or Shouting Won’t Help, available at Amazon and other booksellers

What Do Over-the-Counter Hearing Aids Mean for You?

Katherine Bouton Healthy Hearing, OTC Hearing Aids

Earlier this week, on October 19, the FDA issued its long-awaited proposal on Over-the-Counter hearing aids. Over the counter means direct to consumer, without the intervention of an audiologist.

The FDA’s proposal followed four years of discussion about OTC aids, dating from the passage of the bipartisan Over the Counter Hearing Aid Act in August 2017. The FDA had three years to assess comments and proposals from stakeholders. These include consumer groups like The Hearing Loss Association of America and AARP, professional groups like the Academy of Doctors of Audiology (ADA) and and the American Association of Audiology (AAA), among others.

New to hearing loss? An OTC aid might be the answer.

The FDA’s draft guidelines allow for adults 18 and over with “perceived” mild to moderate hearing loss to purchase hearing aids over the counter – online or at retail outlets – without a medical exam or a fitting by a hearing-aid professional. These non-prescription hearing aids will constitute a new class of FDA-approved hearing aids. At this time, no hearing aid fits that category.

What we now think of as FDA-approved hearing aids – the prescription aids made by Phonak, Widex, Starkey, etc. for moderate to profound loss — will continue to require an audiologist or hearing-aid specialist for fitting. The FDA-approved Bose SoundControl Hearing Aid, approved earlier this year for direct-to-consumer sales, is the only hearing aid in its class.

How soon will you see these hearing aids for sale at Walgreens or CVS or Best Buy? Probably in less than a year. There are several steps between this week’s ruling and the box on the shelf of your neighborhood store.

Most readers of my column have fairly severe hearing loss and already have hearing aids or cochlear implants. Are these OTC hearing aids for you? No. But will they benefit you in other ways. I think the answer is a resounding Yes.

A lot more people will be wearing hearing aids. People who have hesitated up till now because they didn’t have access to an audiologist, or didn’t want to spend $5000-$6000 for a pair of hearing aids, or who simply didn’t want to wear hearing aids because of stigma, may find that their formerly “manageable” hearing loss is really not worth it if they can easily purchase a hassle-free lower priced aid. The more people who wear hearing aids, the more normal they become and so stigma begins to drop away.

A lot more people will be wearing aids for another reason as well. Demographics. More and more people are getting older every day, and with increased age generally comes increased hearing loss. Age-related hearing loss often begins as mild or moderate loss, and these OTC hearing aids may just right for those new to hearing aids.

As stigma drops away, so does secrecy. People with OTC hearing aids may realize that even with the aids, they prefer television with captions. If television, why not movies? If movies, why not town hall meetings? And so on. So demand for accessibility will grow. It will no longer be the relatively small group of people with moderate to severe or profound loss who are demanding accommodations.

Here are some things I hope will happen.

Although everyone should have a hearing test before buying any kind of hearing device, the work of audiologists may change. With fewer patients with mild to moderate losts, they may have more time for the kind of training and rehabilitation that people with more severe loss may need. They may lobby to have insurance rules changed to allow reimbursement for training and rehab. Audiologists have a role even in OTC hearing aids. Having your hearing tested is not just to assess the degree of loss, it’s also to rule out potentially serious conditions like an auditory-nerve tumor or easily reversible conditions like ear wax. Perhaps a new model of audiology would allow a simple hearing evaluation for a fee.

Once hearing aids are divided into over-the-counter and prescription categories, insurers – including Medicare – may cover prescription aids, which serve a medical need. Or alternatively, with hearing-aid prices driven down by the competition of OTC aids, insurers may realize it’s wise to cover all hearing aids, which have a clear health benefit. Acting FDA Commissioner Janet Woodcock, M.D., was quoted in Hearing Health Technology Matters: “Hearing loss has a profound impact on daily communication, social interaction, and the overall health and quality of life for millions of Americans.”

For more on the FDA’s ruling, read HLAA Executive Director Barbara Kelley’s post on HLAA’s “Hear This” blog.

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For more about living with hearing loss, read my books “Smart Hearing: Strategies, Skills and Resources for Living Better With Hearing Loss” and “Shouting Won’t Help: Why I and 50 Million Other Americans Can’t Hear You.” Both are available as ebook and paperback on Amazon.com.

“Captions are the Wheelchair Ramp for the Deaf”

Katherine Bouton Captions for hearing loss, Healthy Hearing

A year or so ago at a meeting on the challenge of global hearing loss, one of my fellow presenters, Catharine McMahon, head of the Department of Linguistics at MacQuarie University in Sydney Australia, said something that has stuck with me:

“The challenge of disability should become society’s challenge. Change the environment, not the Individual:

  • “Rather than focus on the individual as having a problem and expecting the individual to address the problem, it is society’s role to reduce the overall disability through accessibility of spoken information and communication.”

The most direct form of accessibility for the deaf and hard of hearing is captioning. “Captions are the wheelchair ramp for the deaf,” as the author Arlene Romoff wrote.

Not all captions are equal.

A timely essay in the New York Times, by Sara Novic, an instructor in Deaf Studies at Stockton University in New Jersey, addressed accessibility.

In Don’t Fear A Deafer Planet, she wrote:

“Closed captioning is an inexpensive and widely available technology. Since listening and speech-reading is largely dependent on context and atmospheric conditions — for example, whether there is background noise — even those of the projected 2.5 billion people experiencing mild degrees of hearing loss are likely to benefit from captioned material. Still, content on many websites, video applications and social media platforms remains uncaptioned. Even theaters often choose to forgo open captions, instead employing retrofitted “solutions” that overcomplicate and underperform.”

The New York City Council is currently considering INT. 2020, an ordinance that would require cinemas to show open-captioned movies on a regular basis. Not all the time, as Novic is proposing – that’s too big a hurdle right now. But open-captioned screenings of every movie showing at a particular theater every day. You can support the bill by emailing or calling N.Y. City Council Speaker Corey Johnson’s legislative director: Jeffrey Baker, 212 482-5457. Or email jbaker@council.nyc.gov.

You can also sign a change.org petition in favor of open-captioned movies, at Movie Theaters — Captions (Subtitles) are Healthier for Everyone.

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For more about living with hearing loss, read my books “Smart Hearing: Strategies, Skills and Resources for Living Better With Hearing Loss” and “Shouting Won’t Help: Why I and 50 Million Other Americans Can’t Hear You.” Both are available as ebook and paperback on Amazon.com.

“Coda” is about Deaf Culture. Can people with hearing loss relate? I did.

Katherine Bouton Healthy Hearing

There’s a moment in the movie CODA that shocked me – after all these years – with the visceral understanding of how similar and yet how different the experience of deafness is to someone who is culturally Deaf and to someone like me who is functionally deaf and oral.

CODA, which stands for Child of Deaf Adult, is about a Deaf family who live in a small fishing town where everyone else is hearing. Father, mother and young adult son are Deaf. Ruby (Emilia Jones), their 17-year-old daughter, is hearing.

She gets up at 3 am to join her father and brother on their small commercial fishing boat, partly as part of the crew and partly as interpreter. She’s the only interpreter for her family and although there’s a reference to a Deaf community, there seem to be no other Deaf people in town. In one scene she is signing at a doctor’s office for her parents (Marlee Matlin and Troy Kotsur, who are both deaf, as is Daniel Durant, who plays her brother). The parents have a fairly intimate problem and her father is not the least shy about expressing it in the most graphic terms. Ruby gamely edits as she translates. It’s a hilarious scene, and also touching.

At school, Ruby is shunned and made fun of, both for her Deaf family and for smelling like fish. Her brother is mocked when he tries to join others in a bar. The family has only itself, until Ruby finds a way to connect, and brings the family with her. It’s a moving coming-of-age story, funny and sweet, but with the twist of providing an insight into what life might be like for a Deaf family living in an isolated area.

But back to that scene. Ruby loves to sing and joins the school choir (really a chorus, singing nonsectarian pop music). She’s encouraged by the teacher, who sees real talent. The choir holds a concert and Ruby has a solo. She has a beautiful voice and her singing is mesmerizing. But then the camera shifts to the parents – and the sound goes off. You are watching them watch her in dead silence. Instead of faking it, pretending they’re appreciating it, they start signing to each other about what to have for dinner.

If I were in that audience, I also would not be able to appreciate Ruby’s singing. But instead of silence I’d hear a cacophony of sound. Without the visual information, I might not even know it was music. Where her parents are encased in silence, I’d be turning my hearing aids down to spare myself the noise. In the end Ruby finds a way to share her singing with her parents. It’s a beautiful scene, which I don’t want to give away.  

The Deaf and hard of hearing (like me) share many accommodation needs and should be partners in advocacy. In the past, this hasn’t always happened, maybe because the Deaf are afraid that accommodations that work only for them, like sign-language interpreting, will be threatened by accommodations like looping that work only for people with hearing loss, not the Deaf. But we share a need for captions. Marlee Matlin was an early and influential advocate for television captions. In 1995 she testified before Congress on the need for captioning on television, with the result that we now all have captioning on TV. (Now we just need to get accurate captioning on TV.) She’s a spokeswoman for the National Captioning Institute as well as for the largest provider of television closed captions.

You don’t have to be Deaf or hard of hearing to love CODA. But you may relate to it in a different way from those who don’t give their hearing much thought.

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For more about living with hearing loss, read my books “Smart Hearing: Strategies, Skills and Resources for Living Better With Hearing Loss” and “Shouting Won’t Help: Why I and 50 Million Other Americans Can’t Hear You.” Both are available as ebook and paperback on Amazon.com

Talk About Hearing Loss. A Lot.

Katherine Bouton Healthy Hearing

Why is it that everyone who develops hearing loss seems to have to start at Square 1 to figure out what to do about it?

 I was reminded of this when I read an article by Deborah Copaken called PSA: Your AirPods Pro are Hearing Aids. It appeared on Copaken’s blog Ladyparts on Substack. Generally first time writers on hearing loss get a lot wrong, but Copaken got it right. Her discovery of the facts about hearing loss, however, and the apparent novelty of the information for those who commented on the article, reminded me of how little most people know about this condition.

Copaken is only 55, so her hearing loss isn’t age related. She probably had little cause to know about hearing loss because it wasn’t affecting most of her peers. But this lack of awareness is also true for people who are 65 and even 75, when two-thirds will be affected by diminishing hearing – and a diminishing ability to communicate. They don’t know about it either.

There are lots of books and blogs about hearing loss, my own included. Jane Brody writes about hearing loss every year or so. Articles like Copaken’s appear from time to time in the mainstream press and everyone seems surprised by the news. Recent movies have focussed on hearing loss. Sound of Metal was nominated for several Oscars. It got some things about losing your hearing right and some wrong. I haven’t seen CODA, streaming on Apple TV+, but my fellow blogger and HLAA member Shari Eberts wrote that it gives a mostly accurate portrayal of the effect of communication difficulties. A new documentary called We Hear You, produced and featuring members of HLAA, is not yet available to the public. But a preview and talkback are being shown by HLAA this week. Registration is sold out but keep an eye out for it streaming elsewhere.

Why aren’t these voices heard? Why is the fact that Medicare doesn’t cover hearing aids a nasty surprise to so many? Why isn’t it understood that the ubiquitous presence of ASL interpreters is useless to 95 percent of those with hearing loss? Why is that when you note on a plane reservation that you have hearing loss (Any disabilities?) they send a wheelchair to meet you at the gate?

The answer is stigma. Hearing loss is seen as a conditioning of aging – even though 60 percent of those with hearing loss develop it before they are 60. We reject the notion of aging in our society. Some of us think aging is when you’re over 90. Until we get there, we prefer to think of ourselves as forever 40. We don’t want to be old and we don’t want to hear about it.

Hearing loss affects people of all ages. It affects people who are exposed to noise, at work or recreationally. It affects those with inherited hearing loss. It affects people treated with certain drugs, drugs that may save their lives, like some cancer drugs. It affects musicians. It affects veterans as young as their 20’s. It affects almost half a billion people around the world, disproportionately the poorest — but the wealthy can’t escape it either.

Articles like Copaken’s are valuable because they reach a new audience, people who don’t (yet) have hearing loss. My book “Shouting Won’t Help” reached a new audience as well, because I was young and worked at the New York Times. (The reaction seemed to be, Huh? She has hearing loss?) Maybe “We Hear You” will too. It’s already won some distinguished awards.

We can all contribute to raising the profile of hearing loss, with an emphasis on the essential role of communication. We can normalize it, make people aware of the needs we have and the accommodations that work for us. Talk about your hearing loss. Make yourself – and the rest of us – heard.

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For more about living with hearing loss, read my books “Smart Hearing: Strategies, Skills and Resources for Living Better With Hearing Loss” and “Shouting Won’t Help: Why I and 50 Million Other Americans Can’t Hear You.” Both are available as ebook and paperback on Amazon.com.

Don’t Panic. It’s Not Good for Your Hearing.

Katherine Bouton Healthy Hearing

Sometimes, out of nowhere, my hearing loss catches up to me. My frustration about not hearing something important comes rushing back, a reminder of my difficult early days with hearing devices. It can quickly turn into panic.

Ordinarily I’m fine with my hearing aids and cochlear implant, supplemented by a remote mic when necessary, Otter a.i. for in-person captions, and Innocaption+ on my phone.

On Labor Day, though, there was a crisis, and I couldn’t access the direct-to-iPhone  Bluetooth link, which sends the audio to my hearing aid and cochlear implant. I had Innocaption captions, but no audio. It’s a challenging way to deal with an emergency.

Photo by Anna Tarazevich on Pexels.com

I am living in rural Massachusetts at the moment, in a house with a dense woody area behind it going up a hill. My dog, Ollie, likes to sit outside in the evening, ready to bound in when I call him. (Treats are involved.) 

Monday evening around 6:30 or 7, I stepped out to call him. He was on the hillside, waiting expectantly. For some reason, I looked away and when I looked back up he was gone. I heard a loud strangled cry. I ran up to the hillside, afraid he’d been snatched by a coyote or a cougar.

No sign of him. Then I realized he was behind the house, behaving strangely. He’d encountered a porcupine and had a snout full of quills. They hung off his face and rattled when he moved.

My vet was closed but had emergency information on their phone message. I called one emergency vet after another. The most I could make out of what they said — using captions, no audio — is that they were full and could take no more animals. One suggested I get him a cone so I raced to the pet store before it closed. Another customer helped me try (unsuccessfully) to snap the cone in place around his neck. It wouldn’t have helped anyway.

How could Ollie go through the night with quills in his face? That’s when I started to panic.

Meanwhile I had texted my daughter, who took over the search. She found a vet about 45 minutes away, who told her I’d have to go to a different vet an hour and a half away because they were full. Her husband, a paramedic, got on the phone. A friend once said about my daughter’s husband, somewhat enviously, “Paramedics can do everything.” Apparently this includes talking a vet into accepting one more dog. They texted me the information.

I was low on gas and so went to the gas station to fill my car. It was closed. Labor Day. I didn’t think gas stations ever closed. A second was also closed. I finally found a third.

I was able to control my panic once the vet appointment was set up, and drove the long dark drive without incident. The vet took Ollie and said she’d have to sedate him. I said I would come back in the morning. It was not a peaceful night, but at least I wasn’t sleeping in the car. I picked up Ollie at 8 am the next morning and he seemed fine, if a little groggy.

What have I learned from this incident? I knew my phone was having sporadic trouble connecting with my new hearing aid. But I put off figuring out the problem. Yesterday, I had an appointment with customer support. Bingo, a very simple solution. Answer the phone by pressing the button on the hearing aid. I tried it on my next incoming call and it worked perfectly and even took me directly to Innocaption in case I also wanted captions.

Last week I wrote about being prepared for emergencies. I hadn’t really thought of a dog with porcupine quills on Labor Day evening and a nonworking phone connection as the kind of emergency I might encounter.

If one of your hearing instruments isn’t working properly, don’t put it off. You never know when you’ll need everything working perfectly.

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For more about living with hearing loss, read my books “Smart Hearing: Strategies, Skills and Resources for Living Better With Hearing Loss” and “Shouting Won’t Help: Why I and 50 Million Other Americans Can’t Hear You.” Both are available as ebook and paperback on Amazon.com.

Be Prepared

Katherine Bouton emergency preparedness, Healthy Hearing

This summer’s violent storms in the East and out-of-control wildfires in the West, after a winter that included a deadly freak snowstorm in Texas, are reminders that emergency preparation is important, especially for people with hearing loss.

Your hearing aid is not going to do you any good without batteries, rechargeable or replaceable. Your cochlear implant is useless without both the earpiece and the headpiece and the charger for batteries. Your assistive devices won’t work without power.

Devices should be charged and ready to go. I also recommend pads and pens for communication, in case your devices are lost or run out of power.

Even if you’re not deaf or hard of hearing, emergency preparedness is important. This week in the New York metropolitan area we saw how quickly and devastatingly danger can arise, when the remnants of Hurricane Ida resulted, at last count, in 47 deaths. The same is true with fires – you may feel safe one moment and need to evacuate the next. Everyone should have a “go bag” at hand. All of this is true as well for an emergency in your own home: a fire or gas leak or other disaster. Have everything you’ll need ready for a quick exit. And have an emergency contact list for getting in touch once you’ve left.

Flashlight: In addition to hearing instruments, make sure you have a working flashlight. The batteries last longer if they’re not in the flashlight. Have spares. I have a rechargeable flashlight, the Bolder by Anker. It holds the charge for a long time and is quickly recharged with any USB power cord. You can buy them on the Anker website or online at Amazon ($29.99) and elsewhere.

Medication. As with your hearing equipment, keep medications in one easily accessed place, ready to put into your go bag.

Mobile phone and chargers. Again, keep your phone and charger in one reliable place so you’re not running all over the house looking for phone or charger. Remember that your car probably has a power outlet that will allow recharging.

Power Bank: I consider a power bank or portable charger an essential  component in a go-bag. Wirecutter recommends another Anker product: the Anker PowerCore Fusion 111 PIQ 3.0. It’s $39.99 on the Anker site as well as at Amazon and electronics stores.

Your wallet and ID. Maybe it’s time to get rid of all those store receipts and other unnecessaries in your wallet, so you’ll easily be able to find what you need, including your driver’s license.

I’ve written several times about emergency preparedness. It’s a perennial issue for everyone, but especially for the deaf and hard of hearing. This post, Emergency Preparedness for the Deaf and Hard of Hearing, includes links to other helpful sites in planning for an emergency.

My last piece of advice is to sign up for emergency alerts issued by your city or community. In New York City, Notify NYC alerts include not just dangerous weather alerts but also power outages, public transit delays and other useful information.  

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For more about living with hearing loss, read my books “Smart Hearing: Strategies, Skills and Resources for Living Better With Hearing Loss” and “Shouting Won’t Help: Why I and 50 Million Other Americans Can’t Hear You.” Both are available as ebook and paperback on Amazon.com.

Sleeping with Dogs

Katherine Bouton Healthy Hearing

When my dog was a puppy he slept in a crate, then he moved to a chair, then onto the bed. My husband would pick him up like a little lamb, when he came to bed after me, and move him back to the chair. After my husband died, Oliver moved permanently to the bed. I found it comforting, but more than that I also found it made me feel safer.

Oliver snoozing.

Oliver is a Tibetan Terrier, a 30-pound male with a good bark. Tibetan Terriers are not actually terriers but relatives of the Lhasa Apso and Shi Tsu, and they were originally bred as Tibetan temple dogs. They guarded the temple against intruders, sounding the alarm that would alert the larger fiercer dogs, who perhaps didn’t hear as well.

Oliver serves that purpose for me too, though I don’t have the backup fierce dogs. At my house in the country, he barks at anyone who drives or walks up the driveway, which prompts me to go to the door to see who it is. In the city, he barks when someone knocks. I don’t discourage this, although it can be annoying to people arriving. I have trained him to calm down if I tell him to, but only after I’ve determined who the visitor is.

He also barks when the phone rings, which can be handy since I don’t always hear it. This is also a response to a perceived intrusion. In my New York building, the doorman calls on the phone when we have a guest. Ollie associates any phone call with the arrival of a guest.

I wouldn’t rely on Ollie for other kinds of alerts. He is not a trained hearing dog. But we have an alarm system, and the smoke detectors are wired so that an alarm that goes off anywhere in the house sets the others off as well. Smoke in the kitchen, which I’d probably never notice from the bedroom, sets off the kitchen alarm (which I probably wouldn’t hear) and that alarm sets off the others. I’m pretty sure I could not sleep through the alarm ten feet from my bed. People with even more serious hearing loss than mine sometimes install alarms with strobe lights.

Ollie started out at the foot of the bed. Over the weeks after my husband’s death, he gradually crept up so he now he curls up against the pillows. (He’s not under the covers, and won’t be. I do have a few standards.) He’s a good sleeper and doesn’t bother me unless he thinks he’s detected an intruder, which in his case could be a deer walking through the yard or a bear knocking over the neighbor’s trashcan. I get up and look around, if he’s persistent enough. But mostly I mumble for him to settle down and I fall back asleep.

In the early months after my husband died, I’d sometimes mistake Ollie’s movements in the bed for my husband’s. My husband was also a quiet sleeper and when Ollie turned over or moved to a new spot, I would momentarily think it was my husband.

A few years ago, the Times ran an article called “Out of the Doghouse, Into the Bed.” The photos accompanying the story were very funny. The writer, Jen A. Miller, was reporting on a study from the Mayo Clinic in Phoenix. The study subjects were 40 dogs who slept in the bedroom with their owners. The dogs wore a FitBark (an activity tracker, cousin to the FitBit) and the humans wore an Activwatch2, also an activity tracker, made by Samsung, and kept a sleep diary. People slept slightly better when the dog was not on the bed, dogs slept about the same.

Not all dogs belong on the bed, or even in the bedroom. But mine is a cosy furry affectionate watchdog. We both sleep better this way.  

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For more about living with hearing loss, read my books “Smart Hearing: Strategies, Skills and Resources for Living Better With Hearing Loss” and “Shouting Won’t Help: Why I and 50 Million Other Americans Can’t Hear You.” Both are available as ebook and paperback on Amazon.com.

Affordable Hearing Aids are Already Here, but We’ll Still Need Audiologists.

Katherine Bouton Healthy Hearing

We all want hearing aids to be more affordable. That’s the impetus behind the Over-the-Counter Hearing Aid Act of 2017. Although signed into law by President Trump, it is still not active, though it’s been on the FDA’s schedule a few times. In July, President Biden signed an executive order on Promoting Competition in the American Economy, which included a call for the FDA to issue regulations for OTC hearing aids in the next 120 days.

Audiologists should be reimbursed for their services, even if the hearing aids are bought over the counter. That’s partly up to to Medicare. A proposal to separate the cost of devices from the cost of audiological services would seem to benefit all.

The need for affordable hearing aids is also behind the movement for Medicare to cover hearing aids, which would likely have a trickle-down effect on private insurers. President Biden called for Medicare coverage for hearing services in his budget request for fiscal 2022, and it is part of the $3.5 trillion social-policy package that Senate Democrats just approved, along party lines. (This is nowhere near the last step, don’t expect any changes in Medicare soon.)

Affordable hearing aids are also behind the consumer-electronics push to issue devices. Two good devices are already available: The Bose Sound Control Hearing Aids, which go for $849.95 a pair. They are considered hearing aids by the FDA, but not OTC hearing aids even though you can buy them without an audiologist. They are the only hearing aid in their category. They’re so popular that Bose limits purchase to two pairs per customer.

The Apple Airpods Pro ($249 a pair on the Apple website) also have many of the features found in hearing aids. Apple does not advertise them as hearing devices, but experts like Abram Bailey at HearingTracker.com have praised their features and called them hearing aids in all but name.

Affordability is also behind Costco’s popularity as a hearing-aid retailer. Costco sells its own Kirkland brand as well as discounted aids from the major manufacturers. Costco has hearing professionals on staff. Consumers might want to buy at Costco and have their hearing aid services, like programming and cleaning, provided by their audiologist.

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Changes in all these areas could result in widespread availability of less expensive hearing aids, but there’s another problem, which is less often discussed. Audiologists aren’t reimbursed for services that may be needed with these devices.  

Writing on StatNews.com, a highly regarded medical website, three prominent specialists in the hearing field, addressed the issue. Frank Lin, Charlotte Yeh, and Cristine Cassel* urged Congress to distinguish between Medicare coverage for hearing aids and Medicare coverage for the hearing-care services of an audiologist.

Audiologists aren’t needed to purchase OTC hearing aids or any of the consumer-electronics devices. But audiological care can be crucial in ensuring that you’re buying something appropriate for your hearing loss, or that you don’t have an underlying condition that is causing the loss. They can also fit those OTC hearing aids, offer advice on how best to benefit from them, and repair them if necessary – for a fee, of course. The authors call these “essential support services” in maximizing the benefit of these devices.

Those who have more severe hearing loss will still need traditional audiologist-fitted hearing aids. FDA-approved hearing aids should be covered by Medicare. The authors are not arguing that OTC hearing aids be covered, just that audiological services should be. Distinguishing these audiological services from the cost of the hearing aid helps ensure that older adults with hearing loss can safely and optimally benefit from these new technologies.

So perhaps in addition to OTC hearing aids and other FDA alternatives, we need to change the way audiologists are reimbursed. This would be good for people with less severe loss, or not enough money to buy FDA approved hearing aids. But it would be good for audiologists as well. It’s clear that the hearing aid sales model is changing. Separating coverage of hearing aids from coverage of audiological services would seem to benefit everyone.

* The authors of the STAT article: Frank Lin is an otolaryngologist and professor and director of the Cochlear Center for Hearing and Public Health at the Johns Hopkins Bloomberg School of Public Health. He was a member of the National Academy of Medicine consensus study on hearing care that recommended the FDA create rules for OTC hearing aids. Charlotte Yeh is an emergency medicine physician and chief medical officer of AARP Services, Inc. Christine Cassel is a geriatrician and adjunct professor of medicine at the University of California, San Francisco. She was a member of President Obama’s Council of Advisors on Science and Technology which recommended that the FDA create rules for OTC hearing aids. The views expressed here are the authors and do not necessarily reflect the opinions of their organizations.

For more about living with hearing loss, read my books “Smart Hearing: Strategies, Skills and Resources for Living Better With Hearing Loss” and “Shouting Won’t Help: Why I and 50 Million Other Americans Can’t Hear You.” Both are available as ebook and paperback on Amazon.com.