Hearing Loss Won’t Kill You, or Will It?

I published this post on my Psychology Today blog, which is aimed at psychotherapists. But I thought the readers of this blog might also find it interesting.

If you are a therapist and have a patient with hearing loss, please read this to get a sense of what your patient may be experiencing.images

I lost much of my hearing gradually, over 30 years. And then, eight years ago, I lost almost all of the rest of it in a single day. Eventually I got a better hearing aid and a cochlear implant, but I never heard well again.

I was forced to leave a job I loved. Caring for my elderly parents was almost impossible because I couldn’t hear them, I couldn’t hear their health-care providers, and I couldn’t call 911 in an emergency. I flew there often, mostly for crises, because the only way I could begin to function was in person, reading lips, asking for written notes. The stress was overwhelming.

My marriage was disintegrating because of the depression and anger my hearing loss caused. My young-adult children were unable to comprehend how their mother had turned so difficult. I quit my book club. I avoided going out with friends. On election night 2008, the night of Obama’s election, I declined a friend’s invitation to watch together and stayed home alone with a bottle of wine and a box of Kleenex. I drank myself to sleep before the winner was declared.

Most nights I slept no more than two hours at a time, often dissolving into crying jags in the middle of the night. I lost 15 pounds. I thought about ways I might kill myself, assuring myself I wouldn’t actually do it. But I thought it about it too much.

Fortunately I found help. A psychotherapist provided medication and talked me through those dark months. When I developed vertigo, she worked with my ENT to help find the right drug combination to keep it under control.

Hearing loss is not a lifestyle problem, it’s not just a normal part of aging. It is a deeply disruptive loss that changes everything about the way a person lives. Isolation and depression are common responses. It contributes to cognitive decline. Society dismisses it, and this makes it even harder to cope with.

I survived my hearing loss and became an advocate for education and accessibility for the deaf and hard of hearing. I am a board member of the Hearing Loss Association of America. I wrote a memoir of my struggles with hearing loss, Shouting Won’t Help, and included my email address so people could contact me. And they do. Sometimes the emails are heartbreaking. Yesterday morning I got one from someone I had never corresponded with.

The subject line was: “Rage, Anger, Depression, Abusing Alcohol.” I responded, and as more email came in over the day, I realized the writer was in serious trouble. She was essentially alone in a distant state. After consulting with psychotherapist friends I urged her to contact a mental health professional immediately. I wish I had been able to provide a reference for her.

This person had been on medication for depression and anxiety. Her hearing loss was not new, although it was newly worse. Whoever prescribed the medication seems not to have recognized the severity of the impact of her loss, or not to have successfully dealt with it.

There’s nothing more I can do for this person, but I urge therapists to take hearing loss seriously. Acknowledge the significance of the loss. Understand that hearing aids and cochlear implants don’t always work very well. Try to understand what it’s like to lose your means of communication with others. Try to imagine what it’s like to doubt everything you think you hear. Imagine the embarrassment of repeatedly asking for clarification a third or fourth time. Many people just give up. They isolate themselves, they get depressed, they decline cognitively. Sometimes they even think about suicide. Sometimes, they even carry it out.

When I was writing my book, I included the experiences of many people who worked in jobs where hearing well is important. I interviewed psychotherapists, musicians, nurses. I wanted a teacher and finally found a high-school teacher who had been forced to leave his job because he could no longer hear his students. I heard he was depressed and drinking. Before I was able to interview him he was killed in a single-car accident. The cause was never discovered.

For more information about living with hearing loss, my books  “Shouting Won’t Help: Why I — and 50 Million Other Americans — Can’t Hear You” and “Living Better With Hearing Loss” are available at Amazon.com.

Consumer Reports Rates PSAP’s

Bouton Blog - Consumer Reports
CR looked at hearing devices called PSAP’s – Istock

The February issue of Consumer Reports  magazine took an in-depth look at hearing loss and the hearing aid industry, as well as at the newest “hearing helpers” — less expensive, over-the-counter devices that may help some people with mild to moderate hearing problems.

Titled “No More Suffering in Silence?,” the report included the results of a fall 2015 survey of more than 131,000 of CR‘s subscribers. Nearly half reported they had trouble hearing in noisy environments, yet only 25 percent had had their hearing checked in the past year.

This isn’t surprising, as anyone who follows the hearing-healthcare business knows. The National Institute on Deafness and Other Communication Disorders (NIDCD) reports that among adults 20 to 69, only 16 percent of those who could benefit from a hearing aid has one.

Consumer Reports, however, with a subscription base of 7 million, reaches far more people than an NIDCD statistic does. When CR tells its readers about the dangers of untreated hearing loss, it is sending a message to millions who might not otherwise hear it.

The Consumer Reports article begins with an overview of hearing loss, noting the recent changes in understanding of the consequences of hearing loss. Once dismissed as “part of getting older” or a “nuisance,” we now know that untreated hearing loss is a “significant national health concern, one that’s associated with other serious health problems, including depression and a decline in memory and concentration. Several studies even suggest a link between hearing loss and dementia,” the article says.

Cost could be a big reason for this, the magazine notes. The National Academy of Sciences reports that hearing aids cost an average $4,700 per pair in 2013 and can climb to almost twice that price. Plus, hearing aids are usually not covered by health insurance or Medicare.

This is where OTC hearing helpers — also called PSAP’s, for personal sound amplification products — come in. They cost a fraction of the price of an average hearing aid. But do they really work?

The magazine had three of its employees with mild to moderate hearing loss try four devices priced from $20 to $350, wearing them for three to seven days to see how well they could help with hearing in a noisy environment. CR‘s audio labs also tested the devices for amplification, batteries, microphone function and sound distortion.

The most important finding: Pinching pennies can hurt you. The two lowest-priced devices — the Bell & Howell Silver Sonic XL ($20) and the MSA 30X ($30) – were found not only inadequate, but also potentially dangerous. Both overamplified sharp noises, like a siren, to the point where hearing damage could occur.

A hearing-aid researcher who assessed the devices recommended avoiding those under $50. “They don’t seem to help much, if at all, and could actually further diminish your ability to hear,” the magazine reported.

The two PSAPs that fared better were the SoundWorld Solutions C550+ ($350) and the Etymotic Bean ($214 each, $399 for a pair). CR reported on the pros and cons of each device, offering overall “device advice” for each one.

In general, The C55+ and the Bean seem useful for people with mild to moderate loss. The Bean was found to be especially helpful for those with hearing loss in the higher frequencies rather than the lower. For complete details, click here.

If your hearing loss is serious enough to warrant a hearing aid (and much hearing loss is, so have your hearing checked by an audiologist first), the article offered some suggestions for ways to pay less. I’ll write about these in my next post.


A version of this post first appeared on AARP Health on March 6, 2017.

Considering a Cochlear Implant? You’re Never Too Old.

Is there  an age limit for cochlear implant recipients? I asked this question of several cochlear implant surgeons around the country. Their answer? Never.

All have implanted patients in their 90s and, as Anil Lalwani, of New York-Presbyterian/Columbia University Irving Medical Center said, he “routinely” operates on patients over 80. His oldest patient is 93.

Surgeon Jay Rubinstein, at the University of Washington Medical Center, has performed cochlear implant surgery on a 96-year-old. Like the others, he thinks chronological age is -not the issue, it’s a person’s overall health.

In other words, it’s not so much how many years you’ve lived as how well your body has held up. In April 2014, Mollie Smith, 99, became the oldest cochlear implant recipient in Europe.

Cochlear implant surgery takes about two to three hours and requires general anesthesia or heavy sedation, so the ability to tolerate anesthesia is essential. Even so, a 2009 study by Dr. Lalwani and others, found that cochlear implantation in the elderly carries minimal risk from anesthesia.

One of the important preexisting conditions that may preclude surgery is moderate or severe heart and/or lung disease, which could make anesthesia potentially dangerous, said Rick Hodgson, a surgeon with Head and Neck Surgical Associates in Portland, Ore. The oldest patient he has implanted was 92 and he’s doing well, Dr. Hodgson said, noting that as a surgeon he looks more at “biologic age than chronological age.”

Darius Kohan, an otologist-otolaryngologist in New York (who was my cochlear implant surgeon at New York Eye and Ear Infirmary), told me he implanted a patient who was 95 years 6 months old. The patient is still using the implant 21/2 years after surgery.

Even dementia may not be a disqualifier, the surgeons said, assuming that the patient is not violent or likely to destroy the external parts of the implant. A study published last summer on implantees with dementia found a significant cognitive improvement a year later. The patients also received regular auditory rehabilitation. It was not clear from the study whether it was the implant itself or the aural rehab that made the difference in improved cognitive abilities.

Jack Wazen, a surgeon and  partner at the Silverstein Institute and director of research at the Ear Research Foundation in Sarasota, Fla. (and a fellow board of trustees member with me for the Hearing Loss Association of America), was the most conservative of those interviewed on the question of dementia, saying he routinely implants those with mild to moderate cognitive decline, but not those with severe decline.

All agree on the importance of auditory rehab for older patients. As Dr. Hodgson put it, “Auditory rehab helps get the most out of the process. This is amazing and life-changing technology, so why wouldn’t we want to maximize the impact on someone’s life?” He added that younger implant recipients might still be in the workforce and get stimulation from their everyday environment. The older recipients are less likely to get that stimulation. Also important, as all the surgeons agreed, is a social support system. This doesn’t necessarily mean a companion in the home, but a regular conversation partner is essential. Social interaction is important in general for quality of life.

The one issue on which the surgeons differed was which ear to implant: the worse or the better one. With younger implantees, the decision is usually to implant the worse ear, to preserve the natural hearing in the good ear, often using a hearing aid in the good ear. But an elderly person may have been deaf for some time in the bad ear, and thus less likely to benefit from the implant.

Although most said that they would consider implanting the deaf ear, they might not if the ear had been deaf for a long period of time. Dr. Wazen specified five years or more. Dr. Hodgson pointed out that “the longer the duration of hearing loss, the higher the chance of diminished benefit due to deterioration of sensory elements in the inner ear.”

Both Dr. Lalwani and Dr.  Kohan said they would implant the worse ear. Dr. Kohan’s reasoning is that if the patient is still able to hear with the hearing aid ear, there may still be enough plasticity in the brain, with crossover from the nonhearing ear, to make an implant in the deaf ear function. Dr. Lalwani went further: “I would always implant the deaf ear. One does not lose anything from doing so. If the outcome is less than satisfactory, the other ear could always be implanted down the road.”

As for outcomes, all the physicians agreed that older recipients do well with cochlear implants. Dr. Kohan mentioned benefits like delayed mental deterioration, better quality of life and more independence.

Dr. Wazen is completing a study comparing the results among patients over 80 with those under 80. The study found no differences in healing or complication rates. All patients did better with the cochlear implant than they had with a hearing aid. The study did find that speech recognition scores with implants were better in the younger group. This may be due to a number of factors, Dr. Wazen said, “including length of deafness, poorer cognitive function [in the older group] and aging changes in the brain.”

So if your doctor recommends an implant, go for it, no matter what your age. “When elderly patients tell me they are too old for a CI,” Dr. Rubinstein said, “I tell them age is not important unless they are a cheese.”

This post first appeared on AARP Health on February 22, 2016.

Cocktail Party Syndrome

In a previous post I wrote about a new study that shows that older brains have a harder time processing speech than do younger ones. In the study, even people with normal hearing had a hard time hearing in noise, what I call Cocktail Party Syndrome.

Several readers wrote to say that this same problem applies to lip reading and to ASL. I’m about to start taking ASL lessons (I’ll report on my progress) but I do worry that the old brain may just not be up to learning not only a new language but a language that is visual rather than aural.

Meanwhile, for those who may not have gotten to the end of my previous, rather lengthy post, here are some tips for keeping the hearing part of your brain agile. You might start with general brain-training exercises, which help in all sort of cognitive tasks. Physical exercise has been found help brain agility.

For exercises more specific to hearing comprehension you could use techniques like those used in auditory, or aural, rehab, where the brain is trained to recognize words more quickly and accurately. There are formal programs for this, like the online Listening and Communication Enhancement (LACE) programs, but you can also practice simply by listening to a recorded book and then checking the text to see whether you heard accurately.

Make sure you can see the speaker, and pay attention. Visual clues gleaned from facial expression, body language and the movement of the eyebrows and eyes assist speech comprehension. Formal speech-reading classes teach you to pay attention to these signals, but we all speech-read to some extent. It’s why even hearing people crane their necks to see a speaker, even if they can hear the speaker. This need to see as well as hear has an official name: the McGurk effect, named after one of the British scientists who discovered in the 1970s that we comprehend speech better if what we are hearing matches what we are seeing. The scientists called it “hearing lips and seeing voices.”

Make sure the speaker pays attention to you, too — starting with facing you. Ask companions to speak clearly and slowly but also naturally. For those with normal hearing, there’s no point in raising your voice because they can already hear — they just can’t understand. For those with hearing loss, shouting distorts the face and makes speech reading even more difficult. So ask them to speak slowly (but not too slowly) and clearly. And keep your eyes on their face.

Find a quiet corner and make it yours. Let people come to you, so that when they do you can hear them. If there’s someone you’d really like to speak to, ask them if they would sit with you. I find that involving others with my hearing loss, asking them to help, is often happily embraced. People like to be told how they can help. Most people, anyway — there are indeed very grouchy people out there who will be rude to you, but luckily they are not very often found at cocktail parties.


Trouble Hearing? It May Be Your Brain

Bouton: It’s All In Your Brain (Not Your Ears)
When it comes to hearing problems, the blame sometimes lies in the aging brain, not the ears. — Getty Images


Older people may struggle to hear in a noisy environment, even with normal hearing, a recent study by University of Maryland researchers found.

Writing in the Journal of Neurophysiology, researchers Samira Anderson, Jonathan Z. Simon, and Alessandro Presacco, all associated with the UMD’s Brain and Behavior Initiative, found significant differences in the way older and younger people process speech in noise.

The study compared the brains of adults ages 61 to 73 with those ages 18 to 27. What they found was that our brains, as they age, get worse at processing the sound of talking when there are other sounds at the same time. In this case, the older adults scored measurably worse on speech understanding in noisy environments than the younger adults.

Both groups had normal hearing as measured by an audiogram. Importantly, they were also given speech in noise tests, and their hearing was still found to fall within the normal range. So what accounted for the disparity in speech understanding? The answer, alas, may lie in the aging brain.

Using two different kinds of brain scans — EEG (electroencephalogram) and MEG (magnetoencephalogram) — the researchers studied the midbrain area, which processes basic sound in most vertebrates, and the cortex, which has areas dedicated to speech processing in humans.

The cortical test involved listening to a male speaker reading from “The Legend of Sleepy Hollow,” by Washington Irving, while a secondary, female, speaker read from A Christmas Carol, by Charles Dickens. The midbrain test used just the female reading.


In the younger subjects, both areas of the brain responded normally to speech in quiet (one reader) and speech in noise (two readers), but in older adults, the cortex responded more slowly in processing speech whether or not there was secondary noise.

“For older listeners, even when there isn’t any noise, the brain is already having trouble processing the speech,” said coauthor Jonathan Simon in a press release.

“Older people need more time to figure out what a speaker is saying,” he added. “They are dedicating more of their resources and exerting more effort than younger adults when they are listening to speech.”

             What can we older adults do?

We could try brain-training exercises. This link is to an article about physical exercise that helps brain agility, but you could also use exercises like those used in auditory, or aural, rehab, where the brain is trained to recognize words more quickly and accurately. There are formal programs for this, like the online Listening and Communication Enhancement (LACE) programs, but you can also practice simply by listening to a recorded book and then checking the text to see whether you heard accurately.

Making sure you can see the speaker is also essential. Visual clues gleaned from facial expression, body language and the movement of the eyebrows and eyes assist speech comprehension. Formal speech-reading classes teach you to pay attention to these signals, but we all speech-read to some extent. It’s why even hearing people crane their necks to see a speaker, even if they can hear the speaker perfectly well.

This need to see as well as hear has an official name: the McGurk effect, named after one of the British scientists who discovered in the 1970s that we comprehend speech better if what we are hearing matches what we are seeing. The scientists called it “hearing lips and seeing voices.”

To overcome that age-related decline in the ability to understand speech, then, make sure you pay close attention to the speaker. Make sure the speaker pays attention to you, too — meaning he or she should be facing you. Because your actual hearing is normal, there’s no need for a speaker to shout; in fact, shouting distorts the face and makes speech reading even more difficult. So ask them to speak slowly (but not too slowly) and clearly. And keep your eyes on their face.

Another simple solution: Hold conversations in a quiet environment.


This article first appeared on AARP Health on 2/05/17

Try this Trick to Hear People at Parties.

Reprinting this from the Journal of the Acoustical Society of America.

It seems worth a try.

Try this trick to hear people better at parties

People in noisy situations should face slightly away from the person they’re listening to and turn one ear towards the speech.

A new study concludes that this listening tactic is especially beneficial for cochlear implant users who typically struggle in noisy social settings such as restaurants.

The study also finds it compatible with lip-reading, which was unaffected by a modest, 30-degree head orientation.

“Noise can be a big issue for any listener and especially for someone with a cochlear implant,” says Jacques Grange of Cardiff University’s School of Psychology.

“Our study shows that by simply turning one ear towards the person they are listening to, cochlear implant users find it much easier to hear that person above background noise, enabling them to engage in conversations in noisy environments, and not become isolated.

“It’s better to have a clear signal in one ear than a mediocre signal in both.”

When tested in the laboratory, with the speech in front of the listener and interfering noise behind, the technique resulted in a 4-decibel improvement to intelligibility of speech in a noisy environment for both normal-hearing listeners and cochlear implant users.

A 4-decibel improvement can be the difference between understanding nothing and perfect understanding.

To simulate a realistic restaurant listening situation, acoustic measurements were also taken in the Mezza Luna restaurant in Cardiff and used to create a virtual acoustic simulation.

In the simulation normally hearing listeners were tested at each table with three different head orientations: facing the target talker, with a 30-degree head turn to the left, or with a 30-degree head turn to the right.

The UK charity Action on Hearing Loss funded the work, which appears in the Journal of the Acoustical Society of America.

Venus, Mars, and Hearing Loss

Hearing Loss and Gender Differences
Women acknowledge hearing loss differently than men. — Getty Images

We have long known that men and women talk differently. This includes the way they talk about hearing loss.

A 2015 study found considerable differences. Women were more than twice as likely as men to disclose the loss and offer helpful suggestions about how to talk to them. A woman might say, “I don’t hear well out of my right ear. Please walk on my left side.”

( For more suggestions on how to respond creatively and helpfully about your hearing loss see “How to Talk to Someone with a Hearing Loss.”)

Men tend to simply state that they are hard of hearing, and then offer an explanation about how they lost their hearing. One researcher commenting on the Harvard study suggested that men need to develop an “elevator pitch,” a strategy “that they can comfortably deploy when they need to disclose their hearing loss.”

The study, conducted by Jessica West and Konstantina Stankovic, colleagues at Harvard University and Massachusetts Eye and Ear in Boston, suggests that the women’s approach is far more helpful in successful communication.

The women’s strategy gives “a simple, straight-forward explanation of the hearing loss while highlighting ways in which communication partners can help the person with hearing loss to hear better in the situation,” they said. “It focuses on how to improve the communicative interaction rather than on the hearing loss itself.”

Men are almost twice as likely to have hearing loss as women, especially in the 20 to 69 age group, according to the the National Institute of Communication Disorders (NIDCD).

If men are twice as likely to have hearing loss as women, are they also twice as likely to use hearing aids? There is no really good study of this to date.  But how you respond to your hearing loss, with or without hearing aids, is crucial to successful communication.

There are other gender differences besides speech patterns that may influence communication. Men are less comfortable with sustained eye contact than women, and they are less comfortable showing emotion. These can affect the ability to speech-read, which is a substantial benefit to many with hearing loss.

The writer Gael Hannan has given several workshops on speech reading, including one called “Man-Lips: Men and Speechreading — Facing the Challenge.” She thinks there is a gender difference in speech reading success. Women do it better. Hannan has a hard time even getting men into her courses. She suggests that if you want to run a male-inclusive speech reading course, promote it as a “success strategy” and incorporate lots of gadgets.

What about those studies on hearing aid use? We see a lot of men with hearing aids, which might make you think men are more likely to wear hearing aids. But there are two reasons for that perception (or misperception). The first is that a hearing aid is more visible on a man with short hair or no hair at all. The second is that twice as many men as women have hearing loss.

But the fact is that we simply don’t know the ratio of hearing aid use in men and women. Two reputable studies in the past five years have found two different results.

A large 2011 Swiss study of 4979 adult male and 3410 adult female hearing aid users found that women were more likely to use their hearing aids regularly, and for longer periods during the day than men. The men were more likely to blame their non-use on the limited benefits they got from the hearing aid.

A more recent study of hearing aid use in the United States among older adults found that men said they used their hearing aids at about the same rate that women said they did. But it’s important to remember that this is self-report. We all know the temptation to answer the way you think you should answer. Only about one third of the respondents who could benefit from hearing aids had them.  The Swiss study also relied on self-report but added hearing loss data and hearing aid technical information, which may have affected the results.

The bottom line for understanding speech better: talk more like a woman, behave more like a woman and wear your hearing aids.


This article first appeared in a slightly different form on AARP Hearing Health on January 24, 2017