Hollywood and Hearing Loss

Several people have asked if I’ve seen “Sound of Metal,” a movie about hearing loss, which was released late last year. At first I avoided it. The trailer featured a metal drummer playing very loudly, and it didn’t look all that appealing. I finally did watch, with the sound turned way down and the captions on, and enjoyed it.

RiZ AHMED

Riz Ahmed plays the drummer, Ruben, who experiences sudden deafness. The portrayal of the experience of hearing loss seemed very accurate to me. Too little comprehension, too much noise. Ruben’s emotional reaction to the loss – anger, depression, confusion – will also be familiar to many. Ruben is a recovering addict, which adds to the difficulty. Watching Ruben struggling to understand what is happening to him took me back to the days when I too experienced sudden hearing loss. Ruben’s sensitivity to loud noises reminded me of what felt like the physical assault of noise in New York City, where I lived. I was sensitive not just to loud sounds like a siren or jackhammer, but to less obvious ones, including the blast of a city bus braking or accelerating.

“Sound of Metal” is nominated for six academy awards this year, including Best Picture, Best Actor (Riz Ahmed) best supporting actor (Paul Raci), best original screenplay (Darius Marder, Abraham Marder, and Derek Cianfrance). Tellingly, it is also nominated for best sound. When you’re making a movie about hearing loss, sound is important.

The movie has generated controversy in the Deaf community. Neither Ahmed nor Raci is Deaf, although Raci is the son of Deaf parents. Ruben at first joins a Deaf community, where the group leader, played by Raci, welcomes him and helps him learn ASL. Riz Ahmed studied ASL for 7 months prior to filming. Some of the other actors, though not the principals, are Deaf.

The movie has also caused some consternation in the hearing loss community, in particular in its depiction of cochlear implants. The information is misleading and in some cases inaccurate. Ruben receives bilateral implants. We don’t hear any discussion of trying hearing aids first, in an effort to make the most of his residual hearing. In addition, bilateral implants are rarely done at the same time. Surgeons prefer to implant one ear, make sure the implant works for the recipient, and then go back later for the second implant.

We don’t see any of the evaluation process or any discussion that would ordinarily precede this surgery. A surgeon and audiologist would have talked about expectations, which shouldn’t be too high – and in fact Ruben’s first reaction to the metallic sound of the implant is distress. But he’s a quick learner. Some have also questioned this as well. As I can attest, learning to hear again with a cochlear implant takes hard work, if possible with a speech-language pathologist. But Ruben has been only recently deafened, and in real life he might quickly regain good speech discrimination. Ruben is also told that health insurance doesn’t cover implants, which range from $40 to $60,000. This is not accurate. Almost all health insurers will cover at least one implant, as will Medicare and in many states Medicaid.

Perhaps most alarming to me was the lack of any apparent reaction to the fact of his sudden deafness. Sudden deafness can be an indication of a serious medical condition and an ENT should immediately test for auditory nerve damage, auto-immune disease and other conditions. An MRI and a strong dose of oral steroids is also usually prescribed. His drumming would no doubt have contributed to hearing loss, but unless he was exposed to an explosion or other loud sound, the loss would have been gradual.

I liked the movie, and am sorry for the misrepresentations, though the depiction of the impact of hearing loss is valuable, and I’m not sure I’ve seen it so accurately portrayed elsewhere. So many people get their information from movies like this one, and it’s good to show the reality of hearing loss. It’s also a bit of a shame to have cochlear implants inaccurately portrayed.

For other analyses of the movie, I recommend this essay by Donna Sorkin. She is the Executive Director of the American Cochlear Implant Alliance. Sorkin was also interviewed for this article in USA Today. My fellow blogger and HLAA member Shari Eberts wrote about the film shortly after it came out at the end of last year. And here’s an essay from HLAA’s Lise Hamlin: Sound of Misinformation.

The Academy Awards are on Sunday October 25th. “Sound of Metal” is available on Amazon Prime.

Readers, what movies do you like that have characters with hearing loss? Is hearing loss per se — as opposed to signing Deafness — ever portrayed in movies? Can you think of any?

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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.

How Fit is Your Hearing?

Recently, a prominent researcher in the field of hearing loss suggested a simple change in the way we talk about hearing loss. Rather than frame it as a disability, said Dr. Justin Golub of Columbia University Irving Medical Center, “I like the idea of hearing fitness.”

images“Hearing loss” is a negative term. For people who don’t want to admit they have hearing trouble, it invites the dismissive response: “I’m fine.”  But who wouldn’t want to be as fit as possible, especially if it takes little to no work on their part?

Dr. Golub is the lead author on a November 2019 paper in JAMA Otolaryngology-Head Neck Surgery, which found an association between cognitive impairment and what is generally considered “normal” hearing. In 2011, Johns Hopkins’ researchers led by Frank Lin, published the result of a longitudinal study on a large cohort of older adults showing that those with moderate or more severe hearing loss were at a greater risk of dementia. The greater the hearing deficit, that study found, the greater the risk of developing dementia. What Golub and his colleagues have now found is that even minor loss, within the so-called normal range  of 25 dB or less, is associated with lower cognition.

Using two major national databases as their source, the Golub team studied data on hearing and cognitive performance in 6451 people age 50 and over. This study, unlike previous studies of hearing loss and cognition, focused on people with hearing loss in the range usually considered normal. They considered all levels of hearing in that category, down to what would be considered “perfect” hearing, the ability to hear at zero decibels. (Dogs can hear at -5 to -15 decibels.)

After adjusting for demographics and cardiovascular disease, the study found that decreased hearing was independently associated with decreased cognition. The study did not look at whether hearing loss causes cognitive decline. Nor did it look at whether correcting hearing loss with hearing aids offsets the correlation.

“Can Hearing Aids Help Prevent Dementia?” That question was the title of the article in The New York Times Magazine where Golub’s hearing fitness quote appeared. We don’t have an answer yet but Frank Lin and colleagues will conclude what is expected to be the definitive study on hearing aids and their deterrent effect on cognitive decline in 2022. (For those who are interested in learning more about the study, Aging and Cognitive Health Evaluation in Elders (ACHIEVE), funded by the National Institute on Aging, here’s a link to an interview in AudiologyOnline on the study and other hearing-related public-health issues.)

Speaking to the Times Magazine, Golub mused, “We always frame [hearing loss] as a disability.” Telling college students that blasting their ears with loud noise is going to make them more susceptible to dementia 50 years later, he said, isn’t going to be much of a deterrent. “But if you say, ‘Hey, hearing is good for your brain, the more hearing you have the better,” that has immediate implications.”

“Hearing Fitness” is good for people at any age. Whatever it is about hearing loss that aligns it with an increased risk of dementia is of course of paramount interest. But poor hearing has a host of other physical and psychological ramifications, some of which themselves are a risk factor for cognitive decline.

Hearing fitness means taking care of the hearing that you have, whatever your age. And if it begins to decline, as it often does with age, correcting it. Cost has been a prohibitive factor for many up till now, but this year the FDA will announce guidelines for an over-the-counter hearing aid that will cost a fraction of existing FDA-approved hearing aids. Hearing aid companies and the consumer electronics industry are already offering products that are as good as some hearing aids at even cheaper prices. Costco is reportedly the nation’s largest hearing aid dealer (except for the VA), with volume permitting lower prices. Having hearing professionals on staff insures responsible service. Insurance companies are increasingly covering hearing aids, finally understanding their role in healthy aging. In some states, Medicaid covers hearing aids. Even that dinosaur Medicare may soon revise its hearing aid policies.

Tuesday March 3 is World Hearing Day. Although hearing fitness may be a distant goal for the half a billion people worldwide with disabling hearing loss, those of us in prosperous countries can make a start by taking care of our hearing, and by treating it promptly when problems develop. Hearing help comes in all price ranges. Keep your hearing fit!

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For more about living with hearing loss, read my books, available at Amazon.com and maybe at your favorite bookstore or library. If it’s not there, ask for it!

 

 

 

Medicare and Hearing Aids

Medicare doesn’t cover hearing aids. This is the one thing about hearing loss that never fails to surprise people new to the field. The fact that Medicare doesn’t cover hearing aids even for the most severe and disabling hearing loss is even more shocking. Despite universal agreement among health care practitioners that untreated hearing loss can lead to serious mental and physical problems in older adults, Medicare won’t support the single best treatment: hearing aids.

The Good News.  On December 16, Congress passed a bipartisan bill to cover hearing aids and hearing audiology services. HR 3 allows the Federal government to negotiate prescription drug prices and use these savings to cover the costs of hearing, dental and vision services. This is an issue that the Hearing Loss Association of America and other groups have been advocating for for years. In addition to covering hearing aids, the bill permits reclassifying audiologists as practitioners under Medicare, qualifying them for reimbursement. The audiology professional groups — the AAA, ADA, and ASHA — urged the Senate to adopt the measures. HLAA praised the action as a “significant step forward.”

The Caveats. While celebrating the passage of HR 3 as a historic achievement, HLAA urged caution. The bill must be passed by the Senate, where there is significant opposition to negotiating drug prices. “Senators, as well as the Trump Administration, are exploring other ways to lower the cost of prescription drugs,” HLAA said in a statement. “Whether these alternatives will also include hearing aid coverage under Medicare remains to be seen.”

Don’t Wait to Get Hearing Aids. The sooner you treat hearing loss, the more effective the treatment is likely to be. So don’t wait for Congress to get its act together and actually make this provision law.

The National Institute on Aging notes that untreated hearing loss can lead to depression and isolation, as well as cognitive decline and dementia. Hearing problems are also also associated with greater risk of falls, which can be devastating for a vulnerable adult. Medicare doesn’t cover vision or dental care either, meaning that older adults may be on their own financially when it comes to three components of healthy aging. It’s a short-sighted policy and one that may finally be rectified.

If you can’t afford hearing aids sold through private audiologists, alternatives exist. Consider the big box stores like Costco, which sells brand name hearing aids at lower prices than independents. Other stores like Best Buy, Sam’s Club and Walgreens also sell hearing aids, although they cannot legally be called “hearing aids” without FDA approval. Many insurers sell affiliated  brands of hearing aids at a much lower cost than you would pay privately. United HealthCare, for instance, sells hearing aids through hiHealth Innovations. HearingTracker allows you to compare hearing aid prices in a geographical area, Readers, please share other alternatives to high-priced hearing aids in the comments section.

Consumer electronics products are good starter hearing devices (Don’t go too cheap.)  In addition, sometime in 2020 the FDA will issue its regulations for over-the-counter hearing aids, making access to FDA approved hearing aids cheaper and more accessible.

For now, it’s great that Congress was able to take a little time out from impeachment to get this important bill on the agenda.

For more about living with hearing loss, read my books: Smart Hearing and Shouting Won’t Help.