Hearing and Healthy Aging

Recently I was invited to write an editorial referencing two studies on the effect of hearing on healthy aging. The article has just been published, in the Journals of Gerontology. Most readers won’t be able to access it, so I’m reprinting the text here. The title is “The Importance of Hearing in Maintaining Overall Functioning as We Age.” It’s a bit more formal than my posts are, and it’s edited a bit here for clarity.

As my hearing deteriorated in the decades following my initial loss at age 30, I worried that I would go deaf. Now, I worry that I will lose my cognitive faculties. The specter of dementia looms large for people with severe hearing loss. The statistical association between hearing loss, depression, and cognitive decline is well documented. What is not known is whether the association is causal, or shares a common pathogen, or is related in some other way. To explore this, a major study, the Achieve Study, is underway to see if hearing aids help reduce the risk.

The threat of cognitive decline is often cited as a reason to correct your hearing loss—to get hearing aids or cochlear implants or other hearing devices. But as people with severe hearing loss know, these do not fully correct hearing. I have worn hearing aids for more than 30 years. Twelve years ago, I replaced one aid with a cochlear implant, when the aid stopped being helpful. Certainly, I hear better with hearing aids than without. But I can hear adequately only under the best circumstances: in a quiet environment or with 1 or 2 other speakers who speak slowly and clearly. Adding even a fourth speaker to that conversation increases the likelihood of 2 people talking at once. When that happens, I cannot follow anything.

I have long worried that my corrected but far from normal hearing puts me in the same category as someone with untreated loss. One of the articles the journal asked me to comment on confirmed my suspicion. A study by Katharine K. Brewster and others from the Departments of Psychiatry and Otolaryngology at Columbia, Age-Related Hearing Loss, Late-Life Depression, and Risk of Dementia in Older Adults, studied 8529 participants.  Of those 6478 were classified as having no hearing loss, 1102 as having treated hearing loss, and 949 as having untreated hearing loss. The last category included people who had hearing aids but had “hearing impairment despite hearing aid use.” All 8529 participants were free of cognitive decline at the start of the study.

Depressing but not surprising: Individuals with treated hearing loss were at higher risk for depression as well as dementia than those with no hearing loss. But, confounding expectation, they were also at higher risk than those with untreated hearing loss. As the authors wrote, “We expected treatment of hearing loss would be protective against adverse neuropsychiatric consequences.”

What could explain this? The first possibility is an error, meaning the results need to be replicated by future studies. There is also the possibility that hearing aid treatment itself has harmful effects on mood, which the authors thought unlikely. Their preferred explanation was that people who get hearing aids have hearing loss that is both more severe and of longer duration. This more severe loss increases the risk of depression and dementia. Because the efficacy of treatment was self-reported to clinicians—rather than tested audiometrically—it is also possible that some of those with treated loss were not receiving adequate hearing treatment.

The third explanation—that people with treated hearing loss usually have longer-occurring and more severe hearing loss—makes sense. Statistics show that it takes 7 years from the time of diagnosis to purchase of hearing aids, and often even once they own hearing aids many people rarely or never wear them.

But I would not discount the explanation that treatment has a harmful effect on mood.

People who pay $6 000 for hearing aids expect that they will work. They are often dismayed to find that even with their expensive new devices they still cannot hear in restaurants or places where there is background noise. They still need captions to hear TV. They still cannot hear at meetings or lectures. They are told they must buy more devices—assistive listening devices and remote mics. In addition, hearing aids can be troublesome—the batteries run out at inconvenient times or the vents get clogged with ear wax or the charger is not working properly. They are easy to lose. During the pandemic, many found that wearing a mask dislodged hearing aids, and sometimes they fell down sink drains or were lost on the street. Hearing aids by their very presence are a reminder of disability. All this can be very depressing!

It is thought that hearing loss may initiate a deleterious cascade of events including social isolation. Difficulty hearing may affect executive function and result in decreased cognitive reserve. Studies have shown atrophy of brain regions connected to auditory circuits. These “may explain the mechanistic links between hearing loss, depression, and cognitive decline,” they wrote. But the study found that depression was responsible for only 6% of the hearing–dementia relationship. “Hearing loss and depression are independent risk factors” for dementia, but how each affects the other to exacerbate cognitive decline or dementia is not clear.

Even if the mechanisms haven’t been explained, however, the authors advise that because hearing loss and memory problems and depression are so often found together, evaluation of an older patient with symptoms of cognitive decline or depression should include evaluation for hearing loss. This is a much-needed piece of advice. Currently, only 17 to 30 percent of physicians, including gerontologists, screen for hearing loss.

The second study presented here is more heartening or at least part of it is. The Association of Hearing Impairment with Higher Level Physical Functioning and Walking Endurance, an epidemiological study done by researchers at Johns Hopkins, using the long-term Baltimore Longitudinal Study of Aging. It found that hearing loss is linked to poorer physical function, including slower walking. The more severe the loss, as measured audiometrically, the greater the physical decline. The 831 participants with hearing loss, treated or not, overall scored worse in a test of physical performance and walking endurance than people with normal hearing. Over the 6 years of the study, they showed faster rates of decline than participants with normal hearing or mild hearing loss. Vestibular dysfunction was factored in. But, and here is the encouraging news, hearing aid users—regardless of the severity of their loss—walked significantly faster than nonusers.

The authors acknowledged that their study population was more likely to be white and have higher socioeconomic status, both associated with better physical function, than the general population. In addition, hearing aid use was self-reported with answers limited to Yes or No on whether they used hearing aids. But it is still a tantalizing finding. The authors suggest that social isolation, cognitive impairment, and reduced physical activity may play a greater role among the non-hearing aid users. Auditory clues can contribute to balance, and uncorrected hearing loss might affect vestibular function. There is also the possibility that hearing loss and poor physical performance have a common cause.

Another possible explanation occurred to me as I was reading this study. Treating hearing loss takes initiative. People who get hearing aids often must overcome hurdles like lack of access to good hearing health care as well as significant expense, because hearing aids are not covered by most health insurance, including Medicare. Maybe this same initiative contributes to better physical self-care. Just as they have taken the initiative to buy and wear hearing aids, the better performers may have tried to stay healthy in other ways, including diet and exercise.

One takeaway from both these studies is that exercise is good for you. Exercise can ease symptoms of depression (an established risk factor for cognitive decline). The finding that hearing aid users walked longer and faster than nonusers, regardless of the severity of their loss, suggests that “screening for and treatment of hearing loss may delay or slow progression of hearing-related physical decline.” In other words, get your hearing tested and treated, and your overall physical health may benefit.

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.

You’re Not Alone: Books Can Help You on Your Hearing Loss Journey

Nice post on the website of Let’s Loop Seattle, which discusses books for people with hearing loss, including children. You can add your own favorites, either on the original post or on this one. I’m always looking for good new reading on the subject. I’ll be writing about Gael Hannan and Shari Eberts new book, Hear & Beyond, in a future post.

Here’s the URL (which for some reason I can’t link to the title on my page): https://loopseattle.org/2022/02/14/youre-not-alone-books-can-help-you-on-your-hearing-loss-journey/

Does Hearing Loss Affect Your Sense of Direction?

Last April, the New Yorker Magazine ran an article about animal migration called “Why Animals Don’t Get Lost,” by Kathryn Schulz. The article was full of fascinating insights into animal navigation and amazing tales of seemingly impossible journeys. But one passage leapt out at me:

“The problem isn’t that humans don’t have any innate way-finding tools. We, too, can steer by landmark, and we can locate the source of sounds or other environmental cues and make our way toward them. (With sounds, we do this much like frogs: by unconsciously assessing either the intensity differential or the time delay between a noise in our right ear and in our left one.)”

If you have hearing loss, you may not have that sense of directionality. My hearing loss is bilateral and wildly uneven, which affects my ability to locate the source of a sound.  If someone calls to me from another room, I can’t tell where they are. Where are you?, I shout, to their annoyance – and mine. Although I can often hear a bird call, I can almost never find the bird. In that sense, my hearing loss does affect my sense of direction.

Photo by Isaque Pereira on Pexels.com

If you have bilateral hearing loss that is the same in both ears, however, as most age- or noise-related hearing loss is, and if your hearing is corrected by hearing aids, it seems logical that you shouldn’t have any trouble using audible feedback as a guide. But I haven’t read anything about this, so it’s only a surmise. Readers, if you have hearing loss that is bilateral and equal on both sides, do you have trouble locating the source of sounds?

Although we use our ears to locate, we don’t for the most part use them to navigate, in the sense of assessing directionality. Our hearing loss affects our ability to navigate in a more prosaic way. We can’t hear auditory signals. We need other input to aid us in way-finding.

Way-finding is an important component in designing public spaces, and it’s especially important for people with disabilities. The New York City subway is a good example. Until recently, information about route changes, elevator outages, delays, and so on were delivered by garbled public-address systems in the stations and on subway cars. Longer term information (elevator out of service for maintenance or repair) was relayed by paper signs taped to the walls. Many people were confused much of the time, whether or not they had a disability.

In recent years, the MTA has developed an Accessibility Team, including an Advisory Committee for Transit Accessibility. made up of individuals with disabilities (ACTA, I am a member), to improve access for people with disabilities. Most visible are obstacles to people with mobility disabilities who depend on the system’s notoriously unreliable elevators.

But much of what the team addresses is less well understood by the general public. These include the navigational needs of people with hearing loss, the deaf-blind, people with cognitive disabilities. For instance, the subway system includes a number of stations where many lines cross. Jay Street/MetroTech in Brooklyn is one of these hubs. Four subway lines cross, and the station has three levels below street level. A mezzanine level has fare arrays as well as staircases and elevators down to the three different platforms. Trains run on different levels, with the IND trains one level down from the mezzanine, BMT trains two levels down from the mezzanine, all connected by multiple passageways. Talk about confusing. In 2019, SWA turned the Jay Street/MetroTech station into a laboratory for testing accessibility features for subway riders.

Some existing ADA-accessible features are what you’d expect: working elevators and directions to them, hearing loops at information and help kiosks (freestanding blue-light stanchions in many stations), Braille lettering on signage. In the second half of 2019, the Accessibility team installed and tested additional, more innovative accessibility features:: Tactile interactive maps. Bright, contrasting color-coded directional floor treatments , with the colors matching the color-coded lines: yellow for the BMT (the R train), blue and orange for the IND lines (the A, C, and F). , etc). ADA blue (darker blue) indicates the accessible path of travel. Tactile floor guides and warning strips at stairways and platform edge benefit the blind — or, in the case of the platform edge, just people who aren’t paying enough attention.

Way-finding apps include NaviLens, which provides audio information, and ClickandGo Wayfinding,which offers step by step audio descriptions and accompanying high-contrast color maps, similar to the floor designs. You can see all these on the MTA’s Accessible Station webpage. Many of the tested features remain at the Jay Street/MetroTech Station, though not surprisingly the floor guides are beginning to fade.

Here are some photos from Jay Street/Metrotech Station.

Some of these accessible-navigation features would be a help to any traveler. Floor treatments in contrasting colors, clear and consistent icons on all signage, signage at eye level instead of overhead, directional markings on the floor, these benefit anyone who uses the subway, not just those with disabilities.

For the deaf and hard of hearing signage is essential. It’s another form of captioning. If you don’t have to ask for directions, you’re never handicapped by not being able to hear the answer.

So, to go back to my original question: Does Hearing Loss Affect Your Sense of Direction? Yes, it can affect the ability to locate by sound. It also may affect the ability to navigate by sound, but primarily in the sense of not being able to hear spoken directions. The inability to follow sound cues in navigation needn’t be a handicap if those directions are also offered visually. Captions are the wheelchair ramp for the deaf, as we often like to say.

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

New York City Mandates Open Captions in Movie Theaters.

[Note: If this looks familiar, it’s because it was published yesterday under a different title. Feel free to read it again.]

It’s nice to be able to end this generally awful year with some good news.

On December 15th, New York’s City Council passed a bill that requires movie theaters to provide daily showings of movies with open captions.

Goodbye Gooseneck!

Goodbye Gooseneck!

That means no more struggling with individual cupholder-anchored, gooseneck caption screens, or with captioned glasses that weighed heavily on your nose. Once the bill is signed into law, you will be able to see which movies are showing with open captions and at what time. You can walk into the theater, sit down with your popcorn, and watch a movie with captions running right on the screen.

Details are yet to be worked out, but the law requires that every theater offer every movie with open captioned showings on weekdays, weekends and in evenings. The ratio will probably be one out of every four showings.

You probably won’t be able to see captioned trailers or ads, but that might change eventually. I’ve always wondered why ads on TV don’t have captions – don’t the advertisers realize that people who use captions also have money to spend? Why do they ignore such a relatively large market?

If neither the outgoing mayor, Bill De Blasio, nor Eric Adams, incoming, gets around to signing the bill, it becomes law on January 15, 30 days following its passage. Theaters then have 120 days to begin complying with the open-captioned regulations.

The bill was co-sponsored by outgoing City Council Member Helen Rosenthal, who has been behind a number of bills supporting the interests of people with disabilities over her eight-year (term-limited) tenure. Thank you CM Rosenthal.

Supporters of the bill, including HLAA members who testified at the City Council hearing where the bill was debated, point out that captions benefit far more people than simply the deaf and hard of hearing. Jerry Bergman, of HLAA, who has been working with theater owners on open captioning, said: “We believe that open captioning will benefit seniors with moderate age-related hearing loss, children learning to read, and immigrants for whom English is a second language.”

In the movie “True Grit” (2010) actor Jeff Bridges was so difficult to understand that parodies appeared suggesting various hilarious interpretations. Think how much even those with perfect hearing would have gained by actually understanding Bridges, who was nominated for an Academy Award in spite of his mumbling. The winner, ironically, was Colin Firth for “The King’s Speech,” in which King George VI learns to overcome a speech impediment.

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In less happy news, this week saw the death of one of New York’s seminal supporters for people with disabilities. Anne Emerman contracted polio in 1944 and used a wheelchair all her life. In 1990, Mayor David Dinkins appointed her director of the Mayor’s Office of the Handicapped. At the same time, the name was changed to the more person-centered Mayor’s Office for People with Disabilities (MoPD). New York’s current Commissioner, Victor Calise, said of Emerman: “She was fierce… She set a standard of advocacy in city government that is still going on today… She knew her stuff, and you weren’t going to mess with her.”

Like many disability rights activists, she bucked some powerful figures, among them Mother Teresa. Read the obit for details. And while you’re at it, read the obituary of another fierce New York City activist who died this year, Edith Prentiss.

Every New Yorker– not just people with disabilities – benefits from the work of these two determined women. Next time you take the ramp with your heavy suitcase instead of dragging it up the stairs, think of activists like Emerman and Prentiss. And as you settle in with your popcorn for an open-captioned movie, remember that they laid the groundwork for that kind of accommodation as well.

Some Good News, for a Change

It’s nice to be able to end this generally awful year with some good news.

On December 15th, New York’s City Council passed a bill that requires movie theaters to provide daily showings of movies with open captions.

Goodbye Gooseneck!

That means no more struggling with individual cupholder-anchored, gooseneck caption screens, or with captioned glasses that weighed heavily on your nose. Once the bill is signed into law, you will be able to see which movies are showing with open captions and at what time. You can walk into the theater, sit down with your popcorn, and watch a movie with captions running right on the screen.

Details are yet to be worked out, but the law requires that every theater offer every movie with open captioned showings on weekdays, weekends and in evenings. The ratio will probably be one out of every four showings.

You probably won’t be able to see captioned trailers or ads, but that might change eventually. I’ve always wondered why ads on TV don’t have captions – don’t the advertisers realize that people who use captions also have money to spend? Why do they ignore such a relatively large market?

If neither the outgoing mayor, Bill De Blasio, nor Eric Adams, incoming, gets around to signing the bill, it becomes law on January 15, 30 days following its passage. Theaters then have 120 days to begin complying with the open-captioned regulations.

The bill was co-sponsored by outgoing City Council Member Helen Rosenthal, who has been behind a number of bills supporting the interests of people with disabilities over her eight-year (term-limited) tenure. Thank you CM Rosenthal.

Supporters of the bill, including HLAA members who testified at the City Council hearing where the bill was debated, point out that captions benefit far more people than simply the deaf and hard of hearing. Jerry Bergman, of HLAA, who has been working with theater owners on open captioning, said: “We believe that open captioning will benefit seniors with moderate age-related hearing loss, children learning to read, and immigrants for whom English is a second language.”

In the movie “True Grit” (2010) actor Jeff Bridges was so difficult to understand that parodies appeared suggesting various hilarious interpretations. Think how much even those with perfect hearing would have gained by actually understanding Bridges, who was nominated for an Academy Award in spite of his mumbling. The winner, ironically, was Colin Firth for “The King’s Speech,” in which King George VI learns to overcome a speech impediment.

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In less happy news, this week saw the death of one of New York’s seminal supporters for people with disabilities. Anne Emerman contracted polio in 1944 and used a wheelchair all her life. In 1990, Mayor David Dinkins appointed her director of the Mayor’s Office of the Handicapped. At the same time, the name was changed to the more person-centered Mayor’s Office for People with Disabilities (MoPD). New York’s current Commissioner, Victor Calise, said of Emerman: “She was fierce… She set a standard of advocacy in city government that is still going on today… She knew her stuff, and you weren’t going to mess with her.”

Like many disability rights activists, she bucked some powerful figures, among them Mother Teresa. Read the obit for details. And while you’re at it, read the obituary of another fierce New York City activist who died this year, Edith Prentiss.

Every New Yorker– not just people with disabilities – benefits from the work of these two determined women. Next time you take the ramp with your heavy suitcase instead of dragging it up the stairs, think of activists like Emerman and Prentiss. And as you settle in with your popcorn for an open-captioned movie, remember that they laid the groundwork for that kind of accommodation as well.

Has the Pandemic Affected Your Hearing?

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

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?

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”

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.

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