Sleeping with Dogs

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.

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.

It’s Summertime and the Livin’ is Noisy

It’s July 4th weekend and for many of us it marks our return to at least some degree of socializing. Picnics are good. But beware fireworks, marching bands, ceremonial cannon shots. These are all part of celebrating our nation’s birthday. They are also all hazardous to your hearing health.

Fireworks can easily be 150 decibels.

That may be even more true this year. Living in relative isolation, with quick trips to the supermarket, most of us haven’t been exposed to anywhere near the amount and intensity of noise that we encountered in everyday life pre-Covid. I wonder if this respite from noise now makes us more susceptible to noise damage.

Here are a few reminders of how you can protect your hearing.

Fireworks. Don’t stay home from celebrations, but do buy yourself a good pair of earplugs. You’ll still hear the boom, and earplugs won’t diminish the visual spectacle. A website called The Best Earbuds offers advice accumulated from readers and personal experience. This article from Healthy Hearing explains why fireworks are so loud, and also offers a guide to commonly encountered noise.

Yard cleanup. Don’t use that chainsaw to cut dead limbs without a good pair of noise-canceling headphones. I don’t mean those fancy Bose headphones that people wear on airplanes (which cost around $300). Headphones specifically made for yard work are much less expensive and better protection. A chainsaw registers at about 118 decibels. The Occupational Safety and Health Administration requires ear protection in the workplace at that decibel level for any duration of time.

Auto racing. You may be a diehard NASCAR fan, but auto racing is about the same noise level as a jackhammer — that is, LOUD. 130 dBs. The drivers and crew wear headphones. So should you.

Summer workouts. You want to get rid of the Covid 15. The weather finally cooperates. But if you’re motivating yourself with music coming in to your ears through earbuds, check the decibel level. You don’t want to improve your cardiovascular health at the expense of your hearing. Some experts recommend keeping the volume at 80 percent or below..

Outdoor concerts. What could the problem be? You’re in the great outdoors. But don’t forget that music (and sports) venues are designed to retain the sound. In fact, if the noise spills over into neighboring areas, the venue may have to be redesigned. There’s a reason so many musicians and fans have hearing loss and tinnitus.  Wear noise-canceling earbuds or headphones.

It’s summertime, and the livin’ is noisy. Hold on to your hearing so you can keep on enjoying it year after year. My iPhone has a decibel meter and I imagine other smart phones do as well. Check to see what you’re being exposed to. And if it’s too loud for too long, put on your noise-cancelling earbuds or headphones.

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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.

What does new drug for Alzheimer’s have to do with hearing loss?

What does last week’s approval of a new drug for Alzheimer’s have to do with hearing loss? Nothing, according to the articles and commentary that I read about the drug. Hearing loss was not mentioned in a single news story or commentary.

The drug, brand-name Aduhelm, is the first new treatment for Alzheimer’s in 18 years. The FDA’s decision to approve the drug was made despite opposition from the agency’s independent advisory committee, which said that the evidence raised significant doubts about whether the drug is effective, and noted the risk of serious side effects, including swelling and bleeding in the brain.

Biogen set a list price of $56,000 a year per patient. Very few patients will end up paying that amount, but their insurance companies might. Medicare has not yet said whether it will cover the drug. The insurer Cigna said that beyond the cost of the medicine itself, diagnostic care and safety monitoring will cost another $30,000 a year.

Medicare won’t pay for your $3000 hearing aids, but should you develop signs of Alzheimer’s, it seems likely that it will kick in the $56,000 to treat you with Aduhelm.

The new drug was approved without evidence that it slows symptoms of Alzheimer’s. But it does reduce levels of amyloid, which forms a plaque in the brain, and which is thought to cause symptoms. For a fuller discussion of the new drug and the controversies around it, this New York Times article is excellent. F.D.A. Approves Alzheimer’s Drug Despite Fierce Debate Over Whether It Works.

So what does this have to do with hearing loss? In 2011 an epidemiological study by Frank Lin of Johns Hopkins School of Medicine and others found a strong association between hearing loss and dementia, including Alzheimer’s. The greater the degree of hearing loss, the earlier the onset and severity of the dementia. These findings do not suggest that hearing loss causes dementia, although that could turn out to be the case.

Lin and others are conducting a long-term study to see whether the use of hearing aids or other devices mitigate the risk. If their study shows that hearing aids do help delay the onset of dementia, or lessen its severity, many people with hearing loss will be relieved. But that has not yet been definitively proved.

A smaller study, published in 2015, did find some evidence that hearing aids could help, but not why. The researchers suggested that because hearing loss can cause depression and social isolation, which then affect brain health, the use of hearing devices helps offset those other conditions, and thus slows dementia. You can read more about this study in an article I wrote for AARP online. 

The FDA’s approval of a controversial and expensive drug for Alzheimer’s struck some with hearing loss as sadly ironic. Medicare famously does not cover hearing aids, which are expensive and out of range for many users. A typical brand-name hearing aid costs about $3000, and most people need two. But $6000 sounds cheap compared to the cost of Aduhelm.

In 2020, a study by Columbia researcher Justin Golub and others found that even subclinical hearing loss is associated with cognitive decline. Normal adult hearing is defined as the ability to hear at 25 decibels or less. Golub’s paper found that hearing levels below 25 dB were also associated with cognitive decline. The authors wrote that the findings “suggest that the association between hearing loss and impaired cognition may be present at earlier levels of hearing loss than previously recognized; the current 25-dB threshold for defining adult hearing loss may be too high.”

We may find in the next few years that treating hearing loss can help offset dementia. That would be welcome news. But without affordable hearing aids and hearing care, widespread treatment is unlikely to happen. Medicare won’t pay for your $3000 hearing aids, but should you develop signs of Alzheimer’s, it seems likely that it will kick in the $56,000 to treat you with Aduhelm.

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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.

The Best Hearing Aids of 2021

Forbes Health has just published an excellent guide to hearing aids. Best Hearing Aids from Audiologists 2021.

Forbes assembled a panel of three audiologists to come up with a list of best hearing aids in a variety of categories, including best hearing aid overall, best hearing aid for low budgets, best for tinnitus, best for outdoor enthusiasts, and more.

Drop-down text boxes under each device provide further information. The listings are followed by some sensible advice about how to buy a hearing aid.

This seems like a very helpful guide for those considering hearing aids for the first time as well as for those who already have them but need new ones. It’s important to remember, however, that this is just a guide. It’s not a shopping list. Even though a hearing aid is ranked “best,” it may not be right for your hearing. Another hearing aid style or brand may work better. Cost is also a factor. The most expensive is not always the best.

The three audiologists are:

  • Abram Bailey, a doctor of audiology, Forbes Health Advisory Board Member and founder of HearingTracker.com
  • John Coverstone, a doctor of audiology in New Brighton, Minnesota, and host of the AudiologyTalk podcast
  • Lee Weissman, a doctor of audiology and master of science in biomedical engineering with Hear So Good in Novato, California

The package was edited by Kim Acosta, the lead editor at Forbes Health.

Another recent “best hearing aids” list was published by Explore Health, in 2020. Healthline.com also published a list in 2021. It’s interesting to compare recommendations.

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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.

Rain Delay

Here on the East Coast, Memorial Day weekend was rained out. Not only rained out but chilled out. I am currently in western Massachusetts, where the temperature hovered at 45 or lower and the rain was incessant. I worried about my newly planted vegetables. Frozen eggplant?

But it was also kind of a relief. The governors of both New York State and Massachusetts had just announced that the shutdown was over. We could see friends and family, go to parties, barbecues, pools, the beach.

Apologies in advance to the person sitting on my left. There’s no way I”ll hear you. Maybe I’ll catch a few words from the person on the right. The green centerpiece will make hearing across the table impossible.

I’m vaccinated, doubly. I feel safe in a small group of friends. But do I feel comfortable?

No. As I wrote a few weeks ago (The Return of Social Anxiety), the end of the shutdown means a return to in-person life, in the real world. I’d been invited to a few small Memorial Day weekend gatherings, and I was looking forward to them. But I was also deeply relieved when they were canceled because of the weather.

The previous weekend, during a heat wave, I went to a birthday celebration for an old friend. There were nine of us around an outdoor table. The house was beautiful, the hosts were gracious, the food was delicious, and I was glad to be there to celebrate my friend’s birthday.

But I couldn’t hear. I was open about it. I used the captioning app Otter.ai. (If I had had an Android phone, I’d have used Google Live Transcribe.) I practiced mindful listening (see Learn How to Listen). I corralled a friend to be my interpreter. Thank you D. But I left feeling a little sad.

These were good friends, kind, helpful friends who did their best for me. I was younger than most of them but also deafer than all.

What a conundrum. I want to be invited. I want to see old friends and meet new friends and eat nice food and feel part of life. But it’s so hard.

I am privileged. I only have hearing loss. I can see (with glasses), I can walk (if sometimes unsteadily). I can taste (though spicy food makes my mouth hurt and dairy products make me sick). I have my garden, my friends, my children, my dog. I lost my husband last year, but we had time to prepare, and for me to move forward.

The only thing I lack – and have not come to terms with — is my hearing.

Thanks to technology, I even have way more of that – my hearing – than I would have just a generation ago. I’m not an old lady sitting in the corner with an ear trumpet. I’m still me. I’m still here.

But as I think of my new life, emerging from the Covid cocoon, I know I need to strategize about this reentry. Figure out what’s worth it and what’s not, and how to make the best of it.

Seeing my friends is worth it, even if I have to follow up with them individually the next day to ask what it was we were talking about.

Seeing my family is worth it, even if I have to constantly interrupt and say “What?” — or, my preference, “What are we talking about?” If I miss a name, I’ll interrupt and say, “Who?” and then if I still don’t get it, “Spell it for me.”

What’s not worth it? For me, going to a restaurant is not worth it. I can never follow conversations and I also have to monitor the food to make sure it doesn’t include dairy.

Going to the movies is not worth it. Juggling the cup-holder caption device, or wearing the glasses on top of my own glasses, returning the device if it’s incorrectly programmed. I’ll watch at home, thank you, with captions.

Parties. It’s fun to dress up, so I might go. But I won’t stay long because it isn’t fun to spend an evening befuddled.

Public meetings. Yes, if there is CART captioning. No, if there isn’t.

Religious services. Maybe, if there’s CART. No if there isn’t. But even if there is CART I still won’t hear the music properly.

Weddings and funerals. Yes, but. Under some circumstances I might ask for CART. Under others – the wedding is being held in an area where there aren’t CART providers – I’d go anyway. I might use my iPhone captions, but most people regard pulling out your smart phone at a wedding or funeral to be outrageously rude. It’s hard to explain what you’re doing, especially to people sitting some distance from you.

Graduations. Yes. Most schools and universities are way ahead in terms of providing access. Contact the institution’s disability coordinator.

Live sports events. Yes. Hearing doesn’t really matter.

There’s my list of wills and won’ts. I’m interested in readers’ thoughts. Please comment!

My fellow blogger Shari Eberts just posted on essentially the same topic. I guess it’s on a lot of our minds. Hers is How Will a Post-Pandemic World Look to People with Hearing Loss.

The New Bose Hearing Aid

This week a new hearing aid goes on the market that costs a fraction of most hearing aids, has FDA approval, and can be bought directly by the consumer without seeing an audiologist. Moreover, it comes from Bose, which has a stellar reputation in the field of sound technology.

Three and a half years ago Bose announced that the FDA had approved a hearing aid that consumers would fit and program themselves, using an app on their smart phone. But no new product appeared, and some wondered if they’d given up.

Last week, surprising many, Bose announced that its SoundControl hearing aid would be available starting on Tuesday May 18th at a cost of $849 per pair. The hearing aids are intended for people with mild to moderate hearing loss. There’s a 90 day trial period. For now they are available only in five states: Massachusetts, Montana, North Carolina, South Carolina, and Texas, but distribution will cover all the states within a year. The aids have a behind-the-ear component and a dome in the ear, and look like a standard hearing aid. For photographs and a more detailed discussion, read Karl Strom’s article in Hearing Review. The image below is from Hearing Review.

The consumer uses the Bose Hear App on a smart phone to personalize the sound levels. The Bose Hear App has just two controls: World Volume (how loud you need it to be to hear in your environment) and Treble & Bass, which allows you to refine the sound according to your needs. The app also allows you to change the direction of the microphones, from Everywhere to Front, which is helpful in noise. You can also change the Left/Right Ear balance.

The aids use standard 312 hearing-aid batteries, with a battery life of up to four days depending on how and how often the hearing aid is used. (If you are already a hearing-aid user, you know that some batteries seem to have a lifespan of about 10 minutes, but that’s the battery’s fault, not the device’s.) Many people prefer rechargeable batteries.

This hearing aid is not for me or for most readers of my blog, who tend to have more severe loss. But they may be for those who could benefit from a hearing aid but are deterred by cost ($2400 per aid, on average). You can go on the Bose product page and take a hearing test to see if the Bose aid is right for you. Consumers can also try out the hearing aid virtually, wearing headphones, and see how the fitting works.

Since the product is not yet available, there are no user reviews, but I’d love to hear from anyone who tries them out. Just add a comment to this post. A study done by Bose with Northwestern comparing the Bose to prescription hearing aids found that users were happier with Bose’s sound quality than they were with prescription aids.

The Northwestern study also found no difference in hearing-in-noise performance and customer satisfaction in those using prescription-fitted hearing aids and the Bose. Abram Bailey of Hearing Tracker noted that the product used in the study had closed earbud-like tips. The marketed product has tips more like a standard dome that fits loosely in the ear. Bailey wrote that open tips provide less bass, and a “fundamentally different sound quality.” He would like to see Bose replicate its findings using the patented SoundControl product.

Standard hearing aids offer many features that the Bose does not. These include Bluetooth compatibility. You program the hearing aids using Bluetooth (and the Bose app) but you can’t listen to phone calls or stream music or podcasts the way you can with Made-for-iPhone or Made -for-Android aids. Hearing Review suggested that this decision may have been made to provide for longer battery usage. They also have no telecoil, which means you can’t take advantage of hearing loops and other assistive listening devices without an additional streamer.

The Bose SoundControl is not an over-the-counter hearing aid. The FDA approved it under its DeNovo review pathway, for devices for which nothing like it has previously been marketed. OTC Hearing Aids have been delayed again and again, and are not on the 2021 spring regulatory agenda, which covers reviews scheduled through October. “If the FDA doesn’t address OTC hearing aids during the current session, wrote Abram Bailey, the timeline would be pushed back to mid-2022 at the earliest.(The original review period was supposed to conclude in August 2020.) See below for a more detailed analysis of how the FDA schedule might work.

I’m all in favor of hearing aids being as widely used as possible. Bose’s new hearing aid may be a combination of the right price with the right technology at the right time. Over the years, as the Bose consumer ages and experiences more severe loss, this hearing aid may turn out to have been a gateway device. But the earlier you treat, the better. If the Bose introduces hearing aids to people who then go on to need (and buy) standard hearing aids, that’s good for everyone.

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Footnote on FDA and OTC hearing aids, from Hearing Tracker:

“If the FDA doesn’t address OTC hearing aids during the current session, the timeline would be pushed back to mid-2022 at the earliest. Once the rulemaking meeting occurs, a ~60 day public comment period begins, after which FDA has up to 180 days to issue the final regulations. Conservatively, there is an ~8 month delay from rulemaking meeting to regulation issuance, so if FDA addresses OTC in the Fall 2021 session, we could expect to see new regulations anywhere from June 2022 to February 2023.”

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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.

The Mask Problem: Solved

No question about it, masks have been a pain for people with hearing aids. The elastic ear piece gets tangled with the behind-the-ear hearing-aid component and sometimes pulls it off. Wearing a mask has been not only annoying but sometimes disastrous when coupled with hearing aids or cochlear implants. I lost a cochlear implant (found by a neighbor, thankfully).

But most of us wore them anyway, each figuring out our own imperfect solution. Take off the hearing aid? Anchor everything with a hat? Get new, completely in-the-ear hearing aids? Use a mask that goes behind the head rather than behind the ear?

My solution was to take off my c.i. when I wore a mask. The mask still got tangled with the hearing aid in my other ear, but it was easier to manage. Not wearing my cochlear implant definitely negatively impacted my hearing, and not wearing your cochlear implant is not a good idea. Nor is not wearing a mask until the CDC tells us it’s okay.

Last week I was at my audiologist’s office and I noticed she was wearing a headband with one large button on each side just behind the ear. Her mask looped over the buttons. She doesn’t wear hearing aids but her ears get tired wearing a mask all day, she told me, and the mask is much more comfortable with the headband, which goes over the ears.

Genius!

The minute I got home I Googled “headband with buttons for mask” and up came dozens of choices. I ordered one headband to try it out. It was perfect. Soft, stretchy, tight enough to fit but not give me a headache. Then I ordered three more, in different colors and patterns.

I won’t name the brand because what works for me might not work for you. But Google “headband with buttons for mask” and take your pick. Or go to a store like Walmart.

I have no need for four headbands, but I love them. They’re fun. They’re also great for sports, and fit both men and women.

Pictured above are just some of the many choices. (Clearly I’m a bit late to this discovery.) Prices vary widely. Most expensive is not necessarily best.

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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.

Zoom Fatigue for People with Hearing Loss

Zoom fatigue is real, as an article in National Geographic lays out very clearly: “‘Zoom Fatigue’ may be with us for years. Here’s how we’ll cope.

But let me just say that the author of this article has no idea what Zoom fatigue is like for people with hearing loss. We don’t just endure those long sessions, we read them, one word at a time.

It reminds me of the Fred Astaire/Ginger Rogers quip: She did everything he did, but backwards and in high heels.

The image below is a screenshot of a webinar I attended this week. There was PowerPoint (the big box), the speaker (postage stamp, right), live captions (bottom three lines), and captions in context (called “full transcript,” box at the right). This is an example of good captioning — and it’s probably still making you feel just a bit dizzy.

Last week I was on a two-hour Zoom meeting with less than adequate captions. Bad captions, actually. The captions appeared — as these do — as three short lines at a time, at the bottom of a text-heavy powerpoint, but they were much shorter, and pretty meaningless. (I wish I’d taken a screenshot.) To provide context for those free-floating three lines, I clicked on “full transcript”. Full transcript was also three lines at a time, though it gave me five or six segments of three-line text. These three lines are not three sentences. They are arbitrary selections of a certain number of words that would appear on a screen. An arbitrary 10-15 words, whether or not they are complete sentences.

At the meeting last week, I supplemented the provided captions with my own IPhone caption app, Otter. (If you have an Android phone, you can do the same with Google Live Transcribe.) It was a little better, with enough text to provide context. But even Otter was not up to a speaker who spoke too fast, used too many unfamiliar technical terms and acronyms, and was not thinking about who was listening. This was a meeting for people with disabilities, so there was also an ASL interpreter on the screen.

Recently Zoom announced that it would provide free captioning if the originator of the meeting asked for it. This is thanks in part to Shari Eberts’ petition to get Zoom to provide captioning for people with hearing loss. Thank you again Shari. A host can also add Otter captions to a presentation.

Google Meet provides free captions, in a dedicated black box at the bottom of the screen. The captions appear in more or less full sentences. It’s a good ASR system. But Google Meet hosts only smaller meetings.

If a Zoom speaker uses PowerPoint, that adds to the burden for the attendee with hearing loss. The PowerPoint occupies most of the screen, the speaker is postage-stamp size and it’s hard to speech read. Often even after the formal presentation has concluded, the speaker leaves the PowerPoint up, on the screen. So there’s no relief for the hearing-compromised attendee.

Help! We need some new protocols for on-line presentations.

Here are some suggestions for speakers and hosts: Speak slowly and clearly. If you are using PowerPoint, make it text light, not text heavy. If you must repeat the words on the slides in your oral presentation, then make sure you say the same thing – otherwise our eyes are shifting back and forth between the slide and the captions. Provide key words and names to the CART captioner in advance of the meeting. Take down the Power Point when the formal presentation is over, so it’s no longer covering the majority of the screen. CART captioners should set their output directly to Zoom and (this is technical) not use the API third party token.

Despite these troubles, I love ZOOM. Even bad captions make meetings accessible to me that would otherwise not be. Any Zoom meeting is much easier to follow than an uncaptioned in-person meeting.

I want to thank Ann H. Logan for pointing out the National Geographic article in a post on her blog AbyCats’ Thoughts.

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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.

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.