The Toll of Hearing Loss is Global

A new study published in the prestigious medical journal The Lancet offers an unblinking look at the tremendous burden of hearing loss worldwide. “Global hearing health care: new findings and perspectives” was published on July 10th. The authors are Blake S. Wilson, Debara L. Tucci, Michael H. Merson and Gerard M. O’Donoghue. The first and fourth authors organized a three-day discussion at Duke University on the subject, which was followed by a massive review of the existing literature.images

Half a billion people have disabling hearing loss, a number that is far higher than earlier estimates. This is not just a little trouble hearing the TV, your wife mumbles, this restaurant is too noisy hearing loss. This is disabling hearing loss.

“Disabling” means that 500 million people worldwide cannot hear well enough to learn to speak (if they are children), with resulting lower literacy and lower quality of life. If they are adults, “disabling” means they may have a sense of profound isolation, typically withdrawing from community and family, prone to psychological illness and likely to develop earlier and more severe dementia than their peers. “Association is not causation,” as the authors remind us, and in fact causation is the subject of a number of ongoing research studies into the hearing loss/dementia link. But the numbers are alarming: “Indeed, the hazard ratio for developing dementia increases two, three, and five times with mild, moderate, and severe losses in hearing, respectively.”

Eighty percent of those with disabling hearing loss live in low and middle-income countries, and their hearing loss has severe economic and personal consequences. But those in wealthy countries are not immune to these consequences. “In high-income countries… adults with disabling hearing loss have twice the prevalence of unemployment and half the median income of their normally hearing peers.”

The answer, the authors say, is twofold: prevention and treatment. Prevention and treatment of childhood hearing loss would be most effective in poorer countries. Special attention to adults would be more effective in wealthier areas.

Prevention could reduce prevalence by 50 percent or more in some regions of the world, according to the World Health Organization. These preventive efforts include vaccinations against rubella, measles and mumps; education and treatment of HIV, syphilis, hypertension and other conditions. It also includes maternal nutrition and neonatal care, attention to ototoxic drugs, and and universal hearing screening of infants. Chronic or acute otitis media should be treated promptly with antibiotics.

Treatment costs could be reduced by strategies like more competition and lower prices for hearing devices, a change in service provision – and “with disruptive and parsimonious designs” of hearing aids and cochlear implants.

These parsimonious and disruptive designs include many of the solutions now being discussed in the United States: the use of personal amplification devices (PSAP’s), smartphone apps, elimination of the need for a physician’s clearance, revision of regulatory requirements to allow “more competition and comparison shopping for hearing aids.”

Sound familiar? That’s because these are the very same recommendations made by the National Academies of Sciences, Engineering, and Medicine in June 2016, and the earlier PCAST report to the President.

The report calls for a global initiative to reduce “the currently unbridled burden of hearing loss.” It cites the interagency partnership VISION 2020, which began in 1999 with a goal of reducing avoidable vision loss by 2019. Indeed, as the study points out, disabling hearing loss is almost twice as common as disabling vision loss. In the category of mild to complete loss, hearing loss outnumbers vision loss by 46.2 v. 24.5 million in years lived with disability. Hearing loss is the fourth leading cause of disability worldwide.

The report is complex and fascinating and if you are interested in reading the full report please contact me via the comments section on this blog.

And if you suspect you have hearing loss, be grateful that you live in a country where you may be able to find treatment at a reasonable cost. Over the counter hearing aids will not become a reality for several years, but in the meantime get a hearing aid if you can afford it, try Costco or good online retailers for lower prices, get a PSAP if you can’t afford a hearing aid, try out some smart phone apps. But don’t ignore it.


For more information about living with hearing loss, read my book “Shouting Won’t Help: Why I and 50 Million Other Americans Can’t Hear You. 

Consumer Reports Rates PSAP’s

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

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

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

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

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

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

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

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

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

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

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

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

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

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


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

Trouble Hearing in Your Book Club?

Are you in a book club? If you’re hard of hearing, the answer may be no. Even a hearing book club member may miss a lot of the discussion.

Book clubs generally have 10 to 20 members.

An estimated five million Americans are in book clubs,some of them are in more than one. I know people in couples’ book clubs, mother-daughter book clubs, all female or all male book clubs, history book clubs, biography book clubs. You name it.

Book clubs average anywhere between five and twenty members, a size that poses a difficulty for most people with moderate to severe hearing loss. Even with hearing aids or a cochlear implant, it may be difficult to hear in a group this size. But there are strategies and tools that can help you participate fully.

Here are some tips.

*Seat yourself near the center of the group, remind people of your hearing loss, and ask them to speak one at a time. Remind them when they forget. Then remind them again. And again.

*Establish a group leader. In my book club, that person designates herself the “Conversation Monitor.” (She actually refers to herself more crudely, but you get the idea.) Her role is to make sure that people speak one at a time, that no one dominates the conversation, that the group doesn’t roam too far off topic.

*Choose your own personal interpreter. Have a pen and paper available: You write: “She did what?” your interpreter answers: “She married him” You may have been pretty sure you’d heard “she buried him,” but figured it was an unlikely plot twist.

*Voice to text software. Examples of this, which is sometimes called speech recognition software, include Siri and Dragon Dictation. A new app, called Ava, shows great promise in using voice-to-text software to help those with hearing problems follow a conversation. Some friends and I were beta testers and used it successfully with four people, although it can be used for a group of six to eight. The app assigns each person a color, and each time they speak, their color-coded words plus their photo or the first initial of their name show up on every participant’s phone. The app can be restarted with a whole new group the next time you want to use it.The app’s founder says it’s still several months away from being on the market. When it is, it will be available on the Apple Store and Google Play.

There’s a reason five million Americans are in book clubs. They’re fun, they’re educational, they’re a great way to socialize and do something constructive at the same time. Don’t let hearing loss deter you.

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Loud enough to cause an earthquake. So what’s it doing to your hearing?

If you’re lucky enough to attend this coming Sunday’s NFL playoff game between the Seattle Seahawks and the Green Bay Packers, bring your noise-canceling headphones. It might also be a good idea to tie down your valuables before you leave home. Seismographers from the University of Washington have found that the crowd noise at CenturyLink Field is so loud that it generates earthquakes. Minor ones, so far, but this is a big game.

CenturyLink Field holds the record for the loudest outdoor sports stadium, thanks to its famed 12th Man (crowd noise). The decibel level at the record-breaking game, in December 2013, was 137.6 decibels. That’s quite a bit louder than a jackhammer and just below the noise of a jet engine at fairly close range. It’s also well into the range where it can cause immediate hearing damage. (You can read more about this game and other football hearing issues here.)

Seattle Seahawks fans

Researchers from the University of Washington installed two seismometers at CenturyLink Field several years ago. In Seattle’s earthquake prone vicinity, it was big news in 2011 when running back Marshall Lynch made a 67-yard touchdown, setting off seismic activity now fondly known as the BeastQuake. Last Sunday’s playoff between the Seahawks and the Carolina Panthers also set off seismic activity.

The Seattle Times interviewed Steve Malone, professor emeritus at The University of Washington Seismologic Laboratory, after last Sunday’s game. Since TV has a 10 second lag time, he told the reporter, the seismologists were able to see the crowd reaction, in terms of seismic activity, before the play was even shown on TV. It would be good if CenturyLink Field also attracted the interest of audiologists. Maybe they could measure how many Seahawks season ticket holders have hearing loss.

One of the few people at CenturyLink Field not in danger of hearing damage is fullback Derrick Coleman, who is deaf. This gives him a distinct advantage over his teammates, because he can lip read the quarterback’s plays. Even though he can’t hear the crowd noise, he can feel it. He’s a human seismometer

Photo: AP/Elaine Thomson

Katherine Bouton is the author of Shouting Won’t Help, a memoir of adult-onset hearing loss. She has had progressive bilateral hearing loss since she was 30 and blogs about healthy living — and healthy aging — at Hear Better With Hearing Loss. She is a member of the Board of Trustees of the Hearing Loss Association of America.

This post first appeared on Healthy Hearing, AARP website, 1/15/15

Staying Sharp: Keep Your Brain Healthy

What’s With the Purple?

Why purple?

I like it, for starters.

But it’s also part of the color scheme of the logo of the Hearing Loss of Association of America. I’m a fan of HLAA, and a member, and a member of the board. I’m grateful to it for advocacy and support on the national and local levels. And for the many friends I’ve made through the organization.

For more information, and for the location of chapters, go to Hearing Loss Association of America.imgres

You might also want to look at the websites for The Association of Late Deafened Adults (ALDA), The National Association of the Deaf (NAD), AG Bell, and Gallaudet University. They all have useful information, local chapters, and many resources to offer to the deaf and hard of hearing.

A Joyful Racket

For people with hearing loss, parties are often hard work. Such hard work that many simply stop going to them. But the other night I was at the noisiest party I’ve been to in years. And I had a great time.

The party was a wine and cheese gathering at my apartment to meet the Executive Director of the Hearing Loss Association, Anna Gilmore Hall, who had come to New York to talk to some HLAA donors and activists about her plans for HLAA.  I doubt there was anyone there under the age of 50, there was no music, no loudspeakers, no dancing, not even that much drinking. Just 45 people with hearing loss talking to each other. What a racket!

But it was a joyful racket. I think many of us with hearing loss feel marginalized at parties because we can’t hear as well as everyone else. But at this party none of us could understand much of what was being said. We cheerfully read lips and talked louder and louder as the evening went along, knowing that we weren’t missing much that anyone else was getting. It was fun, and I don’t say that often about going to parties.

One guest brought along his Roger assistive device, a pen shaped microphone that he would hold up to a speaker. The sound he wanted to hear — the speaker’s voice — went right to his hearing aid and cochlear implant. All the surrounding noise fell away. Most of us, though, muddled along. Finally when Anna got up to talk, the room fell mercifully quiet.

We could all understand what Anna was saying, not only because she was the only one speaking but because HLAA had arranged to have a CART operator at the gathering, who live captioned her talk on a screen set up in my living room. Here’s a picture of the screen.


We often think of people with hearing loss as living in a quiet world. It is quiet, unless there’s noise around. Then people with hearing loss find themselves in a world that is much noisier to them than to their hearing peers.

As almost anyone with hearing aids knows, hearing aids aren’t very helpful in a noisy restaurant. The human ear — the biological ear — is remarkably efficient in screening wanted from unwanted noise. The younger the ear, the more efficient. Think of your teenager casually chatting with a friend in a room with music blaring at top decibel levels.

The bionic ear — and the aided ear — are woefully lacking in that filtering capacity. All hearing aids, even the most sophisticated, are essentially amplifiers. They pick up the sound and amplify it. The better hearing aids include programs to help screen wanted from unwanted noise but they’re not effective in places like restaurants. The bionic ear, by which I mean a cochlear implant, also lacks the capability to screen effectively.

This is both a plus and a minus. The minuses are obvious. You can’t always hear what you want to where you want to because there is too much noise being transmitted to your brain to allow it to figure out words.

The pluses are not to be discounted, however. I can sit in front of a shrieking three-year-old on a plane and — as long as she’s not also kicking my seat — screen her out by taking out my hearing aid and turning off my cochlear implant.

But back to the noisy party. Because of that same unwanted and unfiltered amplification, most of us at the party were in a sea of noise. Real life SurroundSound. But it was a good noise.

What’s in a Name?

Ever since I first lost my hearing, 35 years ago, I’ve been frustrated by the fact that no one could figure out what caused it. As the hearing loss progressed to the point where I finally got a cochlear implant in the originally affected ear (the left) and a strong hearing aid for the right, I remained fixated on how such a major medical event could happen with no explanation. The term for that is “idiopathic.”

Webster’s defines the word idiopathic as “arising spontaneously or from an obscure or unknown cause.” It also means “peculiar to the individual.”

I hauled out Volume One of my “shorter” OED (two volumes, 4000 pages, three columns per page) looking for insight into the origin of the word. Not surprisingly, it comes from the words “idio” and “pathic” – “of a disease.” The OED elaborates: “not consequent on or symptomatic of another disease,” and then the kicker: “no known cause.”

So imagine my surprise this afternoon when my ENT of some 25 years casually dropped into a discussion of my hearing that the fluctuations I was experiencing were common with Meniere’s. “Wait,” I said, “Does that mean we are now diagnosing this as Meniere’s?” Believe me, I have asked this question many times and never gotten a firm answer.

You know why? Because Meniere’s itself is idiopathic. In fact it’s also known as “idiopathic endolymphatic hydrops.” This mouthful refers to an imbalance in the fluids in the endolymphatic system, part of the cochlea. The symptoms include fluctuating hearing loss (most often unilateral), fullness in the ears, tinnitus, and dizziness or vertigo. I pointed out that I don’t have two of the symptoms (fullness or tinnitus, and I have bilateral hearing loss). My vertigo, which was intense, was also short lived: I had about 30 episodes over the course of a calendar year. Now it’s controlled by medication.

My doctor explained in what I am sure was very clear language why he was now using the term Meniere’s to describe the cause, but I was too thrilled to finally have a name I could put on my hearing loss to really follow.

So what if Meniere’s itself is idiopathic? (It’s also not treatable, and not even fully diagnosable except during an autopsy.) I have a name for my condition! I can capitalize it. Capital “M” Meniere’s. It has a definition and known symptoms. After 35 years of “we don’t know” this seems like a step toward enlightenment.

The fluctuation that prompted this discussion was, for once, a good one.

In July I’d felt that I was hearing much worse than usual in my hearing aid ear. (The hearing in the cochlear implant ear changes only when the audiologist reprograms the implant.). I went to the audiologist and indeed I had lost about 20 decibels, going from being able to hear at 60 decibels down needing the sound turned up to 80 decibels. That put me in the category of a potential candidate for a second cochlear implant. But my ENT wisely prescribed “watch and wait.”

So six weeks later, today, I went back. My hearing had returned to where it was before the July drop. Not that that level is anything to boast about: I still have moderately severe hearing loss and a moderately terrible ability to recognize words on a word recognition test. But no matter. My fluctuations in the past have almost always been permanently downward. “Up” isn’t something I can recall ever happening.

So maybe that’s another reason I was glad to have a name for my condition, one that starts with a capital letter.

Talking About Hearing Loss

Or not, which is more often the case. I didn’t talk about it for the first 30 years I had it, except as a joke, a distraction from the fact that I actually couldn’t hear what someone said to me. That’s okay. We all need to talk less about our various ailments and more about literature and politics and art and the Higgs boson.

But that doesn’t mean we should deny it, to ourselves or to others. Because if we do, that means we aren’t going to hear — or participate in — that conversation about the Higgs boson. (The Higgs is on my mind because I just saw “Particle Fever,” which I can safely say is probably the most fun and interesting and thought-provoking movie you’ll ever see about particle physics).

We also shouldn’t deny it, as a society, because if we do we’re going to end up — in the not so distant future — overwhelmed by a disproportionately large segment of our population who can’t hear, who can’t or won’t correct it, and who therefore can no longer be productive members of society.

So that’s the subject of this blog. Or the main subject anyway. If we talk about hearing loss, if we acknowledge it both personally and as a society, we normalize it. And it IS normal. Twenty percent of our population, from teenagers to nonagenarians has hearing loss. Teenagers themselves have hearing loss in astonishingly high numbers — 19% of them. Most of them don’t realize it, or don’t care, but by ignoring it they’re setting themselves up for hearing problems they won’t be able to ignore — at a much younger age than that should be happening.

My hearing loss is not normal. It began when I was 30. Nobody could figure out why I went from hearing perfectly one day to being practically deaf in one ear the next. They still couldn’t figure it out as I progressively lost almost all the hearing in the other ear as well. But what was normal was how I reacted to it: with jokes, with denial, with a refusal to get hearing aids. And then when it got really bad, when I couldn’t do my job or understand what anyone said to me most of the time, I also got seriously depressed. That’s normal too. But it doesn’t have to be that way. 

It was only when I began to speak honestly about my hearing loss that I was able to overcome that depression, to find my life again.

I was good at denial. I fooled a lot of people for a lot of years. Most of them didn’t know know I had hearing loss. But (as I learned when I started being more open about it) they did think something was off. Was I going senile? Was I drunk? Burned out? Bored? How could any of these impressions be preferable to acknowledging a physical disability? A disability that can be treated, that should not be incompatible with a healthy productive life.

Once I acknowledged the severity of my hearing loss – to myself and to others – I began to learn to live with it. And the more open I was about it, the better I seemed to hear. The better I DID hear. In this blog I want to share some what I’ve learned about living well with hearing loss.


For other information about me, go to That site includes archives of the blog posts I’ve written over the past 18 months, as well as reviews of my book, “Shouting Won’t Help,” information about public appearances, and references to other sites and sources about hearing loss.