What Did You Say?

By Mary Carpenter

THE THING about going deaf is you don’t realize it’s happening… [the moment] when everyone around you begins to mumble, when you cease hearing your own footsteps clicking down a hall,” writes NPR reporter Mary Louise Kelly in her new book, It. Goes. So. Fast., about her discovery at age 43 that she had 70% hearing loss in both ears. “You can fake it…blame it on a cold or on the clatter of a noisy café.”

“None of this [asking people to repeat words or raise the volume] prepared me for…  being told that I suffered severe hearing loss,” Kelly continued. And she writes about her first day with the new aids, discovering the words of songs and hearing her kids chattering in the back seat. “I went about my routines with a sense of wonder, [with] joy that I could hear them now [and] the realization of all that I had missed.”

2023 “really has been the year of the ear, with hearing aids going over the counter and new research confirming how important hearing is for brain health,” according to the Washington Post. “Age-related hearing loss nearly doubles the risk for dementia. But new research also shows that the use of hearing aids can reduce the risk of cognitive decline by nearly 50 percent among adults who have other risk factors, such as elevated blood pressure, higher rates of diabetes or those who live alone.”

“By the time they turn 30, about a fifth of Americans today have had their hearing damaged by noise,” according to a CDC estimate reported in the New York Times. “The leading prescription aid manufacturer, Phonak, says the number of Americans between the ages of 22 and 54 who have been fitted with the company’s hearing aids increased by 14 percent more than the increase for users of all other ages between 2017 and 2021.

Every day more than 10,000 Americans get new hearing aids, a number that continues to grow, according to hear.com. One reason for the high numbers: People are getting hearing aids earlier, with hearing loss beginning by age 39 in almost 50% of people, and by age 59 in 81%.  “Gen-Xers are acting much quicker than older generations. Many of them already wear Bluetooth devices in their ears, so wearing a hearing aid is no big deal.”

Another reason is the reduced cost and easier access made possible by the new availability— starting in October, 2022— of FDA-approved OTC hearing aids. Technological advances are another explanation— including faster processers, Bluetooth connectivity and rechargeable batteries. In addition, wearers report improved work performance, along with income increases in the tens of thousands of dollars.

Long-term effects of hearing loss on health—depression, cognitive decline, falling—may, however, be the most important reason that many seek help from assistive devices. Although income level was an important determinant, more people age 70 and older are using hearing aids than in the past, according to the National Council on Aging —noting a 23.3% increase between 2011 and 2018.

The extra effort required for people with hearing loss to understand what others are saying may help explain worse cognition in these people, Columbia University otolaryngologist Justin Golub told the Post. “The necessary brainpower leaves fewer cognitive resources to process what is heard,” said Golub.  Alternatively, receiving less auditory input from the inner ear could diminish stimulation of the temporal lobe with “cascading influences on brain structure and function.”

A third possible contributor is that “people with hearing loss tend to be less social, and as a result have less cognitive stimulation,” Golub explained. Even mild hearing loss can create the feeling, as some describe it, of slowly becoming untethered from the world. The largest study to date, including more than 100,000 people over age 66, associated hearing loss with increased risk of depression, falls and dementia—but also showed that hearing aids lowered risks for all three.

Price remains a significant barrier for all age groups, according to the FDA. Even with the new category of OTC aids, the combined cost for testing and buying the devices starts around $500 and can exceed several thousand dollars.

Also, the options can be confusing and difficult to navigate, with many models still requiring prescriptions from an audiologist. After trying to navigate the complex market himself, Blake Cadwell created Soundly, a website that allows users to compare hearing aid brands and prices. Said Cadwell, “When I started the process, the main thing I experienced was it’s difficult to know where to start and how to start, just figuring out which way was up.”

Since the FDA approval of OTC devices, big box stores and pharmacies offer auditory testing along with the devices. Concerns remain, however, about purchasing hearing aids without input from an audiologist (usually in an ENT practice), who can help detect causes of hearing loss such as infection or wax build-up—or advise those whose hearing loss is too severe to be helped with external devices, in some cases recommending a cochlear implant instead.

(“Hearing enhancement devices” that include PSAs (personal sound amplifiers) fall into a different category —designed for individuals with normal hearing and for use mainly in entertainment settings. Some manufacturers offer these to people with hearing loss—despite the risk of harming existing hearing—as an alternative to more expensive FDA-regulated devices.)

“By day two I was on sensory overload, posting: ‘Starbucks is the noisiest place in the world,'” writes Mary Louise Kelly. That noisy experience has occurred for me a few times in the almost two years since I got hearing aids—after two audiologists told me that they would want them if they had received my hearing test results. But for me, the primary motivation was research showing potential effects on the brain of undetected hearing loss. While I haven’t had Kelly’s dramatic revelations of hearing sounds I had been missing, I am grateful for the reassurance that I may be helping to protect my brain.

—Mary Carpenter regularly reports on topical subjects in health and medicine.

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