Q: I’ve been told I have a mild hearing loss and that I should start wearing a hearing aid now, but it doesn’t seem bad enough. I get most of what people say so what’s the rush?
A: This is a serious question, one that I hope people pay attention to and one that was reflected in something that happened just this week to someone close to me who made the decision to wear hearing aids. And it’s someone who my whole family has been nagging for a long time, but, thankfully, she may have nipped a problem in the bud before it became a huge issue.
Allow me to make an analogy; a person has a small pain in their back, it’s a bit annoying, but it comes and goes and he/she never bothers to do anything about it. When it flares up they take a pain killer or a muscle relaxant, but neither of these do anything but temporarily mask the problem. After a year he/she notices the pain is a little worse. More medication, but still that’s all they do. When it gets bad enough, they go to their family doctor and he sends them to a specialist of some kind, who then tells them they have a years’ worth of physiotherapy or chiropractic visits to fix the problem, if it can be fixed at all. Had they done something about it sooner, a lot of time, money and pain could have been saved, and in some cases, chronic pain could have been avoided.
Hearing is no different. My relative, (who shall remain nameless), was in denial of her hearing loss for 15 years, twice the statistical average of 7 years, but the one thing that sparked her to finally let me help her was when she was at a quiet restaurant and kept missing words she had never missed before. She heard them, but the clarity was gone. Normally, a quiet environment in relatively close quarters, did not pose a problem for her. With a little extra effort she could understand everything that was being said, despite having the typical sloping mild hearing loss you expect to find in an average 65 year old. But this time was different; apparently there were conversations happening that she missed some key parts of and when she replied completely inappropriately she was horribly embarrassed. That evening she came over and asked for help.
Left untreated, even mild hearing losses can lead to a loss of clarity. Studies have shown that using an appropriate hearing instrument to assist can prevent deterioration of the parts of the cochlea, (the part of the inner ear that houses all the nerve endings that send sound to the brain), that bring clarity to words. In the testing process we do several speech tests; among the most informative is what is called the “word discrimination test”, in which we read a list of single syllable words at a level the patient finds to be most comfortable. We then determine a percentage of words repeated correctly. Some people mistake this for being the “percentage of hearing lost”, (which I will discuss in a future article), but it isn’t. It’s a measure of how clearly the patient hears common words when they are spoken at a loudness level where they should miss either none or very very few. Even people with normal hearing miss some here and there. In most cases a score of 94% or better, (using a 50 word list), is considered acceptable, anything below is a cause for concern. This person scored 96% five years ago with a mild hearing loss, and 80% this year, with only slightly lower hearing, (not enough to move her into the next bracket of mild-moderate). A 16% drop in 5 years, of common words she should have no problem repeating back!
The bad news is, this is not always reversible. Sometimes, but usually the best we can do is maintain the current level. If you have a relative who uses hearing aids but still misses a lot of what goes on, take a look at the results of their recent hearing test. If the WRS, (Word Recognition Score) is below 86%, then that is all they will likely ever hear. Hearing aids do not act as clarifiers when discrimination scores get that bad, they are frequency specific amplifiers, which may even, in some cases, work to exacerbate the issues. In other words, when the distortion of sound is occurring in the cochlea itself, there is no way to clarify it. But in this case preservation of what is left is really the key, because studies show if left untreated, that distortion will continue to get worse and worse.
If we can prevent this deterioration from ever occurring, the benefits are plentiful; better clarity for a longer time; significantly less acclimatization to wearing the instrument; preservation of current hearing levels. None of these are guaranteed, of course but statistically 75-80% of people who have treated hearing loss early, avoid a lot of troubles later on.