Hearing Loss For Dummies
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Hearing loss is about clarity not volume. Most people think of hearing loss as simply turning down the volume on a TV, which makes all sounds quieter. But hearing loss is more like turning down the volume on only specific frequencies or pitches of sound so while some sounds are quieter others are just as loud.

Many people aren’t a very good judge of their own hearing. In fact, most people tend to believe their hearing is better than it actually is, according to research from our own team at Johns Hopkins University. Why are we such bad judges of our own ability to hear?

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Barely noticeable changes

One answer is that hearing loss happens gradually and slowly over time. The snail-like pace at which our hearing declines may make it difficult to notice any changes. Early signs of hearing loss may be situational.

We might miss a word here and there over dinner in a noisy restaurant or have trouble following a conversation with someone soft-spoken. It is easy to shrug off the seemingly isolated early incidents.

Everyone else is mumbling!

For most people, hearing loss affects their ability to hear high frequencies (whistling or birds chirping) while leaving the ability to hear low frequencies (animal grunts or thunder) relatively untouched.

But not all sounds fit neatly into low or high frequencies. Speech has sounds from several frequencies. In fact, a single word can represent multiple frequencies. For example, the word “show” includes “sh” (high-frequency) and “ow” (low-frequency). With the most common types of hearing loss, the “sh” would be difficult to hear while “ow” would be perfectly audible.

This results in a phenomenon where you would hear someone talking, but what they’re saying isn’t clear. This is why a common phrase among those with hearing loss is “I can hear you but you’re mumbling!”

Hearing some sounds but not others affects clarity, which isn’t always something people think of when they think of hearing loss. Hence, sometimes it’s hard to make that leap to suspecting hearing loss.

Compensating until you can’t

Our brain plays a big role in making it tough to recognize hearing loss, especially when it first starts. Generally, our brains are great at their job of processing incoming information and can often still make sense of unclear speech.

The brain does this by using contextual information like the general topic of conversation to fill in the blanks. This means that as we develop hearing loss, our brains initially do a pretty good job of making up for any hearing loss.

But compensating for hearing loss requires a lot of extra energy and effort from our brains. Over time, our hearing tends to worsen and our brain’s ability to compensate lessens until it actually starts to slow down as well from the fatigue of keeping up with all the unclear sound.

Don’t know what you’re missing

Our brains are good at noticing new auditory information and ignoring common and mundane sound. Think about being in your own home versus visiting a place for the first time. In our own homes, we tend to ignore familiar sounds — the humming of appliances, creaking floorboards, or squeaking doors.

But in a new place, our brains are on high alert, and we notice every single new sound. The same concept goes for common environmental sounds when we aren’t specifically listening for them: traffic noise from other cars while driving or chirping birds while walking through the park.

When we aren’t specifically listening for a sound, it often becomes forgotten background noise. This makes it difficult to realize what we miss when we have hearing loss.

Has your hearing declined?

Given how difficult it is for us to judge our own hearing ability, consider having a conversation with those close to you to help you identify any hearing loss. Your hearing loss can impact them, too.

In many situations, it is a spouse, child, companion, or other frequent communication partner who first detects signs of hearing loss — from little things like noticing you turn the TV up louder to feeling isolated from you because conversation has become more difficult. The perceptions of those around you is a great way to gauge your own hearing.

It is also often helpful to look for clues in how hearing may be affecting your day-to-day life. Consider, for example, any changes in your social activity, communication patterns, and regular activities to help identify any hearing loss. You may be subconsciously avoiding situations or even altering the way you engage with people because of difficulty hearing.

Take a minute to ask yourself some of the following questions to get a better feel for whether you may have some hearing loss:

  • Are you asking others to repeat things more often? In follow-up, do you find others saying things like “Never mind, I’ll tell you later” when you ask them to repeat something? This may be a sign that others have begun to notice your hearing difficulties.
  • Are you having trouble following conversations in meetings?
  • Do you find yourself believing many other people mumble too much?
  • Do you have difficulty hearing people when you aren’t looking directly at them when they speak or when they turn away from you during conversation?
  • Have you felt embarrassed to contribute to conversations because you’re unsure of the topic?
  • Do you feel excluded at dinner or other group conversations or unable to keep up?
  • Do you have any difficulty hearing small children? (People with hearing loss often find children’s voices, which are higher pitched, difficult to understand.)
  • Do you turn up the volume on electronics such as the television?
  • Do you avoid talking on the telephone because it’s fatiguing and hard to make out what the other person says?
  • Do others around you complain that the TV is too loud?
  • Do you find yourself avoiding restaurants or social gatherings more than you used to because they’re too noisy?
  • Do you find yourself more tired than usual when engaging in conversation?
  • Are you avoiding activities you used to regularly participate in, such as attending concerts, plays, meetings, or religious services?
If you answered “yes” to any of these questions, it’s a good idea to get your hearing tested. Read on to find out more.

When to get your hearing tested

Hearing loss is very common and more than half of all adults over the age of 60 experience hearing loss. It may be a good idea to schedule a hearing test when you turn 60 if you notice any of the signs of hearing loss mentioned above, whichever comes first.

Screening, testing, and diagnostics

You may see the terms hearing screening or hearing testing thrown around and sometimes you’ll see the term diagnostic hearing test versus self-guided hearing test. Here’s what these mean:
  • Hearing screening refers to any assessment or task that helps identify whether or not you likely have some hearing loss but offers little details. Hearing screenings vary in how they’re performed and could be anything from whether you can hear someone whisper in your ear to a task where you have to identify numbers spoken in the presence of background noise.
  • Hearing testing refers to pure-tone audiometry tests (see Chapter 7) that provides sufficient detail to describe your hearing in each ear using either the hearing number or categories like mild, moderate, severe, or profound.
  • Self-guided hearing testing refers to hearing testing that is performed by you without the help of a professional, such as on a smartphone.
  • Diagnostic hearing testing refers to a full battery of tests performed by a hearing professional, usually an audiologist, for the purpose of diagnosing hearing loss.

Establishing a baseline

A baseline hearing test simply refers to your first diagnostic hearing test, the results of which become the baseline or reference point for future hearing tests to keep track of any changes in hearing.

The baseline test also helps hearing professionals create a custom plan for you based on patterns in changes in your hearing over time. We recommend establishing a baseline as soon as you suspect hearing loss or at least by the time you turn 60, even if you’re not particularly concerned with your hearing at the moment.

Making the appointment

Here are the details you need to know to make an appointment:
  • Insurance, including Medicare, usually covers at least one diagnostic hearing test a year when ordered by a physician (check with your provider when in doubt).
  • An audiologist will usually perform the diagnostic hearing test.
  • Request a referral from your primary care provider (if required by your insurance company).
  • Search online for a local audiologist near you that accepts your insurance or use websites like HearingTracker.com, which maintains a directory of audiologists from across the country with patient reviews.

Curious about testing your own hearing? Try one of numerous smartphone- or web-based hearing tests and screeners such as Mimi Hearing or SonicCloud, which are free and can be found in your smartphone app store. You could also try the AARP at-home hearing screener found at nationalhearingtest.org (free for AARP members!).

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