Sunday February 15, 2009
Please repeat that ...
By LIM WEY WEN
Hearing loss can be debilitating and frustrating, but modern technology has made it possible to hear again, comfortably and yes, fashionably too.
IMAGINE talking to a few other people over lunch, and they are speaking a language you barely understand.
You could catch bits and pieces of the conversation, but you just could not put the whole story together.
Out of 500 million people worldwide estimated to have some form of hearing impairment, the World Health Organisation (WHO) estimates about 278 million of them are living with moderate to profound hearing loss. To include you in the conversation, they look at you periodically and laugh in unison when someone cracks a joke.
You try to follow their facial expressions so you do not seem too out of place. Suddenly, one of them asks you a question.
Embarassed, you manage a feeble “Huh?”, leaving the rest of them feeling as if you are not taking them seriously.
Before you could explain, they resume their conversation and the guessing game begins again.
If this scenario has become a little too common in your daily life, and you feel the same even when people are speaking a language you understand, take heed because it is often the typical early sign of hearing loss.
“Hearing loss is a very debilitating condition. People are not very well informed and they really don’t know much about it,” says hearing aid audiologist Kieran McCarry.
“So, if they have the problem they don’t understand it. All they do is feel its effects without knowing what the cause of it is.
A hearing test can help an audiologist diagnose the type and determine the extent of your hearing loss. The standard test is an audiometric test, where the client is asked to identify sounds of different pitch and loudness is sent through these earphones. “This leads to a lot of frustration, a lot of isolation and a lot of heartache, in many cases, for the people themselves, and of course, their families and those close to them.”
But there is no need to wallow in despair or suffer in silence, because help is available.
As only a tiny fraction of people who need hearing aids are using them, it is important to let people understand that there are technologies that could help them hear clearly again, if only they would come forward to seek help, McCarry says.
Anatomy of a hearing loss
Out of 500 million people worldwide estimated to have some form of hearing impairment, the World Health Organisation (WHO) estimates about 278 million of them are living with moderate to profound hearing loss.
A broad definition of hearing impairment and hearing loss is the loss of hearing in one or both ears. However, the extent of hearing loss can be categorised into mild, moderate, severe or profound.
The complete loss of ability to hear from one or both ears is called deafness.
Kieran McCarry ... We are improving people’s quality of life by improving, or restoring in some cases their ability to communicate While some are born with it (congenital hearing loss), most people with hearing loss acquire it at a later age (acquired hearing loss).
Infants can develop hearing loss in the womb if they are deprived of oxygen or when their mothers were exposed to infections such as rubella (German measles) and herpes. They can also inherit hearing loss from their parents or develop it if their mothers consume ototoxic drugs (toxic to the ear) such as the antibiotic gentamicin during pregnancy.
Adults however, mostly acquire hearing loss due to prolonged exposure to loud noise and the natural deterioration due to ageing.
Regardless of the age of onset, there are two types of hearing loss: conductive and sensorineural.
People with conductive hearing loss lose their hearing due to problems with their outer and middle ear.
Ear wax or a rare tumour may get in the way of sound waves reaching the eardrums. A faulty eardrum or problems with tiny bones in the middle ear may impede the transmission of vibrations into the inner ear.
Middle ear infections can also cause swelling or fluid build-up in the ear canal, effectively blocking sound waves from proceeding further into the ear.
Modern technology has made it possible to make hearing aids smaller and more sophisticated. The smallest open ear fitting hearing aid - the Beltone Marq - is only slightly bigger than a 20sen coin. People with sensorineural hearing loss, however, lose their hearing due to a damaged auditory nerve or damaged hair cells – the cells in the inner ear that convert vibrations from the outer ear into electrical signals to be sent to the brain.
These hair cells can be damaged by repeated exposure to loud noises, ototoxic drugs, fluid buildup in the inner ear, tumours, infections, or simply by getting older.
Telltale signs
How can you tell if you are losing your hearing?
McCarry says that most people do not realise they have a hearing problem until someone tells them they do. However, according to an audiology clinic in New Zealand, it takes people an average of seven years after the onset of hearing loss before taking the first step to have a hearing test.
The reasons why people are reluctant to seek professional help for their hearing problems vary, but some of the common ones are due to ignorance, the association of hearing loss with ageing or the fear of being consigned to living a life with hearing aids.
Some of them simply do not know they can’t hear very well because it happens gradually.
Hearing aids (on the left) can be programmed to receive signals from wireless devices (right) to listen to their mobile phones, mp3 players, televisions, GPS and FM systems. Many do not realise that hearing loss is not just a matter of losing the ability to hear sound at low volumes. A person may also have difficulty perceiving or identifying sound clearly.
“Most people with hearing loss (PHL) have problems with speech discrimination. They can hear the words, but they don’t understand what the words are,” McCarry says.
While a speaker may sound perfectly audible and clear to a person with normal hearing, he may sound all muffled and jumbled up to PHL. So, they can be sitting in a room full of chatter, and still be alone.
However, instead of realising their problem, most PHL develop various coping skills.
“They pretend they can hear; they make excuses to why they can’t hear,” McCarry says. “To them it may be the way people speak, the background noise, or anything, except themselves.”
A hearing test can help an audiologist diagnose the type and determine the extent of your hearing loss. But the signs are usually there before a person steps into an audiologist’s office.
Some of the signs to look out for are:
·You often ask people to repeat what they said.
·Your friends and relatives tell you that you don’t hear very well.
·You often increase and decrease the volume of your TV or radio alternately (you increase the volume because you can’t hear but find it too loud after some time).
·Others say you talk unusually loud (sensorineural hearing loss) or soft (conductive hearing loss).
A more detailed list of signs to look out for can be found at the American Speech-Language-Hearing Association website (www.asha.org/public/hearing/disorders).
Managing hearing loss
While conductive hearing loss can generally be corrected with the removal of ear wax plugs, surgery, or antibiotics to treat middle ear infection, sensorineural hearing loss is often irreversible.
This is where hearing aids play their role.
No one is too young or too old to seek help for their hearing loss. “Whether you are 80-years-old or 18, your interaction with other people is just as important,” says McCarry.
Available in various shapes and sizes, hearing aids come in five types depending on where they fit in your ear. The behind-the-ear type looks like a bluetooth device shaped like a curved shell that fits snugly on the back of the ear. A clear tube fitted into a mould that is customised to fit comfortably into your ear sends the sound signals from the device.
Both in-the-ear and in-the-canal types fit in the ear like ear plugs that are visible from the outside but in-the-canal types fit in the ear further inside the ear canal.
Completely-in-the-canal hearing aids are virtually invisible on the outside as it fits completely in the ear canal.
The latest made available is the receiver-in-the-ear (RIE) type which looks like a miniaturised behind-the-ear device. Its design is based on the open fitting concept where the clear tube which sends the sound signals is very thin and the customised mould is replaced with a tiny, soft dome placed inside the ear.
Every device has its strengths and weaknesses, but essentially, smaller and more sophisticated devices costs more.
Prices of hearing aids in Malaysia range from around RM800 for simple devices up to around RM13,000 for the most sophisticated.
McCarry explains that some people hold off hearing aids because they feel old when they are wearing it – until the problem becomes so bad, they cannot manage it any more. By then, they will need more help with their hearing – which means more powerful and sophisticated hearing aids.
However, with a wider scope of technology, audiologists today are able to deal with a wider range of hearing problems more effectively.
“Of course like anything else, the more of (the sound you hear) is artificial, the less close it is to reality,” McCarry says.
While hearing aids do help in improving the ability to hear in PHL, they do not substitute for normal, healthy hearing.
But programming and fitting a person with a hearing aid is by far the easiest part in the rehabilitation of those with hearing problems.
The more difficult part is, to McCarry, getting the hearing aid to interphase correctly with the person wearing it, and to solve their problems.
The hearing loss is not a problem, says McCarry, it’s the frustration, the isolation and the difficulties caused by the hearing loss that is the problem.
“Treating hearing loss is just the means to an end,” he says. “Because (as audiologists) we must really try to understand how the hearing loss impacts our clients’ lives.”
This involves going through a thorough communication process with the client to find out about their lifestyles, their relationships with people and also, how they feel about their hearing loss.
Hearing aids can then be prescribed according to their individual hearing needs, their ability to use the device (dexterity, cognitive function) and of course, their personal preference.
There are also assistive devices such as FM receivers to help PHL hear speakers from a distance, and hearing aids that have bluetooth function programmed into them to help them communicate on telephones.
“Sometimes people get obsessed with technology,” McCarry says. “The technology is important, but at the end of the day, the basics are still human beings interacting with each other and that’s what we are trying to obtain.
“We are improving people’s quality of life by improving, or restoring in some cases their ability to communicate.”
> Hearing tests are available in certain hospitals and most hearing aid providers which operates retail outlets nationwide. The Department of Social Welfare provides funding to purchase hearing aids for those can’t afford them. Please visit your district or state welfare department for more information.
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