Ageing brings with it a lot of challenges.
We all aspire to have a functional body and mind, but the reality is that our five senses start declining as the years roll by.
While the sense of smell, taste and touch take longer to regress, the most noticeable changes occur in our vision and hearing.
But seniors would rather sort their eyesight out (e.g. removing cataracts) than address their loss of hearing.
Most adults begin to lose their hearing around the age of 65, and more often than not, the elderly are reluctant to wear hearing aids because they feel handicapped, self-conscious or disabled.
Or they are in denial that their hearing is deteriorating.
Says consultant ear, nose and throat (ENT) surgeon Dr Elizabeth Lim, “Hearing loss can happen at any age and stage of life as a result of many factors.
“They include hereditary, environmental and underlying medical conditions.
“However, the most common cause of hearing loss is age-related, or what is referred to as presbycusis.
“Intervention should begin the moment the individual experiences even the slightest deterioration of hearing, to ensure we can catch it early.
“Once we assess the damage, we can begin treatment to preserve the quality of hearing and slow down hearing loss.
“A tip to recognise the first signs of hearing loss for family members is when there is an increasingly frequent verbal communication breakdown.”
Early signs of hearing loss include difficulty hearing other people clearly and misunderstanding what they say, especially in noisy places; asking people to repeat themselves; listening to music or watching TV with the volume on high; or talking loudly because their own voice sounds soft to them.
Seniors with hearing loss may suffer negative psychological and emotional effects that can affect them socially.
For example, they may feel ashamed, inadequate, stupid, awkward, embarrassed, humiliated or abnormal.
They may also experience difficulty thinking or concentrating, which can result in inattentiveness, distraction and boredom – so do not assume these are signs of Alzheimer’s disease!
Or they worry about being perceived as incompetent and feel worthless, so they withdraw from others and refrain from participating in everyday life.
As frustrating as it might be to communicate with someone hard of hearing, we can still play a part by showing empathy and patience.
Presbycusis doesn’t happen overnight, but is a slow process that usually occurs in both ears.
The loss is gradual, so someone with presbycusis may not realise that he has lost some of his ability to hear.
One of the first signs is that the higher-pitched tones become more muffled.
Dr Lim explains: “The organ of hearing in our body is known as the cochlea – a snail-like bony structure located inside our ears.
“This cochlea contains a lot of cells with microscopic hair-like projections, known as hair or nerve cells, which move up and down in response to the sound vibrations received by our ears.
“These cells send the signals to our brain to interpret the sounds.
“Just like any machinery, our body organs and cells are susceptible to ageing and will wear out eventually.
“As the hair cells get worn out and damaged, our hearing ability will be diminished.”
Unfortunately, age-related hearing loss is irreversible.
“The auditory nerve can’t be repaired once damaged,” she says.
“The rate of hearing deterioration is subject to one’s genetic factors, as well as environmental factors such as loud noise exposure.
“We can, however, drastically improve the experience through hearing aids.
“Other sources of hearing loss may be reversible, but ultimately, it would depend on the underlying cause that an ENT might have to decipher through a series of tests.”
An uncomfortable experience
A hearing aid will not restore normal hearing, but it will increase awareness of sounds through magnification of sound vibrations.
However, Dr Lim advises anyone with urgent hearing problems to immediately see an ENT specialist, especially if it involves pain or extreme discomfort.
“In other words, spikes of such experiences should be dealt with by ENT specialists, while more consistent and gradual signs of hearing loss can be handled by trained health professionals known as audiologists.”
Hearing aids are fitted by an audiologist, but the mere mention of the term “hearing aid” sends many seniors into panic mode.
Anyone who has tried wearing hearing aids will have experienced some level of discomfort, especially when first trying them on, which can be a turn-off.
If not, well-meaning friends who have themselves tried hearing aids might warn them that the aid will cause them to hear all kinds of little, irritating sounds.
So they end up refusing to wear the hearing aid and their hearing worsens.
This is a common scenario in many households and can cause a lot of underlying tension and anger among family members as it hinders effective communicate.
Audiologist Kelvin Lee says: “First-time wearers aren’t used to the sounds, especially background noises, and some might feel uncomfortable or irritated with having something physically placed around or inside their ears.
“The common misconceptions are that hearing aids are merely amplifiers that make everything sound louder and uncomfortable, but this is not true.
“Among the complaints are that the sounds are not as natural as a normal hearing person would hear.”
This is where aural rehabilitation (AR) comes in.
Bridging the gap
AR encompasses a wide set of practices aimed at optimising a person’s ability to participate in activities that have been limited as a result of hearing loss.
Lee, who is the founder and executive director of the Listening Lab Group, explains, “AR is an ongoing, interactive process, which requires active participation from the user.
“The programmes are usually customised to suit the learning style, pace and adaptation rate of the user as the rehabilitative process involves relearning how to hear sounds and listening again.
“Rehabilitation itself is the process of restoring a lost function; AR aims to bridge the expectation and the actual change in perceptual hearing with the use of hearing aids.”
The approach of AR for adults and children can be quite different.
“For children who have hearing loss at birth, it is not possible to restore (rehabilitate) the hearing sensory function, which has technically never existed in the first place.
“Thus, the focus is on language and speech acquisition with use of hearing amplification, and involves multiple disciplines such as speech therapy, audiology and psychology.
“In adults, we are focusing on how to manage and adapt to a whole new perception of hearing, as the amplified sounds provided by hearing aids can be quite different from what they remember when they had normal hearing,” he says.
Although there is no guarantee that the outcomes of AR will be automatic or optimal, it aims to improve the activity, participation, and eventually, quality of life experienced by a hearing aid user.
“There is no direct negative implication from delaying AR itself, but one might struggle to achieve better and more efficient communication skills using the hearing technology,” says Lee.
It takes time to adjust to wearing hearing aids, and ideally, they should be worn daily for a minimum of eight hours or more.
“Hearing aids act as a substitute for the ears. It is recommended to use them all the time during your waking hours to make sure that your sound awareness and hearing ability are at an optimal level at all times.
“It can take up to six months to rehabilitate and adjust, depending on the progress of each individual,” he explains, adding that many people expect to have perfect hearing the moment they put on hearing aids.
While there is no local data on the number of hearing aid users in Malaysia, around 2,000 units of hearing aids are fitted yearly in the country, according to the World Health Organization (WHO).
This number might seem especially low, considering our ageing population, but is likely a reflection of people not getting their hearing loss diagnosed or refusing to wear hearing aids at all.
The latest devices have improved in leaps and bounds over previous versions as many now offer artificial intelligence features.
Lee says, “This feature allows hearing devices to learn the user’s preferences and will make changes automatically when the appropriate environment is detected.
“To reduce background noise, these latest hearing devices also feature directional microphones, which are designed to boost sounds coming from the front of the wearer and reduce sounds coming from other directions.”
Learning to accept
Like most things in life, our sense of hearing is not permanent.
Says Dr Lim, “Hearing, like many of our sensory systems, is prone to wear and tear.
“The more you use and abuse a sense, the more it will be damaged.
“The best way to maintain hearing levels in later life is to make sure current exposure to loud noises is minimised where possible.
“Things like loud noises at work due to industrial activity, or loud music from pubbing or clubbing, or personal music devices set at a volume too high or for too long, can all prematurely wear out hearing.
"There are many online resources for what constitutes ‘noise-induced’ hearing loss and it would be good for each person to learn more about them.”
However, even if you do not expose yourself at all to loud noises, there will still be deterioration of hearing levels due to usage and ageing.
“So that is something we all have to be prepared for,” she points out.
She suggests that people gently encourage their elderly loved ones to get their hearing tested if there is a problem.
“We can encourage them by providing information such as features of the hearing aids, for instance, Bluetooth connection, which allows them to stream sound directly via their smartphone.
“We can also offer to accompany our loved ones for their hearing assessment to show our support, and let them know that they can ‘test-drive’ the hearing aids without any obligations.”
Here are some tips from the US National Institute on Aging on how to talk with someone with hearing loss:
- When in a group, do make an effort to include people with hearing loss in the conversation.
- Find a quiet place to talk in order to help reduce background noise, especially in restaurants and at social gatherings.
- Stand in good lighting and use facial expressions or gestures to give non-verbal clues.
- Face the person, maintain eye contact and enunciate well.
Don’t distort speech, mumble or lower your voice at the end of a sentence.
- Speak a little more loudly than normal, but don’t shout.
- Speak at a reasonable speed.
- Do not hide your mouth, eat or chew gum while speaking.
- Repeat yourself if necessary, using different words.
- Try to make sure only one person talks at a time.