Adult’s hearing assessment & management

1. Muffled speech: Speech and other sounds are quiet and unclear

The most common response when testing hearing is “I don’t really have much of a problem, but other people really don’t speak very clearly”. And of course, that is true – regional accents, foreign accents, people who speak faster than normal, people who speak more quietly than normal or who don’t face you when they speak to you – all of these are more difficult to hear. However even a mild hearing loss in the higher frequencies really enhances these difficulties. If you are experiencing them, it may be a very early sign that there is a hearing loss developing.

 

The second most common response is “well I don’t really have a problem, but my husband / wife / friends / children / grandchildren think that I do”. If this applies to you then you probably have a hearing loss that has developed very slowly over time.

 

2. Poor hearing in noise: Difficulty understanding words, especially in background noise or in a crowd of people

The majority of the clarity of speech, and ability to distinguish words, comes from the higher-frequency elements of speech – for example, to tell the difference between /CAT/ and /SAT/ and /FAT/ and /THAT/ and /PAT/ or /SAY/ and /PAY/ you need good high frequency rather than low frequency hearing. Guess what goes first as we age – that’s right – high frequency hearing! Even a slight hearing loss causes these problems.

 

So, put a high frequency hearing loss in an environment with lots of background noise or echo, and the lower pitched noise obscures the higher-pitched speech clarity. This is exactly what happens in social gatherings, restaurants, or presentations when the speaker is some distance from you.

 

People with normal hearing have these problems too of course, however they have a much greater reserve of sound than people with even a slight hearing loss.

 

​3. Pardon? Asking people to repeat themselves

If you often find yourself asking others to speak more slowly, clearly and loudly you may have a hearing loss. People with a hearing loss often feel that those around them are speaking less clearly than they should, or are mumbling. Unfamiliar accents can be particularly difficult to hear clearly.

You may also be having difficulty keeping up with conversations. People often rely on catching key words in a conversation, and fill in the gaps. However if the key words are heard incorrectly, this becomes impossible.

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A hearing loss can also make you feel tired and stressed from having to concentrate harder while listening. This generally makes hearing far more effortful. This in turn makes it even more difficult to follow conversations.

 

​4. Turning up the volume: The radio, TV or music is louder for you than for others

One of my first questions is “do you turn the TV up”, and a sure sign of a hearing loss is yes. The style of TV drama has changed enormously over the years and has become far more “reality” orientated. This means that there will often be music or other background sounds behind the dialogue, main characters will not speak to the camera, lighting will be poor and all those vital visual cues will be lost.

 

Even news presenters have changed their vocal and presentation style. This makes them far more “on trend” but doesn’t do a hearing loss any favours.

 

Of course, a hearing loss also means that the quality of speech and music is not as good as before as you hear less of it. The problem is made worse by poor sound from your TV – flat screens tend to have small speakers that face outwards rather than forwards, and one of the easiest solutions may be to get a good quality sound bar to connect to your TV.

 

If you are considering hearing instruments, make sure that you try out TV accessories – usually a small box that plugs directly into your TV and streams sound wirelessly to your hearing instruments. You can therefore adjust the TV to suit you exactly, and maximise the sound that you hear.

 

Another solution is putting the subtitles on, however these vary in quality. There is nothing worse than only getting the punchline of a joke some time after it has been spoken.

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​5. The Phone: Difficulty hearing on the phone

When we listen over the phone we are totally reliant on what we hear – you cannot use your eyes! Interestingly people hear relatively well over the phone with a mild hearing loss but start having difficulties beyond that point. This may take the form of having to turn the phone volume (if you have one) up, or not being able to hear unfamiliar voices. Often people get key words mixed up, especially numbers, with potentially disastrous consequences.

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People with mobile phones often resort to using them on speaker, with the volume cranked right up. The problem is that everyone else can hear your conversation too.

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Mobile phone companies, particularly Apple, have been very proactive in recognising this difficulty, and that hearing instruments can be at the heart of the solution. You can link many hearing instruments to a mobile phone, and this means that the conversation comes directly to your hearing instruments. You can then adjust the volume to suit you, and no-one else will hear what is being said. People love this solution – it really has been groundbreaking.

 

Of course the other advantage of linking your phone to your hearing instruments is that you can control them with an App if you would like (although they will work without this).

 

Some hearing instruments also allow you to connect your hearing instruments to your landline phone.

 

​6. Feeling isolated and down: Avoiding social settings has a big emotional impact

If you don’t hear so well, then listening will require more concentration, be more effortful and more tiring. Some people cope by withdrawing from settings where they know that it will be difficult for them to hear. However over time this can leave you feeling left out and isolated. This is not good for healthy brain ageing.

 

Be aware that not hearing well can also make you feel anxious and depressed. If you are feeling this way it will be even more difficult to concentrate on what is being said.

 

You may be surprised at how much having a hearing loss can affect your emotions – you may feel helpless or depressed, and get angry or frustrated. Getting help with your hearing loss as soon as possible, and having a good social support system will help you to avoid many of the emotional problems that can be associated with having a hearing loss.

 

Being hard of hearing doesn’t mean that you are not thinking as clearly – in fact there is increasing evidence that the earlier you get help with your hearing the better your brain function is preserved.

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Life is too short to miss hearing friends and loved ones, enjoy music and get back to a normal life.

 

7. Tinnitus: Noises in the head or ears that others can’t hear

Tinnitus remains one of the most common auditory symptoms. Depending on the definition of tinnitus and the criteria applied, prevalence rates in adult populations vary from 8.2 to 20.0% rising to 17.9 to 30.3% in those over 50 years of age. It is more common with hearing loss, but it is not true to say that the worse your hearing is, the worse the tinnitus will be.

 

In most cases it is not associated with anything serious, however you should always mention it to your Audiologist so that they can refer you for a medical opinion if necessary.

 

Sometimes tinnitus only lasts for a short period, often after loud noise, and sometimes it goes on for longer. Most people do not find it to be a problem, however a significant minority of people find it troubling.

 

There are a number of ways of managing tinnitus very effectively, whether or not you have a hearing loss. A hearing instrument is often one of the most effective management strategies. Other ways include low level sound, and many hearing instruments can be programmed to provide bespoke sound options.

 

By far the most important way of managing tinnitus is avoiding the “vicious circle” of hearing it, focussing negative thoughts on it, and becoming anxious and worried about it. The tinnitus sound that you hear is really in most cases a tiny nerve signal that the hearing pathways have incorrectly labelled as a threat. This causes other parts of the brain that govern our emotional and physical reactions to threats to become fixated on the tiny nerve signal, and give it a “fast track” pathway to the brain.

 

Reversing this can take time, however most people do it on their own unless something unexpected happens.