Author: Kashif Mohammed

Not long from now, it will be Christmas, which can bring plenty of familiar sights – and sounds. Whether it is carol singing, the bang of crackers being pulled, the chatter of excited children, or even the familiar strains of Slade’s Merry Christmas Everybody (which turns 50 this year), there is much to enjoy.

However, for some, and perhaps for yourself, those sounds seem somewhat diminished. If your hearing is not quite what it was, you may want to do something about it but be put off by the sense of stigma some feel about hearing loss, a feeling that can be more powerful if a hearing aid is the solution.

This was highlighted by broadcaster and former doctor Michael Mosley, who recently told the Guardian the importance of getting hearing checked and being willing to wear a hearing aid if necessary. He remarked: “Hearing change is completely normal and is nothing to be embarrassed or ashamed about.” 

Dr Moseley noted that many people are not aware they can get free tests, but one of the big issues is undoubtedly the feeling of stigma at the thought of wearing hearing aids, as people can think of them as “big and clunky”. He added: “There’s a feeling that hearing aids are an obvious sign of being old and decrepit.” 

This is not how folk should think, he added, commenting that people wear glasses at any age because their sight is impaired, so they should feel no differently about hearing aids.

As the article went on to note, the old stereotype of hearing aids being large and unsightly items is outdated. Indeed, invisible hearing aids can help people to enjoy better hearing while almost nobody knows they even have them in.

If that isn’t reason enough to ditch the stigma, it is vital to consider the wider implications of hearing loss. It is not just that it impacts on your communication and social interactions; hearing loss is linked to cognitive decline, so a hearing aid, however visible (or not) can have far wider benefits for your quality of life.

Another area where having a hearing aid can help is with balance. It is well known that the ear has a lot to do with this, which is why vertigo sufferers can often find their condition is caused by an inner ear problem such as Labyrinthitis or Meniere’s Disease.

Now, research at the University of Colorado has shown that older people who wear hearing aids suffer two-and-a-half times fewer falls than those who do not, indicating a clear link between enhanced hearing and better balance even in later life.

If wearing a hearing aid might be seen as a little embarrassing by some, the feeling of helplessness at suffering falls and needing to be helped up – or treated for injuries sustained in the incident – is surely worse.

So while you may feel a certain stigma about getting a hearing test or having a hearing aid fitted if you need it, the truth is that having one might be a crucial factor in enabling you to live life to the full, both now and way into old age.

One of the most fascinating aspects of hearing aids is that they are often exceptionally complex, but many elements of how they function are both deceptively simple and highly effective, as well as being small enough to fit in a form factor that is practically invisible.

The best example is the T-switch setting on hearing aids, used to listen to an audio induction loop or hearing loop frequency. It is a standard feature on almost every hearing aid you can buy in the United Kingdom, as it allows for clear audio, something often required for giving and receiving instructions.

Most people with hearing aids know about them and know to switch to either the T or MT setting when in a taxi, a post office, certain parts of a train station or at the vast majority of churches, as well as many other buildings as a reasonable adjustment required by the Equality Act 2010.

However, to understand how they can benefit you, it is important to understand how they work and where they came from, as well as why the induction loop setting is marked with a “T”.

 

How Does An Induction Loop Work?

An induction loop works through two interesting and surprisingly simple technologies.

The first is the physical loop of electric cable, which circles a particular designated area (either a room or a part of a building. This loop generates a small electromagnetic field that works effectively as an amplifier for sound when linked to the second part of the technology.

A hearing aid fitted with a compatible pickup coil then picks up the electromagnetic field directly, allowing for specific sources of sound to be delivered to the ear directly.

This allows for a hard-of-hearing person to more clearly hear an announcement, music concert, event, member of the court or delegate of a meeting without the effects of interference or background noise getting in the way.

This makes it easier, more comfortable and less frustrating to hear vital pieces of communication and respond accordingly, making everyday life far easier as a result.

The original form of the induction loop was known as the telecoil or T-coil, which is the reason why hearing aids to this day mark the induction loop with a “T”.

It was invented by Joseph Poliakoff and his Multitone Electric Company initially as a way to pick up the magnetic field generated by telephone coils, designed to make it easier for people using hearing aids to hear a telephone conversation without a lot of feedback and background noise.

This concept had expanded by 1937, when the first magnetic induction loop was patented, and dispensed with the need to speak to someone through a telephone, instead delivering sound directly through the electromagnetic field.

It is the primary type of assistive listening technology in the UK, although in the United States, a competing “neck loop” system that used FM radio waves to deliver audio became more popular, albeit less convenient for users. An infrared system is also used in cases where an induction loop is impractical.

Children who are deaf or hard-of-hearing suffer from a lower quality of life compared with youngsters who have no hearing problems, according to recent research. 

The University of California in San Francisco conducted a study, which was published in JAMA Network Open, that looked at 299 people aged between seven and 18 with permanent hearing loss. 

Brooke R Warren, together with other researchers, analysed the hearing-related quality of life (QOL) across the deaf or hard-of-hearing (DHH) participants. 

They found that those with less hearing loss had a higher QOL score. At the same time, those who had a greater socioeconomic disadvantage typically had a lower QOL score. 

This association was particularly felt among those who were between 13 and 18 years old.

While the research has shone a light on the link between QOL and hearing loss, the authors concluded more studies need to be conducted to dig deeper into the connection. 

“Future studies should elucidate these modifiable factors to enable multidisciplinary health care teams to provide more tailored hearing loss care and improve QOL in DHH children,” Medical Xpress quoted them saying. 

According to the Centers for Disease Control and Prevention, around one to three per 1,000 young people suffer from hearing loss. 

Therefore, a significant number of kids are facing a lower QOL than their peers. 

The good news is there are several hearing loss treatments available these days, including small hearing aids and cochlear implants. 

Children are also very quick at picking up sign language or learning how to lip read, so they can continue to communicate even if their hearing is limited. 

At school, teachers can use real-time captioning on videos, voice-recognition software on computers, lots of pictures and graphics, and even an FM system with a microphone for the teacher that amplifies the sound for the pupil.

When people think of hearing aids, they tend to think of those wearing them being slightly older, and therefore, having age-related hearing loss. 

But did you know they can also be hugely beneficial to people who are profoundly deaf?

 

Powerful hearing aids

All hearing aid manufacturers provide technology that helps people who cannot hear sounds of below 90dB, which is considered profound hearing loss and means they cannot hear someone opposite them shouting.

These are simply more powerful versions of standard hearing aids, with the battery and speaker unit often being larger.

Although they cannot restore hearing, they can make the sound louder while reducing the background noise. This makes it easier to follow conversations. 

 

Benefits of wearing hearing aids

Not all deaf patients like to wear hearing aids, particularly if they have had profound hearing loss their whole life and it is all they are used to. 

However, there are others who really benefit from the technology. Firstly, it informs people around them they have hearing loss, so if they fail to respond to questions, it does not just appear as though they are being rude.

Hearing aids also make deaf people more aware of their surroundings, which could improve their everyday lives. For instance, they could hear traffic, which can make it easier for them to navigate crossing busy roads.

All in all, some people find wearing hearing aids gives them more security, improving their environmental awareness, hearing important announcements, and making those around them considerate of their additional needs.

 

What other treatments are available?

Super hearing aids are not the only option for those with profound hearing loss, as they could also have cochlear implants or bone-anchored hearing systems. 

These are devices that are surgically fitted, so the sound avoids the area of the ear that is damaged. 

They work by changing the sound it detects into electrical signals, which the auditory nerve carries to the brain. These signals are then transformed into sounds, helping deaf people hear the noises around them. 

They are popular among those who are born deaf or for whom hearing aids do not work effectively. 

Another option is a bone-anchored hearing device, which is fixed to the bone behind the ear. It is fitted using a titanium implant, which sends sound vibrations directly to the inner ear. 

This is a popular system for those who are only deaf on one side, have chronic conductive hearing loss, or have not been successful with hearing aids. 

 

Sign language is still important

Whether deaf people use a hearing aid, a cochlear implant or a bone-anchored hearing device, sign language and lip reading are still hugely important to their communication. 

Being able to communicate with others who have profound hearing loss quickly helps to build relationships and boost confidence. Therefore, having these tools under your sleeve helps to complement the benefits of modern technology. 

Anyone watching the new series of GBBO will have noticed contestant Tasha using British Sign Language (BSL) and an interpreter.

Commenting on Bake Off’s first deaf baker, RNID’s director for inclusion and employment Teri Devine said: “It’s fantastic that the millions of viewers who watch Bake Off every week will get a taste of this rich and beautiful language on their screens at home.”

RNID hopes Tasha will help raise the profile of BSL, representing the deaf community to the show’s huge TV audience.

Not many younger or even middle-aged people will think of going for hearing aid tests, even if they don’t seem to be hearing quite as well as they used to. It will often be assumed that poor hearing is entirely the preserve of the elderly.

However, the reality is that it is at a younger age when people do many things to expose their ears to excessive noise, damaging their hearing in the process.

This is particularly true during working life. Many jobs take place in noisy environments, where hearing protection is often necessary, such as airports, factories, or on outdoor sites where noisy equipment like drills is required.

However, there are other jobs that might surprise people with their capacity to cause ear damage. For example, some might think of farming as a quiet life out in the country amid fields of crops or livestock. But often it involves being indoors with heavy machinery, such as milking equipment.

Ambulance drivers are also at risk, because of the noise of sirens, and while a road worker using a big drill may have ear muffs on, a dentist using a smaller one is not, yet is still at risk of suffering damaged hearing as they fix their patients’ teeth.

Musicians can also endure excess sound when they are at a noisy gig, both from their own instruments and the crowd, while professional sports stars will also be at risk from loud crowd noises.

Although some people operating heavy machinery on building sites might have ear protection, others nearby might decide not to use it so that they can engage in conversation with colleagues. This is not the wisest of moves.

Other people working in noisy environments on a regular basis include bouncers and bar staff, while those who work outside as couriers on motorbikes or cycles will get an overload of noise as they navigate the traffic of busy city streets.

Not only can these jobs damage your hearing, but when you finish work and undertake some leisure activities, you can do more harm then.

Some of these might occur by being in the same sort of environment mentioned above, like a noisy bar, gig, or sports stadium. You might enjoy more choice of where you go than a courier if you ride a motorbike or even a pedal bike, but the noise of the former and potential exposure to traffic noise of the latter can still add to the possible harm.

Even gardening can be quite damaging. You might think of wearing earphones when using a chainsaw, but what about when mowing the lawn or using hedge trimmers? It may be surprising how much harm these can do.

Of course, people may still undertake such activities as they get older; you can be a pensioner and still mow your lawn or go to a noisy football match, for instance. But it is in environments that people of working age find themselves most often that a lot of damage can be done, often without them realising it. 

Most people will by now have had at least one Covid-19 infection. While the consequences of these range from being entirely asymptomatic at one end of the spectrum to death and debilitating ‘long Covid’ at the other, there are many possible consequences that are only gradually being understood.

The possibility that hearing loss can be caused by the virus is not something that gets much attention, but it is something you should be concerned about and if you think your hearing has declined after an infection, that is an extra reason to book a free hearing test.

Speaking to the Huffington Post, Dr Amesh Adalja from Johns Hopkins University Center for Health Security said there have been many reports of Covid impacting on hearing and it is known that the virus can infect ear cells.

“The concern is that SARS-CoV-2 – or the immune response to it – may damage the cells of the ear responsible for transmitting sound information to the brain,” he added.

Earlier this year, a study published in the US found that among patients who had severe Covid, seven per cent had suffered serious loss and between 12 and 13 per cent had endured mild impairment.

These indicators are, of course, the results of the earliest research and due to the novel nature of Covid when it emerged three years ago there may be a lot more to be discovered about how the virus can affect hearing, along with so many other long-term health effects it can have.

Even so, it is important to keep checking your hearing at any time, so if you have had a Covid infection, as most people have, this can be added to the list.

While the idea that the virus can affect eyesight got plenty of early publicity through Dominic Cummins’ infamous drive to Barnard Castle, it is clearly time that your hearing got some attention too.

Because hearing is one of the five senses, hearing damage and hearing loss can have further-reaching effects that affect the other senses.

Whilst the best and clearest way to determine the scale of hearing loss is through audiology tests, there are other common telltale signs that someone who can hear is struggling more than they may be expecting.

One of the most common and yet most surprising is finding conversations more tiring as you have to exert effort to distinguish between different voices in a crowded area.

However, despite there being anecdotal evidence that listening more closely is more tiring, there had not been any scientific studies that confirmed this for sure until the middle of 2023, when two were published within just a few months of each other.

They found a connection between eye movements and focusing on listening, and what these studies highlighted may help with future hearing treatments.

 

Why Eye Movements?

Both papers, the first written by Claudia Contandini-Wright and her team and the second by M. Eric Cuit and Bjorn Herrman, both for the Journal of Neuroscience, focus on the behaviour of the eyes during “effortful speech listening” or times when someone pays attention to speech whilst listening.

The first paper focuses on pupil dilation, highlighting that when trial subjects were focusing on listening to noises that were difficult to parse, their eyes were noticeably larger, typically reflective with sensory arousal and cognitive processing, such as when someone is memorising information.

The second paper focused instead on the connection between eye movements and listening, with there being a typical connection between slower eye movements and increased focus.

This is, for example, why people blink less often when they are reading, and their eyes will move slower and they will blink less depending on how complex the text they are reading is.

This approach was transposed from reading to listening, with 26 young adults listening to several different sound files featuring both short sentences and longer spoken stories, an eye tracker reading their movements.

The findings revealed several interesting results.

The first was that there was a connection between focused listening and eye movement, highlighting the potential to study this further in auditory neurology, with less of the potential environmental disruptions found when trying to detect pupil size.

This also highlights the potential for tracking eye movements as part of hearing tests, as they can be used to detect difficulties of hearing in practical situations even if your ears have the capacity for hearing as determined through conventional pitch testing.

As this is an exceptionally early field of study, however, it is difficult to determine which eye movements relate to which cognitive hearing processes, which will require more study.

As well as this, whilst more effortful listening can be a symptom of hearing loss, it can also be exceptionally context-sensitive.

People will listen more attentively when processing complex or less clear sentences, as well as any speech in languages they are not necessarily fluent in.

These two papers are the beginning of a fascinating field of study, one that could produce a new approach to examining how people hear.

It might be imagined that hearing aid tests are overwhelmingly procedures undertaken by those in later life, but increasingly young people across the developed world are wearing hearing aids – and for more than one reason.

This has been noticed in the US, with the issue being highlighted in an article in the New York Times. Following up on this, ABC News highlighted significant figures showing the extent to which young people in the US are at risk of hearing damage, mainly due to playing music too loud, especially while wearing headphones.

It quoted figures from the Center for Disease Control and Prevention stating that a fifth of Americans aged 30 or under have suffered some hearing damage due to this cause.

However, the report added, need alone is not the only factor in more youngsters wearing hearing aids, as they have advanced markedly from the clunky, visually intrusive versions that existed a few years ago. Now they can resemble ear pods, making it less obvious the wearer is using a hearing aid and thus reducing the social stigma involved.

While the ABC article may focus on the US, the same problem is a threat across developed nations where there is easy access to headphones and online music sources, including the UK.

The Royal National Institute for Deaf People (RNID) offers information on how loud music can damage hearing by over-stimulating sound-sensitive hair follicles in the era, which then stop functioning, with the result being that hearing is impaired.

According to the RNID, this damage is usually temporary, but repeated incidents can cause more lasting hearing loss and other conditions such as tinnitus. It advises people to take steps such as taking a five-minute break from using earphones every hour and not going over safe volume limits.

For some young people, such advice may have come too late. So if you are 30 or younger and have a hearing issue, don’t hesitate to get yourself checked out. If you have damage that requires a hearing aid, you will be in good company.

In many cases, hearing loss is a permanent condition that becomes increasingly noticeable. As most people get older, they struggle to hear certain frequencies, can sometimes have difficulty parsing signal from noise in busy areas or find themselves feeling more fatigued in conversations.

The cause and best treatment path for long-term hearing loss will typically come from audiology tests that determine the cause and severity of the loss of hearing in each ear, but it is not always the case that someone will struggle to hear forever.

If you suddenly notice that you are struggling to hear as well as you did previously all of a sudden, it might be a temporary condition causing it, one that if treated can help restore all or most of your hearing ability.

 

Ear Infections

Very common with children who suddenly lose hearing in one ear, a middle-ear infection is commonly caused by viruses, colds and the flu, as fluid builds up in the middle ear as part of the body’s way to fight the virus.

This can put pressure on the ear and cause an uncomfortable blocked sensation and a total loss of hearing, but once the fluid dissipates either through antibiotics, the illness running its course or the eardrum rupturing and healing, this feeling will disappear and your hearing will return.

 

Sudden Loud Noises

Loud noises can and do cause permanent hearing damage, but in a lot of cases of people who go temporarily deaf after a music concert, hearing an explosion near their ear or another sharp noise, the loss of hearing is typically temporary.

If you rest your ears as soon as possible and protect your hearing in the future with earplugs or earmuffs, you can avoid further serious damage.

 

Impacted Earwax

Earwax is an unsung hero of the human body, as it traps small particles and stops the eardrum from being damaged, before being pushed out naturally through the natural motion of your jaw.

However, if earwax gets stuck in your ear then it can cause a blockage that can suddenly cause hearing loss.

However, most clinics can easily flush earwax out using a syringe treatment, and in some cases, ear drops can be bought over the counter that work in the same way.