New help for hearing loss

“You’re coming through my hearing aids!” laughs Lynne Kingston as she enthuses on the phone about the little devices that have changed her life.

The 57-year-old from Kent, United Kingdom, had been aware of her deteriorating hearing for at least 15 years, as young as her early 40s. She constantly asked people to repeat themselves. Noisy restaurants, parties and the telephone were a nightmare for Kingston, who runs a student accommodation rental business. “I do most of my work on the phone,” she says. “I had to put it on speakerphone, which meant everyone else could hear.”

About 10 years ago she consulted a hearing specialist and tried basic hearing aids, but soon gave up. While they amplified all the sounds around her, she still couldn’t make out the ones she needed to hear. “I was in denial,” she says. “I thought, I’m not that deaf.”

But she was. Eventually, pressure from her children and a friend who wore hearing aids made her think again, as did buying her son and daughter trendy wireless Bluetooth earbuds for Christmas. “If people can have these white things sticking out of their ears, why would I be bothered about wearing a hearing aid?”

Comfortable and discreet, hearing aids can be life changing

So in the summer of 2020, Kingston did some research and was amazed at the improvements in hearing technology. She went to an audiologist to check out the different aids available, and chose ReSound One models from Danish manufacturer GN, a widely available option. She was attracted by the devices' three microphones—two in a tiny unit worn behind her ear and another mic inside the ear. These give more natural sound quality and filter out unwanted background noise.

“I’ve got an app on my phone and depending on the environment I’m in, I can adjust the sound,” she says.

When Kingston put the hearing aids in, she realized how much she’d been missing. “I thought, What’s that noise?" she recalls. “It was my flip flops!”

Kingston can finally communicate normally on the phone and face to face. She is able to route television audio as well as phone conversations through her hearing aids. They are comfortable and discreet, and her self-esteem has risen as a result.

Lynne Kingston is one of around 48 million people in Europe with disabling hearing loss, according to Hear-It, a Brussels-based organization dedicated to raising awareness of the issue. This means they struggle in normal conversation. Yet, unlike Kingston, two-thirds have not had their hearing corrected; Hear-It estimates this costs the European Union (EU) some 55 billion euros a year in lost productivity. A 2020 survey from three different European hearing organizations found that a little more than half of people over 65 admit to having impaired hearing.

Around 90 per cent of hearing loss is due to wear and tear in the inner ear, sometimes as early as in our 40s, with 40 per cent of over-50s having some level of hearing loss. When vibrations come through the ear, tiny hair-like cells change them into electrical signals that are sent through the auditory nerve to the brain, which then interprets the sound. Once dead, these cells don’t renew themselves.

After age-related hearing loss, the next biggest cause is long-term exposure to excessive noise, which can start in your teens. Working in factories or with firearms can damage hearing, as can listening to loud music either through headphones or live.

Viruses can play a part, too. Kingston believes contracting measles in her 20s might have caused her hearing loss. Some medical conditions, such as Type 2 diabetes, heart disease and high blood pressure, are also thought to increase your chances of losing your hearing. Other risk factors include a family history, head injury, smoking and some medications, including the antibiotic gentamicin and some chemotherapy drugs.

The effects go far beyond missing out on conversations. Hearing loss has a profound impact on mental health.

“Hearing is our primary communication sense and losing it leads to social isolation,” says medical physicist Birger Kollmeier of the University of Oldenburg, Germany. He is president of the European Federation of Audiology Societies and head of the German research group Hearing4All, a cluster of experts from three German universities. Researchers have found that a hearing problem doubles the risk of depression.

And that’s not all. Hearing loss contributes to the likelihood of developing dementia by up to eight per cent—and is the highest modifiable risk factor for the disease, according to a Lancet Commission on dementia in 2020. When you can’t hear well, “your brain is not stimulated enough,” says Dr Paul Van de Heyning of Antwerp University Hospital in Belgium.

There are clear signs that hearing aids can guard against dementia. One 2018 study of nearly 4,000 people conducted over 25 years by French health research organization Inserm showed that uncorrected hearing problems led to increased risk of disability and dementia, whereas people who wore hearing aids had the same chance of remaining independent as those who can hear without a hearing aid. And based on data from the more recent PROTECT online longitudinal study, researchers from the University of Exeter and King’s College London, UK, believe hearing aids can reduce the risk of cognitive decline by up to five years.

Surprisingly, perhaps, hearing loss is important for physical health, too. Even mild loss can lead to a three times higher risk of falls, which can prove fatal for older people.

The latest hearing-aid technology can be a huge help. “The quality has improved massively in the last 20 years,” says audiologist Francesca Oliver of the Royal National Institute for Deaf People (RNID), a UK charity. “They can be programmed for the individual’s hearing loss.” An algorithm determines how much amplification at different frequencies is required.

But one of the most exciting developments is the ability to connect your hearing aids to your smartphone via Bluetooth. Using your phone like a remote control, you can adjust the volume and switch between different modes, such as restaurant settings, meetings, or live music. Previously, hearing aids did not have connectivity to smartphones, so you had to physically turn up the volume on the device. “Vast progress has been made with respect to connectivity with communications devices, including public address systems,” says Kollmeier.

What’s more, all this amazing tech is often contained in much smaller devices. There’s even one—the Lyric, which is widely available—that can be worn unseen inside the ear canal for several months at a time. “You can’t feel it, and you can sleep and shower with it in,” says audiologist Paul Checkley, clinical director of Harley Street Hearing in London. “It’s like a contact lens for the ear.”

Shown here are two popular hearing aids: The ReSound One from Danish manufacturer GN (left) and the Lyric from Swiss company Phonak (right)

Most hearing loss is bilateral, and in those cases, two behind-the-ear devices are better, such as the one Kingston purchased. There is a wireless interaction between them, giving the wearer a better idea of where the sound is coming from—replicating what our own ears do. Coming next, Checkley believes, are “hearables.” “Some manufacturers are putting hearing technology into ‘smart’ earplugs,” he explains. These microcomputers, which are similar to earbuds to listen to music, use wireless technology, allowing your personal hearing data to be input to enhance your hearing.

With hearing aids, the sooner you get them, the better. “Research shows that people wait about ten years before seeking help,” says RNID’s Francesca Oliver. Why? It’s not just the stigma associated with going deaf; it’s also because hearing loss is gradual and people are often unaware it’s happening. “Age-related hearing loss affects the higher frequencies first, which means people can hear vowel sounds but miss consonants,” says Checkley. “They can be fooled into thinking their hearing is normal.”

But don’t wait until you can’t hear a thing. “Start early with any intervention, because the brain tends to forget your central hearing abilities if they are not properly activated anymore,” says Kollmeier. Neglecting the problem means it takes longer to get used to hearing aids.

When hearing aids are no longer up to the job, there’s a surgical solution that can revolutionize lives. Cochlear implants can allow for improved speech perception in up to 98 per cent of people who, even when wearing aids, can’t have a normal conversation, according to University Hospital Antwerp’s Dr Van de Heyning.

“Eighty per cent of people who get a cochlear implant can make a telephone call again,” he says. And for people who are unfortunate enough to have tinnitus as well, he says the noises in their head abate by 50 to 80 per cent when they switch on their implant.

A cochlear implant has two parts. One is worn behind the ear and the other is surgically implanted under the skin of the scalp with a wire leading through the ear to electrodes in the cochlea, the “hearing” part of the inner ear. An external microphone on or near the ear picks up sounds, which are analyzed by a chip and sent as code into the implanted electrodes. These send currents to the auditory nerve. “It replaces the work of the hair cells,” says Dr Van de Heyning, clarifying that there is no brain surgery involved.

In fact, the risk of complications and the failure rate are low. Implants are suitable for people whose hearing loss is caused by inner-ear issues—the vast majority—and age is no object. “The only barrier is severe dementia,” says Dr Van de Heyning. These patients don’t have the cognitive acuity needed to interpret the initially unfamiliar sounds they hear.

Still, awareness and uptake remain low across Europe. In high-income countries, less than 10 per cent of people whose lives could be improved by a cochlear implant actually have one. Why so few? “That’s a good question!” exclaims Dr Van de Heyning, who says that even ear, nose and throat (ENT) specialists often seem unaware of the advantages, and which patients would benefit from surgery. “Ideas persist that you have to be completely deaf to benefit.” You don’t.

Jacques Verdière, 88, from Perros-Guirec in Brittany, France, is proof that cochlear implants can restore hearing even when you’re elderly. After years of ear infections, the retired librarian went completely deaf in his left ear. When his ENT surgeon suggested a cochlear implant, he was hesitant. “But my daughter, a nurse, persuaded me,” Verdière says. In 2016 he had a cochlear implant, followed by a second the following year when he lost the hearing in his other ear.

While Verdière had rehabilitation after the first implant to retrain his brain to understand the metallic sounds produced, he required no help adjusting to the second. “I could hear perfectly. It was marvellous.”

Inner-ear hearing loss has always been considered irreversible, but science may be about to debunk that idea. Particularly exciting is a new drug being trialed in Greece, the UK and Germany. “This drug treatment aims to regenerate inner-ear hair cells that are lost as hearing loss progresses,” says ENT surgeon and hearing researcher Dr Anne G.M. Schilder of the Biomedical Research Centre of University College London Hospitals, where the research was done.

Dr Schilder headed the EU-funded trial, dubbed REGAIN. In people with mild to moderate hearing loss, an ENT specialist injects the drug, a gamma secretase inhibitor, into the middle ear, from where it diffuses into the inner-ear to make new hair cells. Dr Schilder believes this and other innovative treatments capable of reversing hearing loss could be available in five to ten years’ time.

"My hearing aids have made me feel better about myself," says Lynne Kingston. "It's an investment in me."

But right now it’s important to prevent, as much as possible, damage to those crucial hair cells. “There are very good quality, reasonably priced ear plugs you can buy that filter out harmful sounds but won’t detract from your experience,” says Francesca Oliver. When listening to music, consider noise-cancelling headphones, don’t turn the volume up too high and don’t listen for too long. Take a break of at least five minutes every hour and, if you’re at a concert, every 15 minutes. Many audiologists believe you should have regular hearing tests just as you do for your eyesight.

After all, why suffer in silence? While you may have to pay for some or all of the cost of state-of-the-art hearing aids, Lynne Kingston thinks it’s more than worth it. “They’ve made me feel better about myself,” she says. “It’s an investment in me.”

Read more: 7 subtle signs you may have hearing loss

Read more: Navigating the world with face blindness

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