Tech Topic | September 2021 Hearing Review

By Claus Nielsen, MA, and Tobias Bollerup Henriksen

In hearing healthcare, we tend to look for dramatic moments which bring a person to appreciate their need for hearing aids and audiologic services. However, in large part, it’s the more trivial, everyday activities that can define the immense impact of better hearing.

In our previous article in the June 2021 Hearing Review,¹ we explored how sound processing has changed over the past 40 years, using the journal quotes of hearing aid users we’ve worked with at Eriksholm Research Centre to illustrate our points. This article uses those same journal quotes to illustrate the hearing aid as an integral part of the users’ lives. We report about the everyday situations which were common across multiple patients through several decades, and often took center stage in their journals.

These descriptions reveal how hearing aids have a significant impact on the daily life of the users and their surroundings—for better or sometimes worse! The empirical data gathered from these journals illustrates how the sounds of daily life are essential to maximal communication and adds substantially to quality of life (QoL).

The “Good Life” and the Complexity of Hearing Loss

Before we proceed, we first must acknowledge that many people with hearing loss who choose not to obtain hearing aids can also live good lives. Similarly, the advantages associated with hearing aid use cannot assure or guarantee that wearing them will result in living or experiencing “the good life.” There are so many variations and infinite permutations across people, across hearing losses, across listening abilities, as well as people’s own attitudes, outlooks, personal needs and goals for attaining a good life. Specifically, many people with similar hearing losses and in the same age group experience tremendously different sound perceptions. It should be remembered that hearing is simply detecting sound; listening is decoding sound and applying meaning to it.

There is great variation in how everyday life is experienced and lived out, and thus also what problems or challenges one may face in relation to hearing. The solution, or at least the remedying of hearing-related challenges, is therefore unique not only in relation to hearing loss configuration and physiology, but also in relation to the hearing aid user’s everyday practices and their perception of what the good life is. Several statements from our transcribed journals reveal this point:

“Actually, there is something wrong with my hearing aid at the moment, but unfortunately I cannot specify what it is. I have had some downturns due to the fact that I am not hearing what I want to hear. For example, nuances in music. Furthermore, my surroundings have started to say that I no longer react as alert as I usually do. I often adjust the volume and maybe experience some sort of filter covering the sounds making them unclear. Is there anything you can do?” —1990, female

These descriptions are not just amusing anecdotes from the past, but serve as insights into what is important for the user—insights that pinpoint situations in daily life. This is particularly interesting from an ethnological viewpoint. Using these types of brief insights, the traditional study of European ethnology (as opposed to the related field of anthropology) can help fixate not only on observing “the differences and relationships between various people,” but rather it turns our analytical interest towards what might easily be shrugged off as trivial aspects of life. Using many of the same ethnographic methods as anthropology, ethnology examines ordinary people and everyday life, often in relation to much larger structures of society. As such these hearing aid users’ journals contain a treasure trove.

“I also regularly attend the company’s switchboard, and it’s not convenient for either me or the customers, as I cannot hear what people are saying, so I do not provide the service to the company and its customers that I should be able to.” —2007, female, 56 years

“At meetings and in the canteen, I have two options: either to take out the hearing aids or to sit in an inferno of noise. None of the parts are optimal, as I miss out either way. I also have disadvantages on the private front. If I am wearing them, they whistle when my boyfriend gives me a hug. And if I do not have them in, I cannot hear what he says. If I hear music or watch TV, the volume has to be turned up drastically if I am not wearing the hearing aids, and the others in the house cannot stand it.”—2007, female, 56 years

“With the right hearing aid, I can still hear birds singing and human voices in private, but grandchildren and music are unintelligible and chaotic. With two hearing aids, the voices of adults are clearer, children’s voices often become intolerable and music on the radio is rattling, distorted, and upsetting.” —2008, male, 65 years

Descriptions of leisure time, family, jobs, colleagues, and social situations in relation to hearing aid use is an obvious occasion to analyze the changes in the everyday life of the users. However, these statements were not originally intended to describe the everyday life experience, as such, or to document historical changes in hearing aid technology. Rather, the written experiences were meant for the hearing care professional (HCP) to adjust and help the test subjects with their hearing aids. Reading through this historical material, it’s clear the descriptions of environments are often similar when describing their challenges. This makes perfect sense since daily life is where most of our experiences with the surrounding world takes place (eg, conversations with our spouse, lunch with co-workers, Friday night out, or watching television). As such, the files contain lots of examples of different problems with sound and hearing, and why these have great significance:

“When several people are talking to each other during the coffee break at work, I cannot hear what the person next to me is saying, especially if it is a man, because the voice drowns in the surrounding speech noise. A loud female voice at the table next to me often sounds significantly louder than the man sitting next to me.” —1996, male, 35 years

“Many joys are taken away from me, for example, at dinner parties. If I have to hear the conversation of those persons closest to me, I am simultaneously almost half stunned by the noise from other people’s knives and forks against the plates.” —1996, female, 59 years

“So much I hear is wrong, so the family teases me in a loving way, but this can’t go on.” —2001, female, 66 years

Although there are many unique cases, and the needs of the individual user must be understood in relation to the specific life lived, several general trends surface in these journals. There has been  incredible progress in hearing aid technology. Hearing aids have evolved into modern signal processing systems that are extremely small—with most RICs being about 1 inch in length. In striking contrast to this rapid development stands human needs. According to Oticon’s retired senior international trainer Carsten Ahlbom, human needs remain unchanged: “We do have the same needs we’ve always had. The need for communication with other people is very, very important. This is because we are social animals. This means that we are forced to be able to communicate with others in order for us to feel that life is as it should be.”

Historically, the need the hearing aid has always sought to fulfill is communication with other people, as well as environmental awareness and social presence. Ahlbom formulates being able to communicate satisfactorily with other people as being crucial to living life adequately. The idea of the good life branches out in as many variations as there are people on earth, but common to us all is the need for communication and presence.

Venturing into a New World

Before the good life with hearing aids can be pursued, the person with hearing impairment must first come to acknowledge their hearing loss. However, the journey to this acknowledgment is not a given; it can be a difficult and long road for many.

“My wife and daughters are pushing harder and harder for me to use a hearing aid, and, in that way I’m probably a typical, potential, hearing aid user who just needs to make the final decision to increase my quality of life.” —2004, male, 57 years

A major market study from 1991 showed an increasing number of hearing tests were conducted by medical doctors, but sales of hearing aids did not increase correspondingly. This was further investigated by asking hearing aid users why they had made the choice to purchase the devices. The result showed that 70% felt that their hearing had deteriorated significantly enough to purchase hearing aids, 30% indicated that their children and friends had encouraged them, and 30% stated that it was their spouse who was the direct reason why they acquired the device.³

More recent studies have focused on the various factors that influence people to acquire a hearing aid. For example, people are unconvinced a hearing aid will be effective or they themselves do not perceive their hearing loss as a problem. However, once communicating and functioning amongst colleagues and family becomes a problem, they experience frustration and pressure from these people and chose to acquire hearing aids.⁴

In addition to acknowledging a hearing loss comes the process of acclimating to a new world of forgotten sounds. Even though the quality of the modern hearing aid has increased significantly through the decades, getting used to hearing aids is not always easy. One of the representative statements from the files talks of “a new world”:

“But also it is truly a new world unveiled—whether it is for the better or worse I cannot quite seem to figure out just yet, but it is different. I now hear “sounds” on the right ear and feel hereby that I have recovered some of my three-dimensional sound perception.” —2004, male, 57 years

Acquiring hearing aids is not a “quick fix” that cures a hearing loss. Rather, it’s more like a process of getting used to—and appreciating—new sounds. As a person with hearing loss, you also need to reflect on the situations in which it is important for you to be able to feel present. Looking at our journal materials, we find statements that largely deal with completely ordinary situations that all people—hearing aid users or not—are able to recognize as important:

“At home, I experience many new sounds such as: the hiss of water in a radiator, a beep from our coffee machine when the coffee is brewed, ringing from the dryer, keys put in the front door and doors opening and closing, water running down the toilet cistern after rinsing, the sound of my dog’s claws when it goes across a tile floor, the sound of the friction between bread and knife when cutting a piece of bread, the refrigerator that defrosts, switches that are turned on and off, the sound of fire at the fireplace, the sound of turning a page in a book and a whole lot more. I continue to make small notes every day with a view to a perhaps ‘last adjustment visit’ with you, but as you can probably sense, everything has become so wonderfully different and wonderful for me. I will soon be a grandfather and I look forward to being able to follow my grandchild’s babble up close here too.” —1996, male, 55 years

“I have also heard the sparrows singing. My husband says that they have been there all along, but I have not heard them until now.” — 2010, female, 73 years

These statements describe scenarios from daily life filled with sound—sounds that play an important part in what are otherwise seemingly trivial activities. However, it can be the little things that make a big difference. In some ways, these are sounds and cues that bring colour to our experience and add depth and presence to our being.

Acquiring a hearing aid is thus very much about identifying what one understands by the good life, and thus how a hearing aid can support it. The process starts first with the acknowledgement of a hearing loss and the motivation to enter the process of attaining this good life.

Indeed, it might be the cumulative trivial situations—including, below, a visit at the local bakery without worrying about becoming frustrated or misunderstood—that come to define the large improvements in QoL due to the acquisition of hearing aids and journey toward better hearing:

“I can do that now, so there are not so many of those situations where I feel lost. And it gives quality of life. That you do not get stressed and nervous about the situations where you cannot cope. And that is also reflected in one’s mood. I think I have become happier; I feel like I have won the lottery. It means something when one discovers you can manage again. And that is, well, that is what you call quality of life, and you cannot get enough of that.” —2021, male, 66 years