What to do when your hearing is failing you

Hearing loss, especially if left untreated, can lead to a 37% higher chance of dementia. Photo / 123RF

New research shows how even mild hearing loss hugely increases the risk of dementia.

What? Sorry, I didn’t hear you. Let me turn my phone volume up.

Hearing loss creeps up on you slowly in later middle age as all those glorious live gigs and club nights of youth catch up with you. Or your DNA just starts doing what it’s programmed to do.

Both of these things were starting to affect me when I was first offered hearing aids 10 years ago, aged 55. Horrified at the prospect - “I’m not an old person! People will see!” - I just learned how to put subtitles on television shows and turned my better ear towards people at drinks parties.

Then calamity struck and an ear infection caused by E. coli lurking in the sea where I was swimming off an English beach caused my eardrum to rupture. In what had been my good ear. An operation to fix it didn’t work and suddenly I was properly deaf and begging for those hearing aids. It was a very long and difficult year before I got them.

At that time, I took on a new contract that involved working in an office three days a week and found it really hard to hear what anyone was saying there, which made me feel old and pathetic. So I told my colleagues about the destroyed eardrum and explained I would just have to stand very close to them to hear. It felt weird and it was mortifying.

Over 60% of people will experience some form of hearing loss by the age of 65. Photo / 123RF

Almost worse was the joy of sparky dinner party conversation becoming a bewildering blur. It was absolutely exhausting trying to keep up enough to contribute, until at a certain point in the evening I would just zone out, letting it all wash over me.

Then there was the embarrassment of not being able to hear what people said to me in shops and leaving a West End play during the interval because I couldn’t hear a thing that heavenly Johnny Flynn was saying.

And on top of all that, there were the normally civilised people who found my hearing loss a great cause for mirth. When I mentioned I had a problem with deafness, people I’d known for years and total strangers would pretend to do sign language, or start mouthing silently as though speaking - then ask me if I’d heard. This would make them roar with laughter. Hilarious! Not.

Over time, between all that, it was starting to feel easier not to try. And this creeping social isolation is exactly one of the reasons why hearing loss is so dangerous for dementia. A risk that has been very precisely calculated. A meta-analysis of six separate studies of people who had five or more years of hearing problems before they developed dementia, showed that hearing loss (assessed according to the WHO measure) created an increased dementia risk of 37%. The study, published in The Lancet, was led by dementia researcher Professor Gill Livingston of UCL, who is very clear about the implications.

“We have identified 14 modifiable [as opposed to genetic] risk factors for developing dementia,” she says. “And hearing loss is the biggest single factor. In terms of the whole population, it accounts for the biggest percentage difference.”

Gosh - but why?

“It’s the decrease in brain stimulation. Interacting with other people is the best form of cognitive stimulation, and when we miss out on that, the central lobe of the brain gets physically smaller.

“People with hearing loss tend to self-isolate because it’s embarrassing and tiring not being able to hear, so they further miss out on that stimulation.

“Struggling to hear also uses up a lot of “cognitive reserve”, the amount of brain capacity we have. On top of this, people with untreated hearing loss are more likely to get depression, which is another modifiable risk factor for dementia.”

In short, hearing loss is a very serious risk to brain health - and 60% of us are going to develop it by the time we’re 65, says Livingston. But there is help.

But although I was thrilled to finally have them (on the NHS, hence the wait), hearing aids are not the instant fix that reading glasses are. Mine are fully digital with a brilliant app which allows you to adjust your levels on your phone, but they still took some getting used to. Eight or so months in my case, but after all that time of not being able to hear and mindful of the dementia connection, I was determined to persist. First of all, get over the idea that they will make you look old. With the thin clear wire looping back over your ear, no one will be able to see them.

There is absolutely no shame in wearing hearing aids, although I don’t particularly like that name, so I call them my ear trumpets. Getting this jokey little term established in the family from the outset made it all less medical.

Bear in mind that when you first put them in you will feel peculiar, like you are wearing space boots. That wears off very quickly, then you have to make the crucial cognitive adjustment.

When I first had my “trumpets”, a crisp packet sounded like a digger moving bottles, my computer keyboard clattered like dropped deck chairs and I was horrified by the volume of my own voice when I spoke, like hearing yourself on playback while you are talking.

It can also be hard at first chatting to more than one person without it becoming a bit cacophonous, but keep wearing your ear trumpets and all this soon wears off. Amazingly quickly, your brain adjusts again to ranking sounds and putting the less important ones to the back of your awareness.

The hardest part for me (and from discussing it with ear trumpet friends, it’s different for everybody) has been getting used to the physical feeling of having them in my ears. A bit like having a very small stone in each shoe.

But each day it gets easier, and there have been times when I’ve had to check if I had the trumpets in or not, and any amount of effort has been worth it for the joy of once more being able to throw myself into fun shouty arguments across a dinner table.

And hopefully, with my hearing artificially restored, there is a greater chance of my brain continuing to be able to keep up with such larks as well.

Livingston’s advice for avoiding the dementia risk of hearing loss

1. If you need to turn the TV up louder, get your hearing checked.
2. If a hearing test shows your hearing is impaired, get hearing aids as soon as possible.
3. Persist with them - your brain needs to adjust and it takes time.
4. If you still have good hearing, protect it.
5. Avoid loud noise.

Modern hearing aids come with phone apps to adjust settings for different environments. Photo / 123RF

How to get used to hearing aids

• Start with short sessions morning, afternoon and evening.
• Gradually increase the length of the sessions until the length of time with hearing aids is longer than the rests.
• Take time to explore and understand the settings on the phone app and try them out. Adjusting to different environments, correcting volume and focusing direction makes a huge difference. I find reverberant rooms brilliant in restaurants (and noisy environments with my family…)
• Changing batteries is fiddly, so practice until you can do it with complete confidence in any circumstance - on a bus, under a lunch table etc.
• Always carry spare batteries with you.
• If your hearing aids are rechargeable, get into a routine with that and into the habit of packing the charger when you are going away.
• Hearing aids are very small, very expensive and very easy to lose. Choose three places in your house where you will put them down and never put them anywhere else. I always keep mine in the clam box they came in. (My approved spots are on my dressing table, my desk and the sideboard in the kitchen.)