If you can hear background noise at a party but struggle to pick out a conversation, it could be an early sign of hearing loss. Photo / Getty Images
If you struggle to make out what people are saying in crowded restaurants or parties, it’s time to get your hearing tested.
Paramedic Christian Hill, 48, is telling me about suffering from what audiologists call “cocktail party syndrome”. “I could hear background noise but I couldn’t pick up on any particular conversation. Looking back there were lots of clues. I’d have to ask people to repeat things. Someone once said: ‘Why are you just looking at my mouth?’ I would have to lip-read a little bit to give me that visual cue for what they were saying. It got worse and worse, to the point where if I was in a noisy environment, I couldn’t hear a thing.”
Today he believes it was caused by DJing at house parties in his youth. “My hearing loss is in my left ear particularly, and that’s the ear that had the headphone on really loud, monitoring the music I was mixing.”
For years he assumed he was too young for a hearing aid, so struggled on. Friends would ask why he was shouting in the pub. He could barely hear his wife’s voice.
Eventually, aged 45, he was sent to an audiologist, who diagnosed damage in one ear. After an internal scan to rule out a brain tumour, he was sent for a hearing aid fitting for his left ear.
Now Hill, from Kettering in Northamptonshire, is evangelical about it. “The first time I wore it, I could hear the birds outside. And driving back, I was tapping my wedding ring on the gear stick thinking: ‘Wow, I can actually hear that noise’.”
Cocktail party syndrome is one of the early signs you may have hearing loss, says Franki Oliver, audiology manager at the Royal National Institute for Deaf People (who previously worked as an NHS audiologist). “You could be losing a bit of the high frequencies which make up the clarity in speech, so consonant sounds are quite high-pitched. And that’s generally how hearing loss progresses, if it’s due to age or noise. A lot of people when they come into a clinic will say, ‘I’m fine one-to-one. But when I’m somewhere noisier, I can hear people are talking but I don’t always catch what they’re saying.’”
Hill says people are surprised when he mentions he has an NHS hearing aid. “I’d only ever seen those big clunky ones. I was thinking: ‘Oh crikey I’ll be wearing one of those.’ But these days, they’re so tiny and discreet.”
He wishes he’d got a hearing aid sooner, and known about safe listening. He’s not the only one. A study by Boots Hearingcare recently found almost a fifth of people admit they may have hearing loss, but don’t wear a hearing aid, and one in six of the UK adult population is already living with hearing loss.
Scientists have long suspected that hearing loss may trigger brain damage elsewhere, and also stop people from socially interacting, which is known to protect the brain from cognitive decline. “There was a period where I chose not to go out,” Hill recalls. “It was too uncomfortable to keep saying: ‘I can’t hear.’”
“We know that unfortunately, a portion of the population may leave employment early because of problems with their hearing, if they aren’t addressed,” says Oliver.
Experts say that tackling the problem means the conversation needs to shift from talking about hearing loss, which connotes ageing, and talking more about hearing health.
Because the good news is hearing aids reduce the risk of death by almost 25 per cent, according to a new study. Dr Janet Choi, the lead researcher with Keck Medicine of University of Southern California, USA, said: “We found that adults with hearing loss who regularly used hearing aids had a 24 per cent lower risk of mortality than those who never wore them.” The researchers believe lower levels of depression and dementia are behind the longer lifespans. Improved hearing goes hand in hand with improvements in mental health and cognition.
And hearing loss isn’t just a Boomer problem. The British Medical Journal estimates more than a billion millennials and Gen-Zers are at risk of hearing loss. Experts say noise over 85dB can damage your hearing and with concerts often having noise levels of over 110dB, going to gigs unprotected could be seriously damaging your ears.
Audiologists recommend that anyone under the age of 50 should take a baseline hearing test (there are several free online versions) and monitor carefully for changes.
But we shouldn’t despair. After years of neglect, it really does seem that aural health is having a moment. Looking after hearing is a key wellness trend for 2024, with people increasingly wearing fashionable ear defenders and ear-plugs at gigs; while the new state-of-the-art hearing aids mute background noise, connect to Bluetooth and even translate foreign languages. “My hearing aid is like wearing an AirPod,” says Hill. “I often forget it’s there.”
Wearing headphones is more normalised for everyone, says Oliver. “And hearing-aid manufacturers are taking note. A few are starting to design hearing aids that look more like ear buds. And there are more devices that can augment sound as well, without being hearing aids.”
Hearing-aid technology is more sophisticated than even five years ago, she adds. Sound capability is the most important thing, but there are additional benefits. “You can use them as an extension of headphones to listen to music or take phone calls. Some manufacturers see the ear as the new wrist, as a way to measure heart rate or brain health, even step count. So it becomes another piece of wearable technology to measure your health.”
Apple is positioning their bestselling AirPods Pro as over-the-counter hearing aids for those with mild to moderate hearing loss, allowing users to adjust the earphones like hearing devices. The Live Listen feature turns your iPhone (or iPad) into a directional microphone, which sends the sound directly to your AirPods. This helps us to pick up voices in noisy environments better. Other premium hearing-aid manufacturers, like Phonak, offer similar remote microphones, which can be placed near the source we’re trying to hear.
Where once it was a badge of honour to leave a rock concert with ringing ears, at live performances you’ll now see people wearing ear defenders and headphones offering active noise cancellation (which helps reduce background noise). You can choose from Blox’s triple honeycomb silicone earplugs or Eargasm Earplugs. Oliver is a fan of Loops where tiny gold hoops sit in your ears. You can switch between Quiet Mode (25dB reduction), Experience Mode (21dB reduction), and Engage Mode (17dB reduction) by rotating the dial on the loop itself. “If a bit of bling triggers behaviour change, that’s fantastic,” she says. And most smart tech will send you alerts to tell you you’ve been listening to your headphones too loud.
It can’t come too soon for many of us. After a serious ear infection in my 50s, I began to suffer hearing loss. I could barely hear what anyone was saying. Worse still, my voice was tiny – when you have hearing loss you think you’re shouting.
For two years I was an outpatient at St Thomas’. When they signed me off, I embarked on a round of ear candling, micro-suction ear wax removal, and hearing care specialists. Today I manage the condition with a daily drop of Earol. But when I’m transcribing interviews I’m convinced I have hearing loss in my right ear.
The only consolation is many of my peer group are in the same state. Sometimes I’m amazed we can communicate at all.
So I was excited to discover that we can potentially train our ears to hear better, whether we’re suffering from milder age-related hearing loss, or more profound loss (and already wear a hearing aid).
Increasingly research is focusing on ways to boost our auditory and brain-hearing skills – called “auditory training”. There are computer games and online training sites, plus apps, where we can train at home with a smartphone and headphones.
To hear speech, we need to pick it out against background noise – for example, in a noisy restaurant – a skill called auditory attention. And of course people vary greatly in their ability to focus on one sound rather than another, known as auditory selective attention. Professional musicians are better at it. Listening to audiobooks (a form of audio therapy) can also help train our ears.
The average person speaks approximately 150 words per minute, but there is a big range: from 120 words to 180 words. For many, our auditory processing speed drops steadily as we age. So training aims to improve our ability to filter out distractions.
In 2020 Andy Shanks, 45, a former DJ from Berkhamsted, and Amanda Philpott, 55, a former local NHS chief executive, set up the digital hearing fitness app Eargym to help users check and train hearing health. Both have suffered hearing loss (Amanda wears hearing aids) and have close family members affected by dementia.
Philpott’s hearing loss is age-related but Shanks was diagnosed with hearing loss in his 40s. When he was DJing around the world, he had no idea how much damage he was doing. “I got my first DJ decks for my 18th birthday. I loved loud music. It made me feel good and I had a ridiculous car with a very powerful bass box in the back. I didn’t show any respect to my ears.”
Our ears work by a sensory reaction in the brain following the vibration of around 18,000 tiny hair cells in our cochlea (the inner ear). Loud music will increase the intensity of these vibrations and if you listen for a prolonged amount of time, loud sounds enter your ear and blow the hair cells flat. When you are young, your hair cells recover after an hour or so and the buzzing disappears. But the more times this happens, the less likely it is that the hair cells will recover, causing permanent damage that becomes hearing loss.
After Shanks quit DJ-ing, he moved into making apps and websites. But then in 2019, socialising after a work event on a Friday night, he had a shock. “I was literally two feet away from a group of six chatting and I could see lips moving but I couldn’t decipher what was being said.” Talking to friends, he discovered many also knew their hearing was changing, but felt powerless to do anything.
He’d just applied to take part in Zinc Accelerator in 2020, a project aimed at creating new businesses to improve the quality of life for millions of older people. Here he learned more about the seriousness of hearing loss. “I’ve seen dementia in my grandmother and other family members and know how devastating it can be. So that was a real wake-up call.”
At Zinc he met Philpott. They bonded over their hearing loss and began to develop an app using video game-inspired tools to test, train and improve hearing health. “We realised that going along to get a test on the high street, in what feels like a very clinical environment, was too much to ask of many people in this new digital age.”
Developed with support and advice from academic experts at the RNID, UCL and Imperial College London, Eargym’s immersive auditory training games target specific aspects of hearing – including pitch recognition and auditory localisation (working out where sounds are coming from).
First you take two step-by-step clinical tests to determine your “ear age”. The “speech-in-noise” test requires you to identify three numbers against a background of noise, multiple times and at a range of volumes. This gives you a score called a signal-to-noise ratio.
The second test involves a questionnaire, based on the Amsterdam Inventory for Auditory Disability and Handicap (first invented in 1995 by Prof Sophia Kramer et al ), which asks you about hearing speech in noisy environments, such as following conversation against loud backgrounds, identifying lyrics in music, or being able to identify where a sound is coming from, such as the direction of a travelling car.
Once you’ve done the tests, you’re directed to the games that will make the biggest difference to your hearing. I actually got 73 per cent on my main check-up test (similar to an average normal hearing person) and my ear age is 53 (I’m 61!) but it’s shown me that I am rubbish at telling similar sounds apart, so I’m doing the hearing training for 10 minutes every day. My favourite games are “Busy Barista” (where you take orders to serve coffees and cakes in a very noisy café) and “Sound Seeker” (guessing the location of birds and animals in a forest location).
You can boost your hearing skills in as little as four weeks, Shanks promises. Which means improved attention, better performance at work, and enhanced social interactions.
Hill is a big fan of Busy Barista. Working in the ambulance service it’s vital to be able listen to patients’ breathing/heart rhythm, or when they confide medical details. “The hearing aid just makes things louder but the app helps me focus and pinpoint noises, especially when I’m in busy environments like A&E.”
Shanks compares Eargym to the Headspace app. “They took meditation, which was a bit hippy, and made it cool. And that’s what we want to do with hearing. We’re not telling people not to go clubbing, but we are saying do it sensibly and respect your ears. "
The RNID estimates that by 2035, there will be about 14.2 million UK adults with hearing loss greater than 25 decibels (the point at which we begin to find it difficult to understand what someone is saying against background noise). So it’s vital we make booking a hearing test like going to the optician or the dentist, says Oliver.
“We’re only given five senses,” agrees Hill, “to lose one would be a huge deficit.”
By Mr John Beharrell, consultant audiologist at Nuffield Health and director at Interhearing
Limit exposure to noise
Noise is the primary cause of preventable hearing loss. Prolonged exposure to loud sounds can damage the delicate hair cells in our inner ears, which are responsible for converting sound waves into electrical signals that our brain interprets as sound. Limiting exposure to noise louder than 85 decibels will minimise the permanent damage to the hair cells of the inner ear.
Manage earwax properly
An excessive earwax build-up blocks the ear canal, can cause temporary hearing loss and potentially lead to ear infections. Do not attempt to remove an earwax blockage using cotton swabs as pushing objects into the ear can result in damage to the ear canal and exacerbate hearing problems. Excessive earwax should be removed by a healthcare professional.
Schedule regular hearing tests
Early diagnosis can prevent further damage and preserve your hearing for longer. Studies have also shown that using hearing aids lessens the risk of dementia and has also been found to be an effective tinnitus treatment for those who already have some level of hearing loss.
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