Opinion: Why Are We Afraid Of The Hearing Aid?

It is World Hearing Day. Your timelines must be full of "Free Hearing Tests" and "Discounted Hearing Aids" ads. Even if you need them, you may ignore the ads.

Studies like "Marketrak-V and VII" by Sergei Kochkin established way back in 2000 and 2007 that it is "stigma", not cost, which stops people from using hearing aids. 

Our Indian movie industry is not helping; it broke my heart when I watched the movie 'Cuttputlli', in which a child wore a huge, outdated hearing aid. To add insult to injury, it was worn upside down. Akshay Kumar is a veteran of movies on social causes, yet he and the director both missed a great platform to accurately showcase today's state-of-the-art hearing aids.

In short, the Indian movie Industry needs to understand that Hearing Health is Public Health, and it has to be taken seriously.

We know that untreated hearing loss is linked to decreased cognitive function, falls, higher incidences of hospitalisations, depression, and increased risk of social isolation and dementia. We also know that the use of hearing aids can lessen the impact of all these factors. Yet, the market penetration of hearing aids is very low. Why is this?

Research has revealed one big reason - age. That is, the perception that the use of hearing aids is "okay" for older people, but not for younger people. If we look at individuals who have a self-reported "moderate" hearing loss, the use rate is over 60% for those over 75, but only around 20% for hearing-impaired people in the 55 to 64 age range.

This large age difference is relatively easy to explain. In most cultures, people with hearing loss are often seen to be older, less able, less intelligent, and maybe even cognitively impaired. This stigma is held not only by society in general, but also by the people who have hearing loss. People fear the labels they believe are linked to hearing aids. They believe hearing loss is less noticeable than hearing aids - which, in many cases, isn't true. So strong is this belief that in one large study, when respondents with hearing loss were asked if they would wear hearing aids that were invisible and free, 35% replied "no."

This is a sort of self-stigmatization often referred to as identity threat or stereotype threat. It occurs when individuals feel they might be judged negatively because of a stereotype. In this case, the stereotype is all the negative perceptions associated with getting old. Because hearing loss is not visible, to avoid stigmatization, many individuals will try to deny or hide their hearing loss.

Changing the way people think about themselves, and society in general, happens very slowly. It often takes a generation or more for stigma to change. Hearing aid manufacturers have tried to speed up the process by making hearing aids less visible and more state-of-the-art. Today, we see products that fit snugly in the ear canal, are thin and slotted discreetly behind the ear, that use sleek gold, silver and black colors, or are designed to look more like a stylish earbud. There is progress, as the average age of hearing aid users is gradually coming down.

Let us talk about what is happening with our youngsters. Are they at risk of Noise Induced Hearing Loss?

Headphone use has skyrocketed since the Covid pandemic, primarily due to remote schooling. Social distancing has forced billions of people around the world to tune into video chat and crank up the sound on their headphones, sometimes with significant hearing consequences.

Studies have shown a stable but persistent prevalence of hearing loss in children. About 15% of adolescents in the US are suffering from hearing loss today and these children are even more at risk from their loud headphones. I am sure the situation in India is no different.

There once was a time when humans were not exposed to loud sounds on a constant basis. But over time, we developed technological wonders, some quiet but some so loud that we suffered long-term consequences. We eventually came to realize exactly how much sound was too much. Exposure to sounds at 85 decibels or more can permanently damage the hearing organ called the cochlea, and the longer you expose yourself to those levels, the more the damage. Even worse, as the sound gets louder, the power of the sound and its potential for damage increases exponentially. 

Raising sound by 10 decibels makes it 10 times stronger. Raising it by 20 decibels makes it 100 times stronger. Raising the volume by 30 decibels, from 85 to 115, means increasing by 1,000 times the power that is damaging the delicate hearing cells of the cochlea. 

It is not hard to reach these high levels. MP3 player sounds can go as high as 115 decibels. Exposure to sounds at such high levels causes damage within a matter of seconds. If the sound is loud enough, it tears the cells of the cochlea apart and they cannot be repaired. Indeed, the National Institute of Occupational Safety and Health (NIOSH) recommends limiting your exposure to 115 decibels for only 28 seconds.

If that is not scary enough, most adolescents admit that they usually play their MP3 players at maximum volume. Regardless of whether they are trying to hear their teacher better or drown out their parents, teenagers are cranking up the volume of their headsets to damaging levels. Most of these adolescents argue that they will not accept interference in their listening habits either. 

So, it's no surprise that parents are worried about the increase in headphone use with video chat and remote learning. The potential of loud, dangerous decibel levels is present and children's habits show they willingly expose themselves to these levels routinely. The manufacturers of these headphones are creating volume limiters, but they do not all work the same. In a 2020 study by The New York Times product recommendation website, the WireCutter, almost half the headphones tested exceeded the 85-decibel safety limit. Fortunately, they did find some effective volume limiters if parents need recommendations.

How are we going to address this audiological crisis? Education and awareness. Articles like this one is a start. But it is reaching the children that may be most important. In response to the increasing prevalence of hearing loss in children, the American Academy of Audiology has taken steps to raise awareness with their "Turn It To The Left" hearing conservation program aimed at educating parents and children about the dangers of noise exposure. 

On World Hearing Day, my appeal to my fellow Hearing Healthcare Professionals is, it's great that you are giving away your professional services for "free" and offering discounted products; however, until and unless efforts are made to reduce the stigma associated with hearing aids, we will fail to achieve the goal to maximize their use.

My appeal to parents, please take the time to read topics that include how headphones/stereo systems are the dangerous and also read on about the ways you can protect your children's hearing. Even if you are not the parent of an adolescent, you are at risk; try to learn auditory limits and help protect the youth. Hearing loss is irreversible, but preventable. So, if you have given them the earpiece, you can also take them away. And yes, it is good parenting.

Dr. Sugata Bhattacharjee, Au.D., CCC-A, FAAA. Doctor of Audiology is the Chief Audiologist at Hearing Center of Southern, Connecticut, Past International Chair American Academy of Audiology and Editorial Board Member The Hearing Review Journal. (Affiliation Starkey Laboratories and NextHear Consulting).

Disclaimer: These are the personal opinions of the author.