Medicine For People!

February 2018: Age and the Ears

Hearing Aid

Age and the Ears

As the old joke runs, the best thing that can happen to a doctor is that he gets gray hair and develops hemorrhoids. The gray hair makes him look as if he knows more than he actually does, and the hemorrhoids give him a look of concern.

On that note, I have reached the stage where I am wearing hearing aids. I therefore have some information that some of you will find useful.

Hearing Loss

Hearing loss does not necessarily mean that the volume of what you hear gradually diminishes, like a radio with the volume turned down. With the most common type of hearing loss, the volume isn't perceptibly different. What it seems like is that people mumble more. They're talking, but you can't always figure out what they are saying. You aren't aware of it, but you lose your ability to tune out background noise and hear what you want to hear.

Now that I wear hearing aids, the world seems no louder. It's just that the background noise is less; I say "what?" less. The company of other people is more relaxing because I don't sometimes have to guess what has just been said. And I hear certain sounds, like the tinkle of water running in a brook, more clearly and pleasantly. I sing more easily and enjoy listening to music more.

In the office, I will often take them out because my stethoscope fits better without them. It's already designed to amplify sound. Also, when I'm talking to someone one on one in a quiet place with no background noise, at my stage a hearing aid makes no detectable difference.


Hearing loss often affects certain frequencies and not others. Testing can identify the challenging frequencies. Hearing aids are adjusted to amplify those difficult frequencies and bring them into balance with the remaining natural hearing.

Preserving Hearing

As my hearing specialist—Doctor of Audiology Megan Nightingale—told me, the longer we go without hearing certain frequencies, the more likely it will be for the auditory cortex to lose the ability to register those sounds. This is similar to what occurs with lazy eye. Children born with weak eye muscles are unable to keep their eyeballs aimed at the same point. So they use the signals from one eye, making that the dominant eye as they learn to ignore the light from the other eye. Problem solved—except the part of the brain (the visual cortex) devoted to the ignored eye does not develop normally. Over time they lose the ability to see from that eye.

And so, if one hopes to preserve one's hearing for the long term, one amplifies the failing frequencies.

A Computer in Your Ear

In addition to providing the elements of sound that you can't hear anymore, the hearing aid must do this without feedback, harm, or extraneous noise. It must be able to leave extra-loud sounds alone and not amplify them. It must be tuned to deal with the different shape and resonant properties of each person's ear canals. All of this is programmed in when you receive your hearing instruments. As Megan explained to me, "you have about a laptop computer's worth of circuitry working for each ear."

Seeing what they cost, I believe her!


Let's talk about cost. Before I joined the ranks of the bionic, I was wrong in my understanding of hearing aids. I thought they were simply amplifying the higher frequencies of sounds that age takes from us. I recommended standard over-the-counter hearing aids, thinking that the cost–benefit ratio was pretty good. Now I understand that I wasn't just purchasing a piece of hardware; I needed a knowledgeable person to choose the most appropriate hardware and fit it to me; I needed someone to give me intelligent care and oversight going forward. Something that cost less now might not last as long, or be cost effective going into the future.

Building contractors and hearing professionals inhabit different price ranges for a reason.

Why Hearing is Important

As a child, a game my introspective friends and I would occasionally play was to raise hypothetical questions, such as "if you had to be blind or deaf, which would you choose?"

Today I know how difficult that question is. Let's leave vision for another newsletter and discuss only hearing. Hearing is the more intimate sense. Our loved one vibrates the air between us, which then vibrates the tissues in our ear, and we know how they feel, whether they hurt or are content, and how much they love us.

Women suffer more consequences of hearing loss than men. Hearing loss makes them less likely to marry, more likely to smoke, and more likely to suffer poorer mental health.[i] Men are not spared. Both men and women find that reduced hearing ability decreases their enjoyment of social interaction and hastens age-related cognitive decline including Alzheimer's disease. When we can't hear others as well, we become, no matter how considerate we usually are, more irritable.

Hearing Aids Can Be Fun!

Now for the good news! Modern hearing instruments can talk to your cell phone via Bluetooth. This lets you check how much battery is left, control the amplification level and adjust other features. Phone calls can go right into your ears through the hearing aids. If you misplace them, your phone will remember where you were when it lost contact and show you a map of where they were the last time you put them down or dropped them.

The best part is, you can rock your tunes without wires and earbuds!


[i] Triple Difficulties in Japanese Women with Hearing Loss: Marriage, Smoking, and Mental Health Issues. PLOS one.

Thanks to Jody Bower and Michael Rienstra for their invaluable help editing this newsletter. Credit to Rick Kirkwood, MD, for additional information included after original publication.



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Medicine for People! is published by Douwe Rienstra, MD at Port Townsend, Washington.