Do Not Go Gentle into That Deaf Night

“Do Not Go Gentle into That Deaf Night”. I have borrowed this title from a paper by Illg and colleagues that investigates the usefulness of cochlear implants in adults who are hard of hearing [1].

As Camisha Jones says in her poem, Disclosure (these are excerpts…please follow the link for the full poem).

I’m sorry, could you repeat that. I’m hard of hearing.
 To the cashier
 To the receptionist
 To the insistent man asking directions on the street

……..

Hello, my name is Sorry
 To full rooms of strangers
 I’m hard to hear

I vomit apologies everywhere
 They fly on bat wings
 towards whatever sound beckons

I’m sorry. I’m sorry. I am so, so sorry
          and repeating
                      and not hearing

………

The mother of a friend of mine can’t hear and refuses to use a hearing aid and keeps apologizing for not being able to hear, just like the lady in the poem. It is impossible to converse with her, unless you face her and speak slowly, in which case she can sometimes lip read, if she knows the language you are speaking in. It has become very difficult for her to go out and while large gatherings are impossible to deal with, at best, she agrees to attend small intimate family gatherings, where her near and dear ones take the effort to speak to her, facing her, slowly.

Hearing loss in the elderly, especially disabling hearing loss is not uncommon and is often the cause of social isolation. It is associated with increased risk of falls [2] and accelerated cognition loss [3]. Just as with poor vision, which I wrote about last year, hearing loss can affect the quality of your adult life and reduce healthspan and lifespan.

Hearing loss is a common problem in those over the age of 60. In India, about half of those over 60 have hearing loss, while a quarter have disabling hearing loss [4]. Often vision loss and hearing loss go hand in hand and make it even more difficult for those affected to move and get around [5]. It is estimated that around 1.2 billion people worldwide have some form of hearing loss, with around 430 million affected significantly [6].

While it is obviously a problem for you, if you have hearing loss, especially of the disabling kind, it also becomes difficult for your friends, family and caregivers to manage you. You owe it to yourself  and to those around you to try and manage your hearing loss in the best possible manner.

So what should you do. If you have definite hearing loss that you and those around you have noticed, then it is best to see an audiologist or an ENT surgeon and find ways of improving your hearing using assistive devices such as hearing aids. The world of hearing aids has undergone a sea change with the advent of digital technologies, bluetooth and apps and no longer are they clunky behind-the-ear devices that we used to see our grandparents or parents use 10-30 years ago. A good hearing aid can make a world of a difference, though less than 10% of those who need hearing aids actually get one worldwide…this figure is likely less than 1% in India.

What should you do if you don’t really have hearing loss? Should you test for undiagnosed hearing loss?  The USPSTF, which we keep referring to for guidance and guidelines has written a guideline paper where it makes no recommendation regarding screening for hearing loss in people who otherwise do not have perceptible hearing loss [7], because there isn’t enough data available to say whether such screening helps or not.

In practice, it is unlikely that you will not know that you have hearing loss, unless you are in denial, which means it is not really necessary to go to an audiologist or doctor to check for hearing loss…but if you catch yourself asking people to repeat what they have said often, or if people around you ask you if you are hard of hearing, then it is time to get your hearing checked. The WHO has an app called HearWHO that allows individuals using their phones to check if they may have hearing loss, though when I tried it on my iPhone, it did not work.

Apart from hearing aids, cochlear implants make a difference in the elderly. In the past, cochlear implants were used mainly in children or young adults, but over the years, they have become very effective in the elderly.

Hearing loss is an area where technology has made a significant difference. Today, there is no justification for living with hearing loss and all the attendant difficulties it creates for you and those around you.

So what does this mean for you and I? If you have hearing loss, you should get it checked and then use hearing aids or get a cochlear implant. As simple as that.

Camisha Jones has also written an “Ode to My Hearing Aids”. (Please follow the link for the full poem)

Then God said

let there be sound

and divided the silence

wide enough for music

to be let in and it was a good groove

……

that God saw

the dark & the light

dangling brilliantly from each ear

and God whispered amen

then smiled when it was heard.

Footnotes

1. Illg A et al. Do Not Go Gentle into That Deaf Night: A Holistic Perspective on Cochlear Implant Use as Part of Healthy Aging. J Pers Med. 2022 Oct 5;12(10):1658.

2. Jiam NT et al. Hearing loss and falls: a systematic review and meta-analysis. Laryngoscope. 2016;126:2587–2596. doi: 10.1002/lary.25927

3. Marinelli JP et al. Association between hearing loss and development of dementia using formal behavioural audiometric testing within the Mayo Clinic Study of Aging (MCSA): a prospective population-based study. Lancet Healthy Longev. 2022 Dec;3(12):e817-e824.

4. Verma RR et al. Prevalence of hearing loss in India. Natl Med J India. 2021 Jul-Aug;34(4):216-222.

5. R D, Kasthuri A. Visual and hearing impairment among rural elderly of south India: a community-based study. Geriatr Gerontol Int. 2012 Jan;12(1):116-22.

6. WHO report on Hearing. March 2021. https://www.who.int/teams/noncommunicable-diseases/sensory-functions-disability-and-rehabilitation/highlighting-priorities-for-ear-and-hearing-care

7. US Preventive Services Task Force; Krist AH et al. Screening for Hearing Loss in Older Adults: US Preventive Services Task Force Recommendation Statement. JAMA. 2021 Mar 23;325(12):1196-1201.