When I first began to wear my hearing aids I was amazed at how much I could hear. More people said hello to me in the street than I had realized, quiet murmurings with a friend around the edges of a concert became possible again, the rustle of dry leaves in the wind and underfoot, marking fall, returned. I was back in the world of friendship and warmth, quick jokes and laughter, love. This world also was bangy and clangy. The sounds of pans knocking together in the kitchen had a new ring, like the cymbals in an orchestra. The set of keys in my hand were noisier than I remembered, chattering away to each other while I searched for the right one. The grind of the garbage truck in the street had more layers – several different gears to grind away at paper, garbage, cans and bottles, each advertising itself individually. The little pieces of plastic-coated technology in my ears were bringing me both the beautiful and the ugly. Regaining this complex world of sound had involved a journey through denial, anger over the diminution of my world, and finally the charting of a new, and happier, path.
I had begun wondering about my hearing several years earlier when I found it difficult to hear the soft, light voices of my nieces and watched them contort their faces in the effort to speak to me more loudly. Or when I could not hear a piano playing in a distant room when asked what that piece of music was. I had brushed these lapses aside, thinking they were isolated events and my hearing was fine, for most purposes. Denial is a very convenient defense. But the experience of an evening meeting persuaded me that the time had come to acknowledge my hearing deficit, wrestle with what it was teaching me about the declines of aging, and do something about it.
It was a two-hour meeting; ten people sitting in a lush, comfortable living room, with wine and Brie, discussing how to raise money for a favorite charity. The light was elegantly dim, antiques gleamed, and the 19th century aristocrats on the wall, one by Sargent, seemed part of our group. I found it extremely difficult to hear what was said; words and phrases slid in and out of focus but didn’t add up to full sentences. Granted, the atmosphere encouraged quiet talk; curtains, rugs, and upholstery absorbed sound; and those particular people tended to speak softly, but still, they seemed to be able to hear each other. Later, minutes of the meeting were written and distributed, all agreeing that they were an accurate rendering of what had transpired. I learned the details of that meeting for the first time.
Missing an entire event terrified me. It had been like watching a TV movie with an erratic mute button on. Piecing together what was going on was work; participating, close to impossible. This was not the way I wanted to be in the social world. What else had I been missing? Finally being honest with myself, I recalled other hearing problems – being on edge before social events, wondering if I would be able to figure out what was going on; asking people to repeat or speak louder, which slowed conversation considerably, damping the joy of quick wit; pretending I had heard things, which always left a gaping hole in the conversation I was sure the other person could feel. Denial didn’t work any more. I really couldn’t hear well enough. I wanted my world of sound back.
While hearing loss is a normal part of aging, perhaps made more prevalent by our generation’s immersion in the high-decibel music of the Beatles and the Rolling Stones when we were young, it seems to be particularly hard for many people to acknowledge and address. The number of people my age who need words repeated, or spoken more slowly and loudly, is so large as to have become a stereotype. New Yorker cartoonists have made careers poking fun at elderly couples in restaurants, older men standing at bus stops, and pedestrians in Central Park nearly clipped by skateboarders; all oblivious to important messages headed their way.
Members of my generation often look young – hair suspiciously near its original color, dressed in Spanx-enabled slim pants and jackets – and move along briskly thanks to regular exercise and physical therapy. Hearing aids are visible and unambiguous signs of aging, though acoustic engineers are getting better at making them close to invisible. Many of us would rather suffer the embarrassment of not knowing what is going on than wear these devices that shout, “Old. Old.”
The very practical family in which I grew up, and my reaction to it, shaped my process of accepting the need for hearing aids. In my family, issues were dealt with in a rational, practical way, with little attention to the emotional side of things. Our clamor for a cheeseburger at an exotic (for the early 1950’s) roadside stand was rejected in favor of sandwiches when we got home, on the grounds of affordability. Sibling arguments resulted in everyone being sent to their room, with little concern for who really started things. Of course, “little attention to the emotional side of things” left me vulnerable to different problems later, but that’s another story. My family’s orientation did have the advantage of getting on with life, with little muss and fuss. I still have the problem-solving skills I developed then.
As I grew away from my family’s focus on the efficient accomplishment of tasks and focused more on being comfortable in my own skin, I learned how to navigate the world in such way that an inner feeling of wellbeing, as well as the virtue of task-completion, was a state to aim for. I began to value things that made my life fulfilling – time spent writing and deep in good books; long conversations with friends and family; careful listening to music, tracing out the inner harmonies played by oboe and viola. I found ways to minimize time spent on things that did not contribute to my sense of wellbeing. Inconveniently, these included mundane household paperwork, and laundry.
Navigating to maximize a sense of wellbeing requires acknowledging when things are uncomfortable. Denial is not an asset here. When terror after that evening meeting brought to my full attention the unsatisfactory state of the world I was living in, anger at the decline of my hearing translated quickly into the search for improvement. I wanted my world back as quickly as possible and saw hearing aids as much like eye-glasses – one might not want to wear them, but they were useful. The trade-off seemed worth making – wearing a barely visible sign of aging in exchange for getting back my world of sound.
“Costco is the place to buy hearing aids,” advised a friend. It might be true. Unfortunately, the glories of the modern hearing aid are not equally available to all of us. Because of the sophisticated digital technology and miniaturization, prices can range from less than $2,000 a pair to more than $8,000 for a pair with all the bells and whistles. Unfortunately, they usually are not covered by insurance or Medicare, though organizations like AARP and the Veterans Administration offer special discounts. Hearing aids are considered medical devices and require a medical hearing assessment done by an audiologist, which functions like a prescription in customizing the hearing aids. Hearing amplifiers come with pre-set sound profiles rather than settings customized to individual hearing needs. These are very inexpensive and can be purchased over the counter, like reading glasses.
I went for the medium/high-end of hearing aids, on the theory that conversation with family and friends and the nuances of good music were basic for me and I wanted to hear them well. My Phonak hearing aids amplify sounds within about 10 feet, toning down background noise; great for dinners in restaurants, where the clinking of glasses and silverware and guffaws of laughter from two tables away would no longer overwhelm conversation with my friends. They also have special programs I can turn on with the flick of a finger – one for expanding the ten-foot perimeter to amplify live music without distortion, another for dealing with the telephone’s close-up electronic sound waves. The former also allows me to eavesdrop on conversations across the room, a feature I discovered quite by accident at a cocktail party a few months ago when I overheard two women discussing stocks from thirty feet and three conversations away, raising the ethical dilemma of when to use my wonder woman hearing. Being digital, my hearing aids have been programmed to amplify just the frequencies where I need help. If my hearing further deteriorates they can be reprogrammed. Mine also use Wi-Fi, allowing the two hearing aids to operate together as one system, mimicking the way two ears work with the brain to process sound. It is now possible to get hearing aids with Bluetooth wireless technology that streams music and calls from computers, Smartphones, and TVs directly through the hearing aid.
Different brands of hearing aids have slightly different qualities of sound. I chose Phonak because it captures the depth and overtones of sound – a rich mixture that is interesting to listen to. Other brands made sound thinner and sharper. The distinction is like the difference between analog music recordings on vinyl and digital recordings on CD’s. The sound of vinyl is fuller, with more depth. The sound of CD’s is crisp and the notes have sharp edges.
My hearing aids are close to invisible. Vanity has influenced the development of hearing aids for decades. The most primitive form of hearing aid, used for millennia, is the hand cupped around the ear, creating a larger area for catching the sound, and signaling to others that volume is an issue. In the early 17th century sailors held long trumpets to their ears to hear the calls of other sailors on distant vessels. Later, smaller versions of those “ear trumpets” were adapted to help ordinary citizens with hearing loss. Over time, increasingly extreme efforts were made to hide ear trumpets. Furniture makers went so far as to build chairs and couches with sound intake cavities hidden in ornate arms and output cavities hidden in the carving of the upper back, near the ear. This drive toward invisibility was more about hiding the individual’s disability than about helping him cope with his problem. It wasn’t until the 1970’s, with the invention of the microprocessor, that truly small hearing aids became possible and our vanity could be satisfyingly assuaged. In an age of wearable computation, hearing aids of the future might become part of our jewelry, jackets, scarves, or hats.
It turns out that mine was the most common cause of hearing loss – loss of hair follicles in the inner ear that convert sound waves into messages to the brain. This follicle loss first affects the higher frequencies of sound, which accounted for my ability to know that people were speaking but be fuzzier about exactly what they had said. Vowels, which I could hear, consist mainly of low frequencies and, for me, speech was a quiet rumble of largely undifferentiated sound. Consonants consist of high frequencies. It was the consonants giving shape to the words that I couldn’t hear well. In correcting for that my hearing aids were also bringing back to me the higher frequencies of pots and pans, keys, and garbage trucks that I had always heard when my hearing was normal. I have re-adjusted to this noisy world. When I am not wearing the hearing aids the sound of the world is quite muted and, I must say, a bit dull.
My encounter with hearing aids leads me to wonder if I had inadvertently stumbled on a more generally useful strategy for dealing with aging. First, face the facts. Denial at this stage had only trapped me in a diminishing world that it took a dramatic event to shake me out of. Second, absorb the feelings of loss, anger, or fear of inevitable decline, but don’t get stuck. A sense of wellbeing does not lie here. Third, chart a new and happier path with all the inventiveness and energy I can muster.
I now live in a slightly more bangy and clangy world but one that also lets me hear my nieces’ jokes about the dorky guys their age on dating websites and appreciate the edgy music of Prokofiev and Miles Davis. It’s a trade-off, but if I can accept these little pieces of plastic in my ears and the minor inconveniences of managing them, rather than push them away, frightened that they mean “old,” they will bring me the ugly and unpleasant noises of pots and pans and garbage trucks as well as the nurturing sounds of my nieces’ jokes and good music. My hearing aids are bringing me more of both – more of life.