Living with Mild Hearing Loss
Most people equate hearing loss with sounds that are not loud enough. However, hearing impairment involves two factors; loudness and clarity. Generally speaking, hearing loss first occurs in the high frequency range (also called "high pitch") where the most important speech sounds occur. People with mild hearing loss often complain that "people don't speak loud enough" or "people don't speak clearly anymore" and of course, "kids these days don't pronounce words properly."
The term "mild hearing loss" loss actually has a technical definition, used by hearing healthcare professionals. The term "mild" hearing loss is defined as hearing loss between 26 and 40 dB in the speech frequencies. Unfortunately, to affected individuals and to the public -- the term "mild" may say something else. Such as,
"If it's only mild -- it's not serious" and it can be ignored -- at least for now.
Given the disparity in the two operational definitions (above) the person with hearing impairment is likely to think, "I don't have to do anything about it," according to Michael Jones, chairman of the Hearing Industries Association. This presumption can be the first mistake in a lengthy and frustrating cycle of untreated hearing loss.
However, a person with 25 to 30 dB hearing loss can miss 25 to 40 percent of the speech sounds, depending on the environmental situation within which the conversation occurs. For example, there is a great deal of difference in the meaning between the words "deaf" and "death," but very little acoustic contrast between the sounds "f" and "th" upon which the difference in meaning is based. Depending on the noise level in the surroundings, distance from the speaker, loudness of the speaker, and of course the exact type and degree of "mild" hearing loss, speech confusion and errors are likely. There is a world of difference between a mild hearing loss that is a 26 dB loss, and a mild loss that is a 39 dB hearing loss.
To approximate a mild hearing loss, one can purchase a pair of foamy earplugs at the local drug store and carefully insert them as indicated on the package. While a person is using those earplugs, the hearing loss imposed on a normal hearing ear approximates a mild hearing loss. When the additional difficulty of reduced clarity is introduced, there is really nothing "mild" about it!
The individual with a mild hearing loss also loses the ability to selectively hear (or attend to) difficult speech sounds in challenging and noisy environments and they have a great deal of difficulty suppressing background noise while trying to pay attention to speech. In a normal, healthy ear, this function is done automatically, and is somewhat controlled by the nervous system.
Family members are usually the first to notice the hearing loss because the TV, telephone and/or radio are turned up louder. Additionally, the hearing impaired person asks for repeats, clarification, or sometimes just agrees and nods without really understanding what was said. Because speech signals can be contaminated by noise in the environment, a person with mild hearing loss is often told, "You can hear me when you want to!" Interpersonal relationships are frequently stressed and injured because the speech signal is misunderstood.
On the other hand, the perception of "loud" sounds is usually not affected with mild hearing loss. As a result, the person with mild hearing loss hears loud sounds at much the same loudness as a person with normal hearing. Additionally, when speech is perceived as garbled or "mumbling" and the sound is made louder, the result is usually not a clearer sound -- but, rather a louder garbled one! Sometimes, when family members raise their voices in an attempt to be heard, the person with mild hearing loss may say, "Stop yelling at me!" Besides, raising the voice (i.e., making it louder) often makes speech more difficult to understand because the vowel sounds become so loud they mask the quiet, less intense consonant sounds. Family members, co-workers, and others can become exasperated and angry due to the effort required to make their spoken message understood.
People with mild hearing impairments are often the best candidates for hearing aids. It is important to understand that hearing aids cannot make the ear hear clearly. The ability of the ear to hear clearly has to do with the status of the inner ear and the hearing nerve. However, speech sounds which cannot be heard cannot be understood, and when hearing loss prevents certain sounds from being heard, it is easy to perceive the wrong word! Nonetheless, when an individual has a typical mild high frequency hearing loss, well fitted hearing aids potentially have the ability to make speech appear to be "more clear" because the wearer perceives more of the higher pitched, softer speech information which is inaudible without the hearing aids!
Furthermore, specially selected amplification devices (also called assistive listening devices, or ALDs) for the TV, telephones and for use in public places, may also help the person with mild hearing loss hear more "clearly" without making the volume of speech much louder, depending upon the exact type and degree of hearing loss.
Sometimes people become so accustomed to the distorted incoming signals their ears have been providing, that they become highly resistant to the true sounds of the world. Dr. David Goldstein, former professor of audiology at Purdue University calls it the "cycle of negativity," to describe when a person with uncorrected mild hearing loss refuses to try hearing aids. Because many of these people can perceive the loudness of speech at normal levels, they incorrectly assume that hearing aids will make speech even louder, rather than appreciating the potential for an easier to understand speech signal.
In a survey conducted by Laurel E. Glass M.D. (physician) and Holly H. Elliott M.S. (audiologist) it was determined that the average age at which respondents remedied their hearing loss was 42 years for females and 44 years for males. Unfortunately, 57 percent of respondents indicated they were between the ages of 18 and 40 when their hearing loss became apparent to them. Other research suggests that people usually wait 10 to 15 years from the time they first notice hearing loss, until they get fitted with a hearing aid. During that time, a whole spectrum of auditory, psychological, social, and emotional changes may have occurred.
Mild hearing loss is an enormous communicative deficit which makes conversation and social activities very difficult. People with mild hearing impairment may complain of headaches, fatigue, and irritability due to the concentration required to understand speech, and may withdraw from their favorite activities and become socially isolated. Often, people with uncorrected mild hearing loss will require favorable seating (within three feet of the speech signal), good lighting, and a very quiet listening environment. By turning up the loudness in an attempt to hear clearly, they may unwittingly induce additional hearing loss.
Individuals with mild hearing loss can choose to treat it as if it were unimportant, but ultimately this course of action is counterproductive. When vision becomes blurry, most people will take the immediate step of getting glasses. When hearing becomes indistinct, ears should receive the same respect!
Margie Littell Ulrich, CCC-A, is a clinical audiologist working in the Mid-East Tennessee Regional Speech and Hearing Center in Dayton, Tenn. She serves on the board of directors for Tennessee's Women with Disabilities Coalition.
This article is a revision of a previously published article. The original article was published in Hearing Health (Feb/March 1998). We are grateful to Hearing Health and the author for allowing us to revise, re-edit and re-publish this article. ---Editor.