It’s hard to know that someone has hearing issues just by looking at them. So, if you see someone struggling to hear another person, it’s best not to get irritated with them or judge them for being slow. After all, chances are, we will be in the same boat one day too, as hearing loss as we age is very common.
Associate Professor Jenny Loo, Senior Principal Audiologist, Department of Otolaryngology – Head & Neck Surgery at National University Hospital (NUH), reveals that, from the hospital’s community hearing screening data, seven in 10 of the seniors screened have hearing issues.
Also, half of them will need further care in public healthcare institutions despite being served in community audiology clinics.
A/Prof Loo explains that hearing loss is a natural part of ageing that happens gradually over the years. It can show up in different degrees of severity, affecting one ear differently from the other.
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"For example, someone with age-related hearing loss cannot hear consonants like 's', 'f' or 't' clearly but can still hear vowels like 'a' and 'u' pretty well."
According to the PopulatION HEalth and Eye Disease PRofilE in Elderly Singaporeans (PIONEER) study, for Singaporeans above the age of 60, 26.8% had moderate hearing impairment in at least one ear and 4.6% had severe hearing impairment in both ears. However, only 0.8% were using hearing aids.
Dr Joyce Tang, Consultant, Department of Otorhinolaryngology – Head & Neck Surgery, Singapore General Hospital (SGH), further elaborates that the term ‘presbycusis’ refers to hearing loss in both ears that occurs with age, and this typically becomes noticeable from the age of 60.
However, there are instances where someone with hearing loss can hide their condition, by guessing what you are saying based on context.
"Other times, you might observe that they may be the most quiet person in a group discussion or meal-time conversation. They may have simply given up on following the conversation and realised that if they keep quiet, no one will notice that they cannot hear clearly."
Hearing loss can impact your relationship with loved ones and the higher the severity of hearing loss, the more adverse the effect on one’s communication and social life as well as their work and relationship with others, says A/Prof Loo.
The importance of catching hearing loss early
Kevin (not his real name) started experiencing hearing loss around 10 years ago. His job required him to travel a lot and he found it especially hard to listen to conversations during take-off and landing. The ENT doctor sent him for a hearing test, which showed he had lost his high-pitched hearing.
"They advised me to do ear flushing to remove the hardened wax and monitor further. In recent years, my hearing has improved but I might not grasp some high pitches."
Now aged 60, Kevin is cautious when he travels and does mouth-breathing exercises during take-off and landing to avoid any hearing blocks. He also avoids high-volume devices so as not to worsen his condition.
He admits that, when he first realised he was losing his hearing for high-pitched sounds, he acknowledged that “this is not as bad as compared to others who have a more severe affliction than me”.
How to test for hearing loss
A/Prof Loo urges everyone to get their hearing checked as soon as they notice a difference. She explains that a diagnostic hearing test is typically done with a calibrated audiometer and headphones in a soundproof booth, with steps that include air conduction and bone conduction testing carried out by a qualified professional.
But what about free hearing loss tests you can find online – would they be sufficient to diagnose hearing loss?
"But it is not fully reliable because the test results could be affected by the ambient noise and also the calibration of the mobile devices' microphones."
Dr Tang elaborates that the issue with online hearing tests would be the accuracy and calibration of the devices used, like the speakers or earbuds.
"However, they may be useful as a screening tool as a start for seniors to seek medical attention for their hearing impairment."
If you’re aged 60 and above, Project Silver Screen offers three simple checks to ensure your eyes, ears and mouth are in good health, for $5 or less. Also, the Ear, Nose and Throat (ENT) clinics under public healthcare institutions offer hearing tests that are subsidised if there is referral from a Polyclinic.
The link between hearing loss and dementia
Credit: NUH
A/Prof Loo says many only realise they have a hearing problem when it reaches moderate level, at which point it starts to significantly affect speech understanding and communication.
"Early detection and intervention through amplification devices will also help to reduce the risk of depression, anxiety and paranoia, and improve social communication."
It’s not just about improving your hearing and not irritating your loved ones who have to keep repeating things to you; looking after your hearing is also about your overall health.
Dr Tang shares that, in a landmark study, doctors in the United States tracked 639 adults over 12 years and found that people with moderate hearing loss had triple the risk of developing dementia, and those with severe hearing loss were five times more likely to develop the disease.
“Even the MRI scans show a difference with just three years of hearing aid use, compared with no hearing aid use.”
A healthy lifestyle = healthy hearing
Credit: SGH
Dr Tang shares some tips on how to prevent or slow down hearing loss. Since noise exposure – both occupational and recreational – is directly responsible for hearing loss, anyone in an occupation that involves being in noisy environments should have annual hearing checks, as well as hearing protection provided.
Recreational noise exposure includes prolonged listening to music with earphones or otherwise. Dr Tang states that the World Health Organisation (WHO) has an easy phrase to remember what is a safe amount of music (sound) exposure on your personal devices: 60-60, i.e. 60 minutes on 60% of the maximum volume a day.
She adds that it’s also essential to have a healthy lifestyle and control chronic diseases as this maintains the health of your body and your ears. Having a diet rich in anti-oxidants also assists the ear to heal from noise exposure.
Hearing aids for hearing loss
The two most important things to do when purchasing a hearing aid are to pick one that provides sufficient power to compensate for the amount of hearing loss and to get it correctly fitted by a qualified audiologist.
"For those with higher degrees of hearing loss, sometimes in-the-ear hearing aids may be prone to feedback. In those cases, behind-the-ear hearing aids may be more suitable. This is also true for those with finger arthritis, as it may be easier to handle behind-the-ear hearing aids."
It’s also crucial that you use your hearing aids often. Dr Tang advises consistent usage of hearing aids during all waking hours (except when showering or swimming) as it takes time for the brain to acclimatise to louder and clearer hearing.
This article is part of a series on invisible disabilities, an umbrella term that refers to types of disabilities, chronic conditions or medical/neurological conditions that are not immediately apparent to others. We seek to understand more about these invisible disabilities and how we, as loved ones or as general members of society, can better support others going through it.
