A May 2016 post discussed the monologue strategy adopted by some people with hearing loss who choose not to purchase hearing aids, or not to use them even if they make the purchase.  Those people were characterized by their tendency to

“speak loud and long, dominating conversations by turning a dialog into a monologue.”

That post must have hit a nerve because it continues to be a popular post in this section. In addition to describing the monologists among us, the post went on to describe two more inappropriate strategies adopted by people  with uncorrected hearing loss:

  1. Fake it:  nod and laugh at appropriate times. Unfortunately, it’s not so easy to figure out when to insert a laugh if you can’t hear what’s going on.  These folks get found pretty quickly and often come to our office after an embarrassing incident.
  2. Retreat: isolate, lose life connections, get depressed.  These folks are on a downward spiral unless intervention comes from an unexpected source.


Strategic Choices: An Audiologist’s View


The monologue post prompted the following response from an audiologist in the field, who says “I was talking with a friend last night about the Retreat Strategy.  The conversation went like this”:

Q : Why do so many people with hearing loss avoid wearing hearing aids?  Cost? Looks? What?

A:  Only 20-30% of people who would benefit from hearing aids actually get them.  Part of it is Cost, but we know that even when hearing aids are free (as in the VA) there is a large percentage of people with hearing loss that don’t get them.  Part of it is Looks:  stigma still exists linking hearing aids to age and infirmity.  But we know that factor is diminishing rapidly as more and more ear-level audio devices are adopted by young people using their iPhones and Bluetooth devices.

Q:  OK, it’s not all about Cost and Looks, but you still haven’t answered my question.  Why do people adopt these odd strategies instead of getting help with hearing aids?

A:  You’re not going to like this answer, but a major, often overlooked, reason that some people don’t get hearing aids is that they don’t care about hearing what others have to say.  That’s harsh, but it is true for some people who are in the habit of having others do things for them.  If you can get your wife to hear for you, why bother wearing an aid?  If you can turn up the TV, why bother to wear an aid (even though you’re blasting your neighbors out)? If you can get your secretary or lower management to handle everything and then give you a typed report, why bother to wear hearing aids?

Q:  OK, I’ll admit there are some people like that and maybe they were like that even before they had a hearing problem.  But what about people who don’t have anyone to do the heavy lifting for them?

A:  That’s where the picture gets very sad.  It is the Retreat Strategy.  People who have not worked on their communication and social skills often find themselves alone as they age.   Others have limited their social contact to only a few and if they lose those few, they are isolated.  Either way, depression is likely.  Uncorrected hearing loss cements the isolation and adds to the depression or kicks it off.

Q:  Oh, now I get it.  You know, Jimmy Buffet wrote about that along time ago in a song called He Went to Paris. It’s about a guy who starts out interested in the world, loses the things he loves, calls it quits, loses his hearing and doesn’t even care.


We Checked Out the Lyrics


Naturally, we ran out and found the lyrics, which are sad, to say the least.  Here are the relevant lines:

He went to paris lookin for answers
To questions that bothered him so…
Now he lives in the islands, fishes the pilins
And drinks his green label each day
Writing his memoirs, losin his hearin
But he don’t care what most people say


A Better Strategy


The audiologist finished by offering one more option for those with hearing loss:

Oh, there IS one other strategy that people use when they have hearing loss.  They come in and get fitted with hearing aids and then work with their audiologist to optimize their hearing.  That turns into a long and fruitful relationship.  Just ask our patients — all of them are out their socializing, communicating, interested in others, loved by others.  Hearing is a Win-Win proposition.  Don’t end up like that poor guy up above, sitting in the dark, playing a guitar all by himself.

Recently, we wrote about guidelines for working with patients who experience  Sudden Sensorineural Hearing Loss (SSNHL).  SSNHL is an often-devastating syndrome that takes its victim by surprise and all too often persists even after attempts at treatment.  

The Audiologist-Patient relationship is fragile and fraught, in part because of patients’ fears and in part because of the limited scientific information the Audiologist can offer:

…the audiologist meets the patient for the first time as the result of this sudden, devastating  event.  There is no time to get to know one another.  The patient is terrified, probably has little if any knowledge of audiology, and enters the relationship is a decidedly defensive position.  Unlike typical counseling … that accompanies acquired hearing loss, the audiologist’s professional response in the case of sudden loss must be at once highly diagnostic and highly supportive.

Perhaps without exception, patients are concerned with two questions:

  1.  What caused this?
  2.  Will my hearing recover?

Audiologists’ ability to answer either question is limited: recovery is a wait-and-see proposition, as covered in our last post.  As for causes, what is know is listed below. It is clear from this list that most cases of SSNHL cannot be causally linked but when the cause is known, the problem is not due solely to a problem in the inner ear.   another ref:  https://www.nidcd.nih.gov/health/sudden-deafness

  • 12.8%:  systemic infections (e.g., meningitis, syphilis, or HIV infection)
  • 4.7%:  diseases of the ear (e.g., cholesteatoma)
  • 4.2%: trauma (e.g., blast trauma, skull-base fracture)
  • 2.8%: cardiovascular disease
  • 2.2%:  paraneoplastic involvement of the inner ear

Over 70% of SSNHL cases cannot be linked to a cause. These cases, called   “Idiopathic Sudden Sensorineural Hearing Loss” (ISSNHL) are attributed to effects of unknown viral, vascular, or immunological disturbances.

SSNHL represents one of the few true emergency situations that Audiologists face in practice management. A good policy is to see the patient as soon as possible for diagnostic audiologic evaluation, using a test battery that does NOT include acoustic reflex or acoustic reflex decay testing, due to the fragile condition of the ear.

Weekly audiologic monitoring commences, along with adequate counseling time, until the otologist, audiologist, and patient feel that hearing has stabilized.  Hearing aid(s) may be considered at that time, with the caution that acclimatization to amplification through the injured ear is a slow, unpredictable, and highly individual process.