Hearing loss: Is there a cure?

• Ear / Nose / Throat • • Public Health • Mar 14, 07

How do you protect your ears from abuse in our increasingly noisy world? And once the damage is done, can you fix it? Jeremy Laurance sounds out the facts

Deafness, unlike blindness, has always been a bit of a joke. The flesh-coloured box behind the ear emitting periodic whistling sounds is, like the mother-in-law often found wearing it, easily mocked. Embarrassment and denial are the first reactions of those losing their second most important sense. As a result, most people are ignorant about the causes of hearing loss - and the cures.

Last week, the Government published new guidance to the NHS advising it to set up one-stop shops to speed up the assessment and fitting of hearing aids and to use the private sector to help tackle demand. But there is little guidance for individuals on how to protect their hearing and, when protection fails, how to navigate a market in which hearing aids range in price from less than £300 to almost £3,000.

Jeff Rich, the drummer with the 1980s rock band Status Quo, knows the damage loud music can do. “I sat on stage between two banks of speakers pumping out 4,500 watts. We called them the Wall of Death and Death Row. No one ever worried about your hearing then,” he says.

After 15 years of touring with the band, he left to run master classes in drumming for schools and colleges (http://www.jeffrich.co.uk). Three years ago, as he turned 50, he began to notice that he could not hear as well as other people. “I would be in a pub or club and I couldn’t pick out features of the conversation. I would just nod and smile. Then I was sitting with my wife watching television and I asked if she could hear it. She said it was really loud.”

He admits to having been in denial about his failing hearing for some time - a common reaction. But since he had a hearing aid fitted 18 months ago, he is never without it. “It’s incredible. As a musician, my hearing is most important to me. You can only work with what you have, but I am making the best of it. I am a happy man.” He was fitted with a top-of-the-range Phonak Savia, a tiny digital device that fits directly into the ear canal and is almost invisible.

Digital aids have revolutionised the treatment of hearing loss over the past decade. Their advantage over the old analogue devices, which were little more than amplifiers, is that they can be programmed to suit the individual and can then be adjusted for different situations, from a quiet chat at home to a noisy party.

Rich says: “I had a test at Boots, in a David Ormerod Hearing Centre, and my hearing loss was programmed into a computer. They took moulds of both ears. Then, when the microchip came back, it was programmed to compensate for the frequencies I had lost. It’s fantastic.”

It is not only musicians who are at risk - so are their audiences. Excessive noise is, after the effects of ageing, the single biggest cause of hearing loss. The Royal National Institute for the Deaf (RNID) has launched a campaign, Don’t Lose the Music, targeting the iPod generation, who are endangering their hearing when they turn up the volume.

Angela King, an audiologist at the RNID, says the worst affected are those whose MP3 player headphones are glued into their ears for long periods on the bus, train or Tube. The background noise means they have to turn up the volume - and the damage is compounded by going to noisy bars and nightclubs after work.

King says: “The growth of MP3 players is worrying because of the time people are hooked up to them. Then they go to nightclubs, and some noise levels there are frighteningly high; more than 100 decibels. At that level, you only have to spend one evening a week there and you’re way over the safe limit.”

Damage to hearing is caused by a combination of two factors - volume and length of exposure. Health and safety regulations specify a maximum safe noise level in the workplace of 85 decibels over a 40-hour week. But for every three decibels above that level, the maximum safe period of exposure is halved, bringing it down to less than two hours in a nightclub where the sound has been cranked up to 100 decibels.

Ageing rock stars who are now in their fifties and sixties have begun to admit to their hearing problems as a warning to the young. Rich has tried to protect his son Marc, 23, who plays with the London band Jagged, by buying him earplugs. “There are things you can do now,” he says. “These earplugs have attenuators so it doesn’t sound like you are playing through a pillow.”

But it is too late for the older generation. Pete Townshend of The Who, once listed in The Guinness Book of Records as the loudest band in the world, has paid the price. The racing driver Stirling Moss has told how his hearing was damaged by a combination of engine roar and wind noise.

For such people, the question is how to fix it. Here, there is a divergence of views. The RNID says that the NHS, which supplies 80 per cent of hearing aids (all digital since March 2005), is a good enough solution for most people - if it weren’t for the long wait. It now takes an average of 47 weeks to get a hearing aid. The Government has announced a maximum wait of six weeks to be assessed from 2008 - but the RNID argues that this is “perverse” without a time limit on the supply of the device after the assessment.

Angela King says: “This is a nonsense. The wait for a new digital hearing aid can be up to two years. They are very good, but the long wait means that people are driven to the private sector.”

Prices in the private sector include testing, fitting and aftercare. But King claims that one digital aid is much like another in terms of hearing quality; the differences between them are principally cosmetic, she says. NHS devices fit behind the ear; if you want one of the tiny, almost invisible “in ear” devices, you must pay privately. “The choice of model matters less, because they can be programmed to suit individual needs. The choice is about the cosmetic effect rather than the hearing,” King says.

But Heather Pitchford, an audiologist at the David Ormerod centres, disagrees. It is like choosing a car, she says: “You can have one that will do 0 to 60mph in five seconds. Or you can choose one that will just get you from A to B. Similarly, you can have a hearing aid with five programs, or with 20. A top-of-the-range model has features such as speech tracking, which means that you can recognise and track who is speaking in a crowded meeting, even if they are behind you.

“You can also have a remote control attached to your watch so you can change programs without fiddling behind your ear. Some models automatically adjust if you walk out of a quiet room and cross a noisy road. It means the difference between just managing and hearing well.”

Jeff Rich says that, like washing machines, it is nice to have the programs but most people don’t need them all. “I use three. I have one for listening to music and watching TV. Then I have an all singing and dancing one for crowded situations, which homes in on the voice and cuts out the background noise.

“But the best feature is the mute button. That is fantastic. I press it when I am playing the drums and I can just hear enough coming through for me to keep playing without it damaging my hearing further.”

A flick of the mute button and you can switch off the world. With features like that, hearing aids might soon become as fashionable as dark glasses.

Hearing aids: what they cost, what they do

STANDARD NHS RANGE

Fitting Behind the ear

Number of programs Three

Directional microphone Yes

Remote control No

Cost Free

CLARITY

Fitting In ear canal or behind the ear

Number of programs One

Directional microphone No