Who'd Rather Be Deaf?

A TINY electronic device can make the difference between a successful career and a disappointing one, between a full social round and a lonely existence, yet thousands of people in all walks of life are still denying themselves the benefits it offers.

More often than not, resistance to hearing aids is based on vanity. Businessmen sometimes ask for after-hours appointments at hearing centers, and slip inside as furtively as though they were visiting a house of ill repute. In dealing with women, audiologists find they need to be skilled beauticians and hair stylists. “If I have to have one of those cords hanging out of my ear, I’d rather be deaf!” is the cry of women of all ages and all degrees of comeliness. In at least one hearing center, the director is usually able to lessen this resistance by mentioning the attractive staff audiologist.

“Do you think Mrs. Lansing looks bad?”

“Mrs. Lansing?” The client stares incredulously. “Why, she doesn’t wear a hearing aid, does she?”

“She not only wears one, but two, one in each ear,” replies the director, and explains how much the right hairstyles and other such means can do to make the cords unnoticeable.

Although variations are numerous, the principal types of hearing aids are four. Earliest developed was the familiar variety, in which the ear mold is connected by a cord to a small case containing the microphone and batteries. This kind is still best in some cases of severe (65 to 80 decibels) or profound (85 to 100 decibels) hearing loss for which large batteries with a great deal of power are needed. Besides the cord, however, it has other disadvantages. The rustling of the shirtfront or blouse against which the case rests is often as distracting as static in a radio. The position of the microphone is unnatural, since we do not normally hear from the center of the chest; and while the microphone is well placed to pick up important sounds in front of the wearer, such as tête-à-tête conversations, it is of less help in coping with the bons mots of a dinner partner, and of little help at all in picking up sounds coming from the rear.

A second type, used for cases involving bone conduction of sound waves, is worn behind the ear. Though less noticeable than the first type, it is not suitable for some conditions of hearing loss, and its principal disadvantage is that the microphone faces to the rear and picks up sounds behind the wearer with greater efficiency than sounds coming toward him. Socially, at least, the latter are likely to be the more important.

A third type, the in-the-ear aid, might seem ideal if it were truly contained within the ear to the point of invisibility and were able to provide sufficient power in all cases. Actually, however, this kind tends to be more noticeable than most others. Battery costs are highest, too — about one cent an hour, whereas behind-the-ear aids average 0.7 cents, eyeglasses aids 0.5 cents, and chest aids 0.3 cents.

Because it is the best disguised, the eyeglasses type of hearing aid is the one most people immediately think of when the results of testing finally persuade them to consider an aid. Many who do not need glasses are wearing them with plain lenses today in order to conceal their hearing aids in the glasses’ bows or temples. Fortunately, the development of batteries no larger than a shirt button yet powerful enough to give sufficient amplification has made this variety a satisfactory solution in many cases. It offers the additional advantage of having its microphone placed at ear level and faced sideways. Though prohibitively expensive at first, and still subject to a wide price range, eyeglasses aids now include satisfactory models costing less than $100.

When original cost, batteries, and repairs are considered, however, all hearing aids are expensive instruments. Some are priced at well over $400, and if binaural aids are necessary, the original expenditure and upkeep are doubled, since each ear’s aid is a completely separate apparatus. Yet less care often goes into the selection of a hearing aid than would be expended by the same shopper in picking out a suit or dress at a clearance sale.

The old army rule “Hurry up . . . and wait” is too often reversed by the person who has decided at last to do something about his hearing problem. Having waited longer than he should have, he is suddenly in a great hurry to face what he considers a disagreeable business and to get it over with. In this frame of mind he begins by answering the first advertisement he notices in the pages of his Sunday newspaper’s television supplement or by walking into the offices of a dealer about whom he knows nothing.

The ads will offer him everything from a 99-cent hearing-aid checkup to a dollar gadget to help him hear television better, or a free “inactive” hearingaid replica to “test-wear,” or even a free educational booklet (these latter items being aimed at getting the addresses of prospects for enterprising salesmen).

Since among ordinary disabilities deafness seems to be hardest to face, many sufferers tend to make their hearing-aid inquiries secretly. They go forth as babes in the wood, without even the protection of a recommendation from some friend or relative who knows of a reputable dealer or can help find one. The stranger who wants to buy something without having the slightest idea of what he should expect to pay for it has always been a tempting target for a salesman. Even so, the chances are good that the dealer will produce the aid best suited to the customer’s special needs, but there is also the chance that a dealer will sell him the most expensive aid he can sign him up for rather than the most suitable one. Indeed, not all cases of profound hearing loss, especially among the very elderly, can be helped by hearing aids; but how much can flesh and blood be expected to bear when a senior citizen sidles in ready to take on those twelve easy payments? Recently a self-willed old lady of eighty-five was on the point of signing an agreement to pay $900 for binaural aids. Fortunately, the bank charged with handling her financial affairs checked with a United Fund agency audiologist and learned that in her case neither aid would have been of any real benefit. Instances such as this, to be sure, are the exception, especially now that more and more dealers are forming associations to police their own industry.

THE proper approach to problems of hearing loss is a major national concern, because deafness is the most common of all physical handicaps. Since it is an invisible affliction, with no outwardly obvious physical effects, sufferers attempt to ignore it. In a majority of cases, too, hearing loss is gradual and painless, often so gradual that the affected person does not realize he is growing deaf. Commonest of the conditions causing gradual loss in younger adults is otosclerosis, a hardening or overgrowth of the tissues of the labyrinth and middle ear that prevents proper functioning of the soundconducting mechanism. In older persons the loss usually results from presbycusis, a condition of the cochlea, or internal ear. Often the loss continues over a period of many years before becoming severe. The humming, buzzing, rattling sounds of everyday life slip away. Friends’ and relatives’ diction becomes increasingly sloppy.

In marriage, a depressing amount of domestic discord can be traced to one partner’s gradual loss of hearing, and yet many couples are at the frayed end of their rope before they finally attempt to do anything about it. The other day a typical elderly pair faced me across my desk, a pair who were not going much further down the sunset trail together without a murder in the family if something was not done. Jerking his head at his glowering wife, the husband snapped, “The old fool never understands a word I say!” Behind this complaint lay several years of growing — and, as it turned out, completely unnecessary — irritation. The irritation works both ways, of course. As another old gentleman, himself the deaf one this time, put it concerning spouses in general, “The only thing worse than hearing them is not hearing them!”

The best place to begin, in dealing with hearing loss, is the same as with any other affliction — a doctor’s office. A physical checkup should then be followed by an appointment at a clinic or hearing center operated by a qualified hospital or a social agency with nothing to sell but service, for which a moderate fee is charged. All such clinics and centers require medical approval prior to audiological examination, a requirement dealers should also make but rarely do.

Through a series of tests, a staff audiologist first establishes the amount of hearing loss in each ear, after which various types of hearing aid are tried on. The audiologist’s equipment includes many current models, furnished as samples by the dealers, and a wide variety of plastic ear molds. These, fitted to the ear opening, transmit to the middle ear the auditory impulses picked up by the microphone. This part of the test is an approximation, of course, since the exactly fitted individual ear mold which will eventually be made for the client will increase the efficiency of any hearing aid used.

In many communities, the practice is to have a center or clinic evaluate the hearing loss, establish the need for an aid, and then refer the client directly to the retail market and let him select his hearing aid independently. The dealers have a complete inventory of new models and are equipped to provide the most accurate fitting possible. The clinic, in cooperation with the dealers, takes the responsibility of final approval before purchase.

Attitudes toward hearing aids are highly subjective. The client who says he hears better with one than another is often swayed by the more attractive look of the “better" one. Clients may also declare they hear better with binaural than with monaural aids, even though the audiometer readings show no improvement. In these cases many audiologists are inclined to accept the claim as valid, the assumption being that, in so subjective an area, to think we hear better is to hear better.

Many users buy a new aid every three or four years because of the improvements that are constantly being made, but most aids are built to last much longer. One university professor is still contentedly wearing an antique chest model that has given him twenty years of faithful service. Many persons, however, treat a hearing aid as just another novelty gimmick that is too much bother, and the expensive gadget soon ends up in a bureau drawer. For that matter, a sudden improvement in hearing is not always an unmixed blessing, as many an older person living in a household full of noisy grandchildren has discovered. Unfortunately, fiddling continually with the volume knob is not a satisfactory solution, since this is hard on an aid’s innards.

“When you had normal hearing, you couldn’t turn it up and down to suit you, could you?” the audiologist points out. “If a loud noise bothers you now, do what you did then—cover your ears with your hands. But leave that volume knob alone!” To be sure, this advice does disregard the fact that sitting around with hands on ears may be taken by one’s family as evidence that Grandpa is growing crotchety.

In any circumstance, sudden resumption of hearing is not easy to adjust to. There are some forty different adjustments that can be made in the intricate mechanism of a hearing aid, but that is nothing compared with the number of adjustments that may be involved in the intricate mechanism of the wearer. One elderly woman changed her eyeglasses to bifocals at the same time she had binaural hearing aids installed for the first time in her eyeglasses temples. The results were not happy. She was asking herself to make far too many adjustments all at once.

hi an increasing number of cases today, surgery is eliminating the need for hearing aids. Conditions of middle-ear deafness, which respond best to aids, are also the best prospects for successful surgery. The operation most frequently performed is stapedectomy, the repair or replacement of the soundconducting mechanism of the middle ear. This is a painless operation, invoking only a local anesthetic, and the percentage of success is high. When surgery is successful, as much as 90 percent restoration of hearing may be instantaneous, and startling. After a successful stapedectomy, one woman described her ordeal of adjustment in these terms:

“I was constantly leaping for my life when I worked in my garden. I’d be down on my hands and knees when suddenly a car would seem to whiz past right behind my back. Actually, the street was fifty feet away. I discovered that our distance concept is a learned concept. I had to learn all over again how to judge the point of origin of any noise. It was a long time before I could sleep easily, without the impression that all the street traffic was coming through my room.”

Chronic dizziness is often another side effect of a stapedectomy, and may last for months — five months, in the case just mentioned. Most dispiriting of all, however, is the discovery that in our increasingly clamorous modern world so many decibels of sound are produced that would be better left unheard. In one sense our hearing apparatus is no different from any other mechanism, whether it be made of iron, steel, or tiny bits of bone: overuse wears if out. No doubt some really effective noise-abatement campaigns would do more to preserve our hearing than all the efforts of surgeons and hearing clinics put together. Considering the results of such campaigns to date, however, it seems safe to say that these dedicated workers will not only have to stay on the job for quite some time to come but steadily increase their efforts.