Hearing Aid for Elders:

(Last updated on: December 8, 2021)

The Shaky State of Available Options…

hearing aid

Madame de Meuron with ear trumpet

A hearing aid is probably in your future, if you live long enough. And perhaps, even in your present!

This blog shares my misadventures with a hearing aid and explains why the need is near-universal. The following blog offers sound samples and spectral displays, and shows the way to an ideal hearing aid. (That ideal will be far-removed from Madame de Meuron’s picturesque “ear trumpet.”) Here are the main sections:
– Lost: Four Notes!
– My Hearing Aid Experience
– Do We Care About High Frequencies?
– Look at the Data
– What the Data Tells Us

Let’s begin with, not a Lost Chord, but a few Lost Notes…

Lost: Four Notes!

As readers know, I enjoy playing the piano. And sometimes other people enjoy my playing as well.

I have a lovely size M Steinway that has kept me company for twenty-five years. In early 2018 I noticed that something was different: the top four notes on the piano sounded like clinks, not notes. I could hear the percussive sound of the key, but not the musical tone. The highest note I could hear is the key called G#7, which has a frequency of 3322 Hertz. I had lost my hearing above that position.

Of course, hearing a tone is not a yes-or-no thing. Human hearing gradually declines as notes get higher and higher, there’s not a sudden cliff. But subjectively, when I played G#7, I could hear enough of the higher harmonics to perceive it as a musical note. And when I played the next note up, A7, there was a twang of the string but not a tone. So in this case, my frequency cutoff was between those notes, say 3421 Hz.

(Now, almost four years later, I’ve lost two more high notes. My cutoff is now 3048 Hz.)

My Hearing Aid Experience

Now, I know that my hearing is not as acute as it once was. And Nola has nudged me about not hearing words clearly in noisy surroundings. But I could not ignore the clear evidence that I had lost four notes from my Steinway. After all, it only has 88 keys!

So I consulted an audiologist recommended by our family doctor. Because in retrospect I believe they did a poor job, I will allow the audiologist to remain anonymous.

The audiologist had the usual stuff: a soundproof booth and lots of audio equipment. They tested me with pure tones, clear speech, and speech accompanied by noise. And the tests showed that my hearing response was normal up to 1000 Hz, then started dropping. At 4000 Hz, my left ear had sensitivity had fallen by 60 dB and my right ear even more. (FYI, 20 dB is a factor of 100 in reduced sound energy.)

            A Couple of Failures

The audiologist fitted me with a demo pair of “Bi-Cross” hearing aids made by Phonak (CROS and Audéo). With this combination, sound reaching the right ear is sent wirelessly to the left ear, so the left ear gets an amplified dose of sound from both ears. The hearing aid boosts the loudness of the high frequencies, where my hearing is deficient. Because these were up-to-date models, the price for the pair if I decided to buy would be $4195.

Nola and I tested my hearing at four venues: a restaurant; a sports bar with many raised voices; a performance of Pirates of Penzance; and a bar with a loud rock band. My ability to understand Nola’s speech was unchanged, with or without the hearing aid. Moreover, in Pirates I could hear the soprano’s ornamentation equally well with and without the hearing aid. Assessment: zero stars!

I returned the demos and asked for a set of conventional hearing aids instead. Accordingly, they fitted me with a pair of Phonak Audéo models. Moreover, at my request, they unlocked the setting allowing me to adjust the volume. (How annoying: user-available options are turned off by default on all hearing aids!) Nola and I tested this hearing aid and found it to be equally ineffective. Zero stars, again.

            Hindsight is 20-20

Knowing what I know now, what do I wish the audiologist had done? She should have advised me that when a person has significant high-frequency hearing loss, amplifying hearing aids are not useful. What’s needed is to transfer sound energy from high frequencies to lower frequencies. Although the Phonak B90 SoundRecover feature supposedly does this, I don’t think my audiologist knew anything about it, because she never mentioned it to me. She seemed to have only minimal knowledge of the devices she sells.

I mentioned to her what I had read: that the audiologist should test the client with speech and noise when fitting a hearing aid. She said that she doesn’t do that test for a trial fitting. First, you have to buy the hearing aid, or pay them for a separate test. However, if they had run that test, the failure of the aid would have been evident even in their office, saving me the “fun” of testing it myself!

Do We Care About High Frequencies?

You might wonder: do we really care about hearing these high frequencies? After all, men’s voices are mostly in the frequency range of 85 to 180 Hz, while women’s and children’s voices are 165 to 255 Hz. And these ranges are far below the 1000 or 2000 Hz at which significant hearing loss appears in older people.

The problem arises in understanding words. Frequencies below 1000 Hz are adequate to understand vowels very clearly. However, distinguishing words such as “time” and “dime” requires hearing high-frequency sounds that distinguish one consonant from another.

To illustrate this problem, I used my baritone-pitched voice to record several sequences of words, differing only by the final consonant. Here is one of those recordings, for the sequence saa – sab – sac – sad – sap – sat:

Here is a spectrogram that shows the frequency spectrum of each of these words:

A casual viewer would say, hey, those all look pretty much alike! And that’s exactly the point. The cues that distinguish one consonant sound from another are subtle. They depend on features over a wide range of frequencies, especially those above 2000 Hz.

The English language, at least, depends on its consonants for word clarity. So yes, we care about the high frequencies that consonants rely on.

Look at the Data

Is my lousy aging hearing unusual? Sadly, not at all. Consider the following data from Rigters et al. They measured 675 Dutch adults whose mean age was 71.1 years:

hearing aid

In this group, seniors lose about 20 dB of their hearing with each doubling of the frequency above 2000 Hz. The dropoff is sometimes referred to as ski slope hearing loss. And not surprisingly, seniors also lose hearing with advancing age: after age 70, about 10 dB every 12 years.

These are only averages: amazingly, almost 20% of people in their 80s have no loss of high frequency hearing. But unless you’re in that lucky fraction, hearing loss is on its way for you.

Hmm, you might say. What if these Dutch folks are different? Based on many US articles, I think that Americans are the same, although I can’t find an exactly comparable data set here. However, I can find almost the same kind of data reported by Park et al. They compiled data on 15,600 Koreans, screened to represent the entire population of 33,000,000. Their hearing loss data by age, plotted on the same scale as above, appears here:

hearing aid

To create this chart I extracted Park’s data ages lying in the center of Rigter’s age groups. And it yields similar results to those obtained 5,500 miles away in The Netherlands: the seniors lose about 18 dB of hearing with each doubling above 2000 Hz. They lose about 19 dB of hearing with each 16 years of age, which is similar though not exactly the same as in Rigter.

            Hearing Loss by Gender

The Park et al study yields a bonus: data on the differences between men and women in hearing loss with age:

dB Threshold, Female minus Male at these ages:
67.574.583.5
500-2.5-3.2-3.8
1000-1.9-3.2-7.2
20000.000.0
30008.98.67.0
400014.013.310.8
60009.58.56.3

At frequencies from 3000 Hz up, women hear roughly 10 dB better than men of the same age. (The actual average of the 3000, 4000 and 6000 numbers is 9.7 dB.)

Thus we know that the hearing of older people differs by gender in at least two ways:

  • Women’s voices are pitched higher, and thus are harder to understand by a person who has lost high-frequency hearing; and
  • Women, on average, can hear all voices better than men of the same age.

            Hearing Loss for Art

You might well wonder how Art’s hearing aid test compares with the data above. Here it is, plotted on the same scale, for each of my ears:

Now it’s not at all clear that these numbers directly compare with those given by Rigters and Park. For one thing, the doctor told me that my right ear hearing was flat up to 1 kHz, then dropped off, whereas my left ear was flat up to 3-4 kHz. Whereas these numbers look a lot worse than that. However, generally speaking the steep drop with frequency is consistent with the findings of the researchers.

What the Data Tells Us

The data above suggests the following to me:

  • Dropoff with frequency is so profound for older folks that merely amplifying the high frequencies is worthless. Making high pitches thousands or millions of times louder will add random noise. Moreover, the additional pressure delivered to the inner ear may be painful or even damage the ear.
  • In addition, it’s difficult to amplify more than about 20 dB without causing feedback noise (whistles). Because many people’s loss of hearing exceeds 20 dB, mere amplification is not enough.
  • If high frequencies are critical for speech understanding, and we can’t easily hear high frequencies, we should lower those frequencies.

The last item above gave me an “aha” moment. There are digital apps which can change audio frequencies. The change may be miniscule, so that a pop singer’s recording will sound on pitch. On the other hand, the change may be substantial, to help a singer or instrumentalist record a song in a more convenient key.

I thought: perhaps these modern signal processing tools can also improve speech understanding in a hearing aid. In the next blog I’ll tell you where this “aha” insight took me, in my quest for the ideal hearing aid.

We now know that many older people have such deep hearing loss that hearing amplification isn’t enough. A hearing aid needs higher-tech help, which is the subject of the next blog.

Credits:
– Madame de Meuron with ear trumpet from Wikipedia
– Bulldog from Anna Shvets on pexels.com
– Spectrogram from Edward Ball, Michael Ruiz and Boris Smus on academo.org
– mp3 edits using Audacity.app
Rigters et al, Progression of Hearing Loss in the Aging Population/ Repeated Auditory Measurements in the Rotterdam Study
Park et al, Age- and Gender-Related Mean Hearing Threshold in a Highly-Screened Population

Comments

Hearing Aid for Elders: — 13 Comments

  1. Art, You may remember me from our “ion laser days” at Hughes. I”m now 87 and receiving a lot of flack from wife Linda (just celebrated 35th anniv.) on my lack of understanding. I have sound amplifiers, but hate to wear them; they are over-the-ear type and get tied up in my glasses, face masks, etc. I also have expensive hearing aids prescribed by an audiologist, but they are no better, and require battery replacement as well. Keep me posted on your studies.

    • Hi Bill, you still have your sense of humor, I see! You were a highlight of my days at Hughes as well as a friend and mentor, and I’m happy to hear from you. Lack of understanding speech is unfortunately a very common problem for all of us seniors, and our spouses are a good measure of that. It sounds as if your experience with hearing aids is as disappointing as mine. I’ll post the rest of my insights this Wednesday but unfortunately the next step for you given today’s technology would be to find a really competent Au.D., or join a clinical trial where several researchers would try to address your particular needs. Best wishes to you and Linda for a great holiday! – Art

  2. I love hearing from you. But, if I get anymore of these depressing reports I think I’ll just jump off the St. Vincent Bridge right now, at least while I’m ahead.

    It is interesting what you had to say about frequencies, etc. I’m concerned that when it comes to listening to Nola, you don’t hear so well. Now, this is quoting you, “… And Nola has nudged me about not hearing words clearly … ” I think there could be room for improvement in the area about taking Nola more seriously and focusing a little better. I don’t believe an audiologist would be helpful in that area.

    And then one day, when we are seated at your memorial service, these are Art’s closing words, “saa – sab – sac – sad – sap – sat.”

    I’m so thankful that my Dad and Mom got hearing aids when they did. Dad was good until the end. Mom with little bit a memory lost always had us worried that she’d forget where she put them … and at $5000 a crack. Fortunately she had a least one hearing aid until the end, stepping on the other and breaking it getting out of her hospital bed. But having that one hearing aid, working, while she was in hospice was a Godsend. Lucky us.

    I’m looking forward to your next report on the Chester Hearing Aid Company and the results from family / marriage therapist.

    We miss you a ton out here, we love you. Best wishes.

    Will we be getting additional reports from you on Covid-19?

    Sincerely,
    Steve

    • Thanks for the comment, Steve! It’s certainly true that paying attention to the spouse goes a long way toward improving everything.

      Your parents were fortunate in getting useful hearing from their hearing aids. It no doubt enriched their lives as well as your relationship with them.

      Will I write more about Covid-19? Each time I write a blog on that subject, I hope that it will be the last! So I have to say: it all depends. I try not to blog except when there’s something new to say. Let’s both hope that Covid will quietly disappear into old memories…

      I too miss you folks in California, especially when I read the schadenfreude NY headlines about CA troubles. However, Nola and I are old enough to want to live near relatives, and most of ours are far from the west coast.

      Warm wishes! – Art

  3. Thanks for the information, way more than I believe I need. I’m 85 and have had hearing aids (Unitron) about 5 years that cost $4,800.00. Everything is improved, movies, TV, general conversation, theatre. Now having said that ambient sound can be a pain in the ass in the begging but I’ve gotten used to it. They are chargeable just like your iPhone so overnight I put them in the charger and there ready for me in the AM. Simple to put in and easy to take out. I was told when I first started having hearing problems that there is nothing one can do about hearing loss so Iv’e embraced these little devils with great love and caring. Thanks for all the data….. Arnold

    • Thanks, Arnold. I’m glad to hear that you are one of the success stories. They are costly but I think that you are getting your money’s worth. If you need further adjustments, stick with your audiologist, it sounds as if you have a good one! – Art

  4. Art, thanks very much for your informed view and analysis thus far of hearing and old age: most timely.

    I am now 78 and first tried hearing aids maybe six or seven years ago, maybe more, Siemens they were, and I did not like them much since they were uncomfortable as behind the ear devices and their batteries seemed to expire remarkably rapidly. However when I was told that each one cost about £400 (and maybe it was £800: I cannot now recall) and since they were free on the NHS, I took them at once without demur. They did improve my hearing a bit, but they itched and I never got used to them. I was tested again maybe five years ago and they gave me a new improved and smaller behind the ear pair, with which I persevered – but within a couple of months, I had more or less given up.
    Then maybe a couple of years ago a female friend recommended some privately purchased in ear phone aids and I went for a test but they were going to cost at least about £3500 from memory and I finally decided that I might well be wasting my money if I failed to adopt their use properly and permanently yet again.

    The result is I have to ask my wife increasingly often “say that again” and I have to ask for the TV volume to be turned up and/or for the subtitles to be inserted sometimes instead, which she finds irritating (expect for foreign films).

    But I had no idea that it was possible to transfer sound energy from high frequencies to lower frequencies. Wow, that sounds good if it is viable enough to make a difference. I have always been concerned that by just boosting the volume of higher frequencies in one indifferently functioning ear, that might have a deleterious effect over time.

    I have a son Gussie, who used to set up discos in London, with his huge vinyl record collection and he says that it is not the extent of the volume that harms hearing but more the extent of the distortion in the sound at loud volume music which is damaging. Well, that sounds likely enough, and then I have always thought that just by increasing the volume would probably end up damaging one’s auditory ability, so that I almost prefer to keep saying “What was that?” if absolutely necessary. I have to say I used to work revising for exams etc when young with earphones jammed on my head, blasting away 50/50 classical and 60s rock etc which doubtless never improved my hearing, and even less my concentration. I still do much the same but avoid earphones now.

    But then I have also been told that if one’s hearing declines then that also has a diminishing effect on IQ and understanding, which given my attempts to describe the operation of mind and memory over the least four decades, I find ironically perturbing. (Have I sent you my recent radical description of Dark matter revised in April this year having nothing to do with wretched particles, and mediated by consideration of the limiting effect of the observable universe which had earlier never occurred to me? If not I will, being delighted by my contrary ingenuity here)

    But certainly I find some story lines in TV series far harder to divine than I used to. So perhaps I ought to try again and pay for the best equipment available for these remaining few years of existence to enable not too much loss of incoming information. And I recall that in ear devices were not so efficient as behind the ear versions, but perhaps things have advanced considerably on this question? Advice on this point would be much appreciated. Possibly hearing aid devices in the USA are more advanced than those marketed in Europe?

    • Hi Nick,

      Thanks for a fascinating comment! Your experience sounds much like mine. Like you, one ear (my left one) hears better than the other. However, when I tried a hearing aid that transferred sound from the right to the left ear, it was of no use at all.

      Concerning TV story lines, something else might be going on. When Nola and I watch Saturday Night Live, for example, we enjoy the opening skit but many of the others are simply opaque to us. But that’s not due to our hearing: rather, due to our out-of-date understanding of popular culture.

      Concerning in ear versus behind the ear, which is best is complicated (wind noise, ear wax, frequency profile of hearing, adjustability). This appears to be a nice summary: https://www.mayoclinic.org/diseases-conditions/hearing-loss/in-depth/hearing-aids/art-20044116. Personally, I find stuff inside my ear to be too itchy.

      I think the technology of hearing aids is international. After all, the profit margin on them must be immense, so there’s a great motivation for manufacturers to get their product approved in every country where people can afford them. As the next blog will note, at least a half dozen makers have aids that transfer frequencies using different, patented strategies. But you would have to try many models and have a very patient audiologist to find an aid and an adjustment that matches your need – and the best answer may change as your ears age! Nothing is easy…

      Art

  5. In looking at the chart for the study of Koreans, the first 2 data points for all ages seems to indicate that the hearing threshold “improved” slightly with increasing frequency for all 3 age groups. Is that real, and if so why would it be different from the other charts you show (which are monotonically decreasing for all data points on the chart, for all ages).

    I like the concept (the “aha” moment) of down-translating the frequencies into a range where you CAN hear and distinguish speech sounds, so I’m looking forward to your next article.

    • Hi Charles,
      Yes, you’re right. At the lowest frequencies measured, the Korean data seems to show an improvement in hearing between 500 Hz and 1000 Hz, which is surprising and on which the authors do not comment. It’s true that women tend to hear low frequencies more poorly than do men, but that effect is small; and moreover, the apparent improvement in hearing at 1000 Hz is the same for men as for women in the Korean data.
      In their original article the Korean graphs are plotted as a function of age, not frequency. Each of them approaches 0 dB at the youngest ages except for the 500 Hz and 6000 Hz charts, which approach approximately -8 dB. This makes me wonder whether the measurements did not all use the same “zero point” for calibration.
      It’s also possible that the different results for the Dutch and Korean data reflect actual differences in the groups tested, due to genetics or environmental noise exposure or diet, or, you name it! I’ve asked for full text of a US article (https://pubmed.ncbi.nlm.nih.gov/20683190/) which may shed light on the situation.
      Art

      • Also – the Korean test group was selected to represent the entire country’s population, which would include younger people and might also include the 20% of elders who have no hearing loss at all. The Dutch group was all age 55 and up, and chose whether to participate in the study or not. We might expect differences since the subject groups were not selected in a similar manner.

  6. Interesting.
    I am 81 years old and I have had a Costco hearing aid for three years. I do I find it useful although a frequent response to someone talking to me is “what?”. I do notice a big difference watching television.
    I found the lady at Costco Roseville MI very professional and helpful. If I remember correctly my devices cost around $1500

    • Hi Linos,

      I’m glad to hear that you had pretty good luck with your aid. I think highly of Costco. I note that their hearing aids are made by Phonak, the same company that makes aids sold by audiologists. The Costco aid Phonak model number is unique to Costco, however when I study the spec sheet it appears to be functionally equivalent to the more expensive non-Costco Phonak devices.

      Your comment on finding the aid useful with television is interesting. It’s possible that TV audio encoding, transmission and presentation is intentionally or unintentionally packaged into a narrower frequency range, so that amplification becomes more effective.

      Art