Of hearing loss, context, sermons, sales, ear aches and birds, hearing aids, clastooms, busines meetings, and a rainy morning . . .

Bren came into the library this morning and said:

"Rainin' now"

Huh? It was said with plenty of volume, but the sound carried no information for me. It was meaningless - like a noise made by the cat. I asked her to repeat it. Still no meaning.

I think this is one of the least understood aspects of hearing loss - and I don't know how widespread it is. What I do know is all the males in our family - and some of the females - suffer from it. Much more on that in a moment from many others. Right now I am talking only about my own experience. My problem with what Bren said was simple. Audible information, for me, is conveyed largely by context. If I have no context I will not be able to make sense of the sound. It has nothing to do with volume. People always assume that if they speak louder, it will help. A meaningless screech is a meaningless screech, no matter what the volume.

For me "Rainin' now" wasn't English. It wasn't even human speech. It was simply noise. This is not because Bren does not speak loudly enough. it is not because she mumbles. It has absolutely othing to do with the sound - it has to do with the fact that these were words I did not expect at that moment. True, we had talked a half hour ago about the weather forecast which calls for several dismal, rainy days. And I had mentioned at that time that it was not raining when I took my walk just a few minutes before. So the words were not completely out of context, but between that conversation and the "Rainin' now"
announcement we had covered several other topics. What's more, it had not occurred to me that she had gone outside.

Early in my life I developed a strategy for coping with my hearing loss that I don't understand fully to this day, but I know it had something to do with putting things in context and being satisfied with guessing at what people were saying - guessing so frequently that it was a subconscious habit. Eventually - about 20 years ago when I was asked to teach English 101 at UMass Dartmouth one semester, I broke down and bought hearing aids. They helped. But I still dread the face-to-face classroom environment because I can't handle the questions well. In that case I think the problem is a combination of different voices and context. Frequently a question comes from an unexpected direction (both physical and contextual) and that makes it difficult to handle.

I continue to wear hering aids, though I've just started to wear them in something other than social contexts. Before I only put them on when I was about to walk into work, or some other social environment. Now I put them on to go outside to walk - and listen to the birds. Amazing. I never heard hose birds before. I have hiked many, many woodland paths over the years and always just assumed there were no - or very few - birds in the woods because I didn't see them. I am stunned now by the expereince I get walking in the woods with my hearing aids on. The woods are loaded with birds - you can hear them - you just don't see them often. And I am more stunned by tire noise when walking on the road. Oh, how I have come to hate that sound!

You see, without the hearing aid the only car sound I was really aware of, was the motor - and that only when the car was very near. Now I hear the tires when the car is out of sight - sometimes as much as a minute away. By the time the car passes me the sound is almost unbearable. What an aggravatingly noisy world you all live in! I love the sound of the birds - but I am glad that I have a choice - that i can turn my hearing aids off.

That said, the family recently had an email exchange on this whole hearing problem. I've excerpted and printed much of that exchange below. I've removed names out of respect for privacy, but retained all else because I found the exchange very interesting and I assume others who have similar problem might be helped by it. Hearing loss, as with any special problem, can have far-reaching and unexpected influences on your life. But again, I don't know how widespread our particular problem is, or whether this type of hearing loss is unusual.

In what follows I've identified people by sex and generation, considering myself "first generation," my children second. But, the loss actually goes back to the generations which preceded us.

This exchange began with an inquiry from a second genertaion female, concerned with her children.

I have some questions about the hearing loss in our family which I hope that some of you (especially Greg) may be able to answer.

. . . My son , who is 3 1/2, has to get his hearing checked every 3-6 months, and his hearing is in the low normal range. Both [he] and [my other son] have an ear, nose, and throat doctor who wants to do a CAT scan on them to help determine the cause of the hearing loss.

Over the winter,[my other son] had chronic fluid in his ears and they were on the verge of having him get ear tubes, but today at the pre-op appointment, it turns out his ears are clear, and so the ear tube surgery has been cancelled. They still want to do CAT scans on both boys...this may help determine the cause of the hearing loss. The doctor also mentioned our seeing a geneticist...only because if we are willing, they may want to study our family, because it is so obviously a genetic issue that keeps being passed down. Our ear, nose, and throat doctor's name is Dr. Michael Williams and he works at Harvard Vanguard in Wellesley and operates at Mass Eye and Ear Infirmary.

My response:

As to my hearing loss:

- I've never known the cause.

- I've used hearing aids for about twenty years with reasonable success.
(the ones I have now include a switch which cuts out background noise.
Sitting at a table in a noisy restaurant I can sometimes hear better than
anyone else at the table because I switch out the background noise and aim
my hearing aids at the person speaking simply by looking at them.)

- I do fine with the telephone or headphones. I've hooked up headphones to
the TV and sometimes when we are both watching, Bren will ask me what is
said! (That would never happen without the headphones.)

My hearing loss is not so much a matter of volume, as frequency. I hear
sounds - even low sounds - if they are at the right frequencies and I miss
sounds, even loud ones, if they are at the wrong frequencies. I don't hear
the birds sing at all unless I put on a hearing aid. That's because most of
them -crows are an exception - sing at the wrong frequency.

The older I get, the more I understand that my hearing loss has shaped my
personality and my life in subtle ways I never appreciated. This is not all
bad - and bad or good, it's there, so you live with it.

I find, for example, that I can deal with one person at a time much better
than a crowd. I just can't make the switch from one person's voice to
another's. I have great difficulty, for example, answering questions from
students in a face-to-face class - which may be why I prefer to teach on the
Web!

I find that I rely to a great extreme on context. This makes it very
difficult for me to hear anything in a Quaker "silent" meeting. In such a
meeting people speak when moved to speak. What they say, therefore,
frequently has no context. It may be about anything - and I seldom can
follow it, even when they speak loudly.

On the other hand, I do much better in a structured meeting where I know the
topic, I know the speakers and I can guess what is likely to be said. I
combine my guesses with what I actually hear to get a result that's pretty
good. All of this is done on a subtle level and it is only recently that I
have understood how much of this I do - in part because as I have aged my
hearing has deteriorated and I rely on this more. (Hints there regarding
problems your children might face and strategies for dealing with them.)

On a positive note -

- A hearing loss can make you a good listener. You pay attention, or you don't hear anything. You can't half listen.

- My inability to deal with the audio world effectively I think lead me early into writing and there I've had more success. I feel much more comfortable carrying on a conversation in this medium. . .

I'm convinced my hearing loss made me lousy at getting names - which are usually spoken to you - and getting pronounciations of names and words correct. I think this is one reason why I always had trouble learning foreign languages in school. I mention these things because you should be sensitive to them if you have children with hearing loss. If you're aware of the problems you may be able to develop strategies to help them cope - and make their teacher's aware.

It also makes me a lousy musician, which is frustrating because I love music and so like to sing and try to play various instruments. At first I learned to read music and was religious about not playing anything without the notes in front of me. I became completely dependent on the written music. I was in my thirties before I made my first feeble attempt to play by ear. I found I could do it - to my satisfaction, not to others ;-) Again, keep these things in mind with your children.

This missing of frequencies is subtle. It means you hear words incorrectly. It means you have difficulty processing. It leads to what I always thought of as "delayed hearing." That is, I would fail to hear something you say, I would ask you to repeat, and before you could repeat I would "hear" the words - meaning I found some way through context to figure out what you had said.

If you are conscious of this when speaking to someone with this hearing problem it helps. Every once in a great while Bren will say something out of context. (I usually have no problem with her voice and she's careful to speak loudly and clearly to me.) When this happens - when she suddenly appears in the room and says something totally unexpected, I am at a complete loss to understand it. She may repeat it three or four times and it just sounds like gibberish - a foreign language. When I know the context, it suddenly falls into place.

I won't blame my hearing for my failure in school - but I think it had something to do with it. But again, on the positive side, this lead me to learn well on my own - through books. And that, in turn, meant that when computers came along I was quite comfortable with them and using computer manuals which most people ignore at their peril ;-)

From a second generation male:

Hey, I'll throw in my 2 cents. Some of the things Greg said, especially the delayed hearing, I want to throw in a "Amen, brother Hallelujah" (good ol' spell checker for that Hallelujah) :-) Dad and I have the same hearing doctor for lack of what the technical Dr term is. I don't think are charts are as similar as he thought they would be.

It's interesting as I look back on how my personality is perceived by others because I'm a little louder and will speak up and ask questions or reiterate what was said, namely because I really didn't hear what was said the first time ... that translates to people perceiving me as being either smart or confident with the speaker being thrilled or terrified that somebody was actually listening.

There are many things I wish I had heard but really the thing I like best about my hearing aids and I don't wear them as often as I should, is when I take them out, the world is quiet and peaceful again :-)... remember, I have a 19 month old boy, a 5 and an 8 year old :-).

My only useful advice for [person who started this conversation], is get the ear tubes if needed. We set [our son] back a little language wise, he had ear infections and fluid for a solid 6 to 9 months from when he was about 2 to almost 3, basically language aquiring time. The infections would go away with antibiotics, but the fluid stayed and that was not good. Neither [another son] (5, almost 6) or [another son] (19 months yesterday) has had the ear infections that [frst son] had. [first son] now has digital behind the ear hearing aids even though his loss is only in the 10 to 15% range (compared to my loss of 30 to 40% in some ranges) and they help. He's doing fine now but for a while he stuttered. [first son] had tubes twice and had his tonsils and adenoids removed the second time (buy one, get one free deal, who could pass it up?)

and from a first generation male:

I have always had a hearing problem, but do better today than ever since I have a couple of the latest hearing aids. Greg's note on the subject is in line with my own experience. I am afraid I have just accepted the fact and not investigated much further than finding a capable hearing aid man (many are a laugh in my estimation). . . . I have had fluid in my ear from time-to-time, and it can cause a problem with not only hearing but balance as well. At one time I was ready to go to a specialist, but the fluid cleared up. My doctor was not anxious to give me an antihistimine for it due to side effects.

My biggest problem is with weekly company meetings where there are a couple
of hundred people in a room and making presentations from all over. I find
that I can understand what is being said when people are facing me (even at
a distance) but if they are facing elsewhere it can be garbled. [a child] and
[another child] had no problem, and my only question might be [a grnadchild]. I don't know with him, but will ask [his mother].

My hearing aids are by Sonic Innovations (http://www.sonici.com/) they are
completely in the canal. I am afraid the way I selected my current
audiologist was because a brilliant scientist, Carver Mead, founded Sonic
and this local firm was their primary agent. Mead, came to me via George
Gilder (he was always praising him), and he is a CalTech professor who is
well known and respected for many inventions. He is really the Feynmann of
recent times.

from my wife, Brenda, a psychologist

I want to expand on something [earlier writer] said. Hearing loss often leads to language processing problems, and language processing problems often lead to difficulty acquiring reading skills. A deficit in phonological processing, or the ability to hear sounds in spoken words, is the reason most children have a reading disability. So, in other words, not being able to hear accurately affects the ability to read. Teachers and parents need to be aware of children who may have difficulty with phonological processing so that special accommodations and modifications can be put in place.

As an aside, I found out when I was doing my master's and doctoral research that Greg's phonological processing is extremely poor. He is an outstanding reader, but he got where he is only because he has superior skills in other areas. Most individuals with deficits in phonological processing do not have these phenomenal skills and therefore have difficulty learning to read.

second response, first generation male;

I just remembered one point on hearing loss that might be of interest. When I was a young child I had a serious hearing problem. My "Uncle Dick" (really a great uncle married to Aunt May and father of Bill) was a leading eye, ear, nose and throat specialist. Dad always told me that Uncle Dick recommended that my tonsils and adenois be removed, and in those days they "punctured ear drums". I cannot say that the result was an improvement, because that was like 65 years ago. However, I have always had hearing problems but not to the degree possibly of others in the family. At least in my day and age the medical community and school systems did not pursue to the degree I hear about today.

Whether what was done makes sense today, I have no idea. Therefore, for whatevery its worth that was what they tried on me.

from a second generation female (married to a stone)

When I was pregnant with [son], because of my age at the time, I met with a genetic counselor. When I mentioned the family hearing loss in [husband] and [another son], she was so interested she asked me lots and lots of questions. I gave her the limited information I had about it, and she made a genetic family tree map. I don't think I got a copy of that, but I'll call the genetic family counseling center and see if I can get a copy of what she did for you.

from the second generation female who started the conversation:

What a great response! It was very interesting reading how [others] have adapted to their hearing loss, and in which ways the hearing loss has shaped each person's personality. I could see and understand how on a smaller scale, I too have adapted to and respond in similar ways due to my hearing loss. Like [another], when I read Greg's description of 'delayed hearing'-how by the time something is repeated, you have already filled in the missing pieces of the message - I instantly recognized that that happens to me.

I can see how [another's] personality and behavior has also been influenced by his hearing loss. I think one of the reasons [another person] will often talk more than his fair share in a conversation is because he is trying to cover up anything he has not heard, rather than let on that he didn't understand or ask for the upteenth time for someone to repeat something. He himself has told me this.

A few years ago I found that while teaching a class I was having trouble hearing students' questions, so I did get a hearing aid. Supposedly it is adjusted for for my specific hearing loss, but I find there is so much background static, that I only wear it for teaching. I have never had a problem while tutoring students, or at the movies, but I do have cordless headphones for our TV, and I keep our radio too loud...It even sounds too loud to me, but like you, my hearing is weak in certain frequencies but not others. (I know that at some point within the next five years I will need two hi tech hearing aids.)

My hearing chart, and my son's, look similar. We both have a 'cookie cutter bite shape', that is, the left side of the chart is normal, and then it dips down (mine to a 40/45db loss at 2000Hz, his at a 30db loss at 2000Hz) and then it comes back up to normal.

[Earlier writer], I think there is some truth to what you said. Doctors nowadays say that prolonged fluid in the ears (not necessarily infected) can cause hearing loss, possibly by pressing on the inner parts of the ear while they are still developing. This is one of the reasons why ear tubes are often recommended in children ages 1-5. These years, as Brenda said, are also the prime language developing years, and because ears full of fluid can't hear well, language development can be inhibited. (THis is the number one reason for ear tubes.) Children can have fluid in their ears, but no infection necessarily. They can walk around and seem fine. This could be part of our family's hearing loss...but I do not know for a fact. So maybe you were spared some of the hearing loss in your developmental years?

After my boys (my daughter's hearing is normal) have their CAT scans on their ears and we get the results I will let everyone know. And I will keep everyone posted about these Mass Eye and Ear doctors' possible interest in studying our family. (and what that would entail?) They were fascinated that it was so dominant in so many generations.

and in response to Brenda's note:

Wow, that really hit the nail on the head when it comes to describing some of the problems [a son] has had over the past year and a half learning to read!

and from another second generation male:

It is absolutely fascinating to see that others have had many of the same experiences you've had with a disability!

There are certain frequencies that I don't hear. If it's somebody I deal with a lot (like a professor in college or a certain woman at work), I learn to pay close attention and ask such people to speak up. I find that I am often complimented on my listening skills -- I appear very intent because I rely on the moving lips (and the context of the conversation) to understand what is being said (this was a huge benefit when I got interested in old movies -- I could follow the old soundtracks, others had problems!). I'm perfectly fine on the telephone one on one, but when I have to get onto a conference call, I miss almost everything.

As Greg pointed out, out of context speech is hard to understand. I often totally get it wrong or ask "what?" only to realize that I have decoded it while asking the person to repeat. I find it very hard to understand some accents -- a woman at work is Indian which means the sound cues don't match the lip movements since she stresses syllables in a way foreign to me (what's worse is that her voice is in a frequency I don't hear well). . .

As for my hearing loss, when I was a child I suffered from regular earaches. Dentists have told me that my teeth are stained slightly grey from the drugs I took as a child likely in connection with my hearing loss. I'm told that my eardrums burst due to pressure behind them (one ear doctor asked whether this had happened based on the scars on my eardrums).

As Greg said, I've learned to get along...but I also believe that my hearing loss wasn't that extreme until later in childhood -- not at a very young age.

an added note from me:

Several people mention the ear aches and various other childhood problems. To the best of my memory I never had any of these problems. I'm not sure, therefore, if this is all genetic, or if the physical problems make an existing condition worse, or if they are just coincidence?

and finally, a note from another first generation male:

This is a wonderful exercise. You know my mother would have good input on this one. But you know I do think back and in those days kids got their tousils out routinely and I think it was related to possible hearing problems. . . .

I found out that I had a significant hearing loss in the early 60's. I had never been tested before that. In fact I can't even recall being asked to sit in the front row in class at any age. The only incident that I can recall that would say that I had a significant hearing loss at a very young age was those many times that I challenged Mom's pronounciation of "manila" as in ice cream. She would make me repeat it and repeat it. She would say " manila, not manila", and I would repeat it just exactly as I heard it. manila. Manila, manila till she let me have my "manila" ice cream cone anyway.

I am sure "manila" wasn't the only word that Mom corrected me on. Foreign languages were not for me, science and math were. Reading came on for me late, as an adult, cause I realized that was the best way for me to learn something. I actually assumed no one really heard what was being said in lecture halls, so I skipped most of them in college. Lab work was preferred.

I can't say I really ever heard a sermon in church even as an alter boy. I was sure no one every heard a word that Bishop Bennett or Bishop Higgins preached. Not only did they speak ever so softly but also at triple normal conversation speed. By the time I just caught one word they were a few paragraphs ahead of me.

I would like to hear birds sing, church bells ring, etc. but than I don't hear squeaky shoes, faucets dripping, noisy diesel engines, and many unpleasant sounds. I do love my "quiet world" which allows me to think just about anywhere anytime. I have no problem with my concentration. I can mentally actually disappear in a crowd.

I do wish I could hear most conversation, music etc, a whole lot better. When I discussed my hearing problems with Dad, I am talking about when I was in my late 40's and 50's, Dad would tell me to work at becoming a "good listener ", and that should prove sufficient. He would go on to talk about people he knew who had normal hearing that he couldn't have an intelligent conversation with because they didn't know how to listen. Dad was indeed a very good listener.

AS a salesmen, and taking Dads advise, I forced myself to listen by setting up my own criteria for what made a good sales call. "If the customer learned more about you and your company than you learned about he and his problem it was a bad sales call." Instead of a product sales pitch I went in with a list of what I had to find out about the customer to know if he could use my damn product. Just about all of my sales calls that I made alone were "one on one" abd I rarely felt unconfortable. If it was a group I always took a tech support guy in to handle the questions. In those cases often he had to tell me what went on after the call. YUK! I still applied the same criteria thou.

Woops, I am off topic , but just perhaps this will explain some behavior you might observe among your kids.

Whew! I don't know if this will be helpful to anyone else, but just rereading it myself I find it fascinating. Wish I had more "conversations" like this one.

Posted by Greg Stone at June 18, 2003 08:34 AM