Dr. Ross on Hearing Loss
For a Body Hearing Aid to a Cochlear Impant: Some personal and professional reflections
by Mark Ross, Ph.D.
I have been writing bimonthly articles for this journal for almost eighteen years, ever since I “retired” from a full and thoroughly rewarding professional career. It has been my pleasure and privilege, one that has added meaning and purpose to my later years (when this article appears, I will be eighty-five years old). It’s time now to call it a day and finally, really “retire.” So I’m afraid this is my last one. Our indulgent editor, Barbara Kelley, has agreed to permit me to be somewhat more autobiographical in this one, as I review my personal experiences in going from a body aid in January l952 to the cochlear implant I received four years ago. In recounting some of the events in my personal journey, I’m also going to comment on a few of the lessons that can be drawn from my personal experiences.
In late l951, I was told by an Otolaryngologist that I had a progressive hearing loss and would eventually go completely deaf. And that was it. As I’m pleased to note, he was completely wrong. Evidently he was basing his prediction on a medical model which ignored the potential role of hearing aids to keep me auditorially connected to the world. . And, thanks to developments in hearing aids and cochlear implants, there has never been a time when I was functionally “deaf.” With every significant decrement in my hearing, there has always been some technical development that could help offset its full impact. Nowadays - I’m pleased to say - I doubt that any Otolaryngologist would offer such a grim prognosis without, at the least, informing the patient of non-medical remediation measures that could be taken.
In January l952 I was enrolled in the Aural Rehabilitation (AR) program at Walter Reed Army Hospital. There I soon received my first hearing aid. It was a vacuum tube body aid that was worn either in a harness under one’s shirt or, as I mainly did, placed in one’s shirt pocket. The aid was provided to me as one component in a comprehensive AR program. The program lasted for two months, eight hours a day for five days a week. Our days were filled with speechreading and auditory training exercises of various kinds, some quite ingenious, as well as informational lectures. Yet, as much as I may have learned, looking back now it seems to me that the chief benefit of the program was basically a side-effect of the group setting and not the formal curriculum.
There were approximately twenty or twenty-five men in my group, and we not only went to classes together but bunked and ate our meals in the same facility. It was in these informal settings (plus the frequent, unplanned, discussions that would arise in our classrooms) that we learned to acknowledge our hearing loss and to accept the value and necessity of the hearing aids. We would joke with one another with such comments as “Are you plugged in yet?” or “Are you on the air?” In short, we were not alone; other people shared our plight. This helped reduce the sense of isolation and anxiety that so bedevils many adults with a late onset hearing loss.
I think the biggest weakness in contemporary hearing aid dispensing practices is the fact that most people receiving hearing aids do not receive this kind of opportunity. While effective communication training and hearing aid management can be carried out on an individual basis, it should complement and not substitute for the psychosocial benefits that a group experience can provide. Clearly, the kind of program I received cannot be emulated today, but there is evidence that demonstrates that even a short-term AR program, optimally associated with the hearing aid selection process, can be beneficial to the recipients. Some Audiologists now offer such a program, but they are, unfortunately, still very much in the minority.
Beyond its auditory benefits, the body aid proved to be advantageous in other respects as well. For example, in noisy places I could take the aid out of my pocket and place it close to the lips of my conversational partner. In other words, in some situations it functioned as an effective assistive listening device. It also gave rise to some amusing experiences, like my being asked what the score was during a World Series game when someone noticed the aid in my ear and mistook it for a radio. Or, when at a USO dance, in bringing my dance partner close to me, I felt and heard a “thunk.” Now as a young man full of overactive hormones, I expected (and hoped for) some kind of sensation, but certainly not that one. But I persevered, brought her close to me again, and again felt and heard a “thunk.” It turned out that the lady also wore a body aid and that our hearing aids were colliding as we drew together. It made for a good laugh and a pleasant evening; certainly a comparable experience is impossible nowadays.
I served in the Air Force for three more years after receiving the hearing aid. During this period, I traveled widely both in the States and abroad. In some places, as in North Africa, I was likely the first person that other people saw with a hearing aid, and I myself cannot recall ever seeing anyone else using one. But wearing a very visible hearing aid never became an issue; I did my job and functioned and socialized normally. I made no attempt to disguise the hearing aid; when someone noticed it and asked what is was, my typical response was to simply say “It’s a hearing aid, it helps me hear better the way those glasses you’re wearing help you see.” I can’t remember a time when that simple explanation didn’t suffice. I did not, I’m sure, convey the feeling that the aid revealed some personal flaw, some stigma that had to be denied or disguised. I’m now convinced that it was my personal acceptance of my condition, an attitude that I must have at least subliminally conveyed, that led to others accepting me as I was. There’s a lesson in this that, unfortunately, is still very pertinent today. In my judgment, self-acceptance is the key factor in successfully adapting to the hearing loss and the use of hearing aids. And the hearing aid industry doesn’t help with its obsessive focus on invisibility, an appeal that simply reinforces the feeling that a hearing loss is a shameful condition, one that has to be denied and disguised at all costs.
I started my professional training after my discharge from the Air Force. My B.A. and M.A degrees were as a Speech and Hearing Therapist (Audiology as a separate profession barely existed in those days), and I worked with people who had speech and/or hearing problems. Again, I made no attempt to disguise my body aid. And, again, I’m convinced that my personal acceptance led to its acceptance by others. It was not until I began my doctoral work that I functioned primarily as an Audiologist. I wore body aids for about fifteen or twenty years, and switched to behind-the-ear (BTE) hearing aids when the V.A. made them available. For the first time, BTE aids made binaural hearing a realistic possibility, as few adults would accept the inconvenience of wearing two body aids. Selecting which ear to use, not always obvious, became a crucial clinical skill. For myself, I opted to alternate ears, sometimes in one and sometime in the other; this was my attempt to provide stimulation to both ears. I believe that this effort ultimately paid off, when I used a BTE aid in each ear.
Initially, however, with my first BTE aid I wore it only in the better ear and used the body aid in the worse ear. It was an unusual binaural arrangement, to say the least, but though the full binaural advantage was not possible, I still felt that the listening experience was superior to that possible with a monaural fitting. This was a time when many Audiologists felt quite skeptical about the advantages of binaural hearing; they required objective evidence regarding possible binaural advantages. The almost unanimous report of hearing aid users was considered insufficient. Many Audiologists dismissed the presumed advantages of binaural as simply a ploy by hearing aids dealers to sell a second hearing aid (This was in the days before Audiologists could ethically dispense hearing aids.) To be fair, the objective evidence was rather mixed - primarily, I believe, because the test conditions were unrealistic while the tests themselves were insufficiently sensitive. Nowadays, the routine hearing aid recommendation is binaural, with the understanding that it may not be appropriate for everyone.
BTE aids brought their own set of problems, one that I still experience with the BTE aid I wear along with a Cochlear Implant. And that is the occurrence of acoustic feedback. While this phenomenon can now be controlled somewhat with an effective feedback suppression system, no such system existed in those days. We’d try different and tighter earmolds in an effort to eliminate the acoustic squeal, but to no avail. Many of these molds were literally an intolerable pain in the ear. Indeed, one major limitation in benefiting from the full electronic capabilities of a BTE aid could usually be traced to the earmold. Often, in visiting a classroom full of hearing-impaired children one would be met by a cacophony of acoustic squeals emanating from the hearing aids of many of them.. It was so common that both the children and the teacher often ignored its presence. This was not a trivial situation; effective use of residual hearing is impossible during the occurrence of feedback.
FM listening systems became available in the late l960s. At the time they were used almost exclusively in schools for the deaf, ultimately replacing all other systems in use at the time. The potential benefits of such systems were immediately apparent, basically resting on the increased signal to noise ratio possible with a close-talking microphone. I began using one myself when confronted with particularly challenging acoustic situations. But as an adult I found these early systems inconvenient to use, requiring as they did a belt receiver and transmitter for both the talker and the listener. For hearing-impaired children in classrooms, however, it was a different matter. It was at this time (early l970s) that I co-authored several articles on the effects of FM systems for hard of hearing children in regular schools. Compared to hearing aids, the listening advantages were immense and immediately apparent. Still it took many years before these systems were routinely adopted for use by mainstreamed hearing-impaired children.
It was not until twenty or twenty-five years ago that FM microphone/transmitters that could conveniently be used by adults became available. AVR Sonovation (or one its corporate ancestors located in Israel) was the first to develop a hand-held FM microphone-transmitter; the device broadcast to a BTE aid that had a two-inch antenna sticking up from it. I probably became one of the first people to use such a system since I was consulting with the company at the time. My favorite FM system, however, was the first hand-held system developed by Phonak. This was a slender, rectangular rod about four inches long that transmitted an FM signal to a receiver plugged into the base of a BTE aid (or to a neckloop plugged into an FM receiver). It proved to be extremely useful at any noisy gathering making participating at such events possible and much more enjoyable. It also included a hinged gate on one side, permitting it to be conveniently propped up on a podium or aimed at a speaker across a table (it also include directional microphones). The model was discontinued years ago, much to my regret. As my hearing loss worsened to the severe and profound levels, I found the FM system more and more helpful in compensating somewhat for the increased hearing loss.
Finally my hearing loss progressed to the point where no hearing aid provided sufficient help. While my use of a BTE aid with an effective feedback management system did prolong this period, the time had come when I had to seriously consider a cochlear implant. It was not an easy decision for me to make. While I had recommended cochlear implants to many people with severe and profound hearing losses, I found that making such a recommendation for others proved to be a lot easier than making it for myself. But, finally, it was clear to me that it was time. And it has proved to be a wise decision. While I still have difficulty comprehending speech in noise and my appreciation of music still leaves much to be desired, overall the cochlear implant has been a godsend. It has kept me connected to the world in a way that would not have been possible otherwise.
As I reflect on my continued capacity to auditorially connect to the world, it is clear that this would not have been possible in previous times and even now in other places. Among the activities I engaged in some years ago was a six-year stint as vice-president of the International Society of the Hard of Hearing. (Thanks to my services being “volunteered” by Rocky Stone, the founder of the HLAA; he was a hard man to say no to). In that position, I became keenly aware of how fortunate we are in this country compared to people in the “third world.” The resources available to me are not easily available (or affordable) in less developed countries. There, a progressive hearing loss leads to one’s growing isolation from the family and from the wider society. Here, on the other hand, the use of hearing prosthetic devices enables people with every degree of hearing loss to participate in our society and to enjoy the blessings of the sense of hearing. I shudder to think what my life would have been like had these devices not been available, or what it is like now in other societies.