March 2019 Joy Victory, managing editor, Healthy Hearing
Since I started working for Healthy Hearing this January, I’ve learned endless new things. Some weird: Did you know our ears and noses grow our entire lives? Some fascinating: Your ability to hear songbirds may be one of the first things you lose when you develop age-related hearing loss. (That alone is motivation for me to keep tabs on my hearing.)

Joy VictoryAuthor Joy Victory getting prepped for her hearing test

But one topic rendered me a little skeptical: The notion that hearing requires effort and hearing loss exhausts the brain. It makes sense, of course, but I've always thought of hearing as akin to breathing or blinking—something we do constantly, yet passively. And then I took a hearing test at a local audiology clinic earlier this month. I had started the day shadowing audiologists and learning the ins and outs of testing and fitting—and now it was my turn in the hot seat.

Things started out fine as I sat in the sound-proof booth at Estes Audiology in Austin. With special earplugs squeezed into my ear canals, I began with a speech audiometry test. I felt confident as I repeated words like “comb, wave, dove.” Easy breezy, lemon squeezy, as my daughter likes to say.

But then it was time for the pure-tone test, which required pressing a button on a handheld wand every time I heard a beep-like sound. Even if I wasn’t sure I heard anything, I was still supposed to press the button, explained University of Texas audiology doctoral student Hanna Patel. A subsequent series of beeps started up, some loud, some faint, some…wait, was that a beep? Or was it my ears ringing? And before I could decide, I’d hear another beep and hastily press the wand button. Dang, I thought, I think I just missed one. Then I noticed my heart was beating harder, and suddenly I was finding myself mentally strained, trying to focus on the test, worried I couldn’t hear as well as I thought, and getting anxious at the thought of what sounds I’d been missing all these years. I held as still as possible so that any little sound—my hair, my breath—wouldn’t interfere with the testing.

Then the test ended, and I let out a big breath. Did I just bomb it? I wasn’t sure.  We moved on to the next test, known as the hearing-in-noise-test. I listened to a recording of people speaking in a somewhat noisy room, repeating what I thought I heard the main speaker saying. With each sentence, the background noise got more raucous. Suddenly, I no longer heard sentences, only words. By the end of the test, I shrugged: All I could hear was a jumble of voices akin to what a school cafeteria sounds like on ice cream day.  Hanna stepped back into the noise-proof room. And I noticed I was suddenly exhausted. “The hard part is over,” she assured me as she inserted a different set of earplugs to give for an immittance test. This time, I didn’t have to “do” anything; I could literally just sit there and stare at the wall as I let the device measure the strength of my “acoustic reflexes” and the health of my eardrums and middle ears.

The relief I felt made me realise my brain had worked hard as it went through the (painless, non-invasive) hearing test—even though the whole time I had been sitting nearly motionless in a comfortable chair, in a comfortable room. Oh, I thought, this is what people mean when they say hearing requires a lot of brainpower (or "cognitive load" in medical jargon). After all that self-imposed drama, I was relieved to find out I have normal hearing. And I gained a lot more empathy for people who have trouble hearing. When what you hear starts to diminish, your brain tries to compensate, and it will tire easily at the constant guessing game. No wonder people with hearing loss tend to shy away from noisy places.

But this avoidance strategy can backfire, clinic co-founder and audiologist Dr. Soriya Estes told me. Over time, avoiding sounds and noise means your auditory nerve doesn’t have to work as hard. Research is now showing how this can likely add up to an increased risk of dementia—when you don’t talk and listen to speech as vigorously as you used to, it’s a lot easier to forget not just what the words sound like, but also what they mean. “It really is use it or lose it,’” Dr. Estes explained. “The auditory nerve needs to be stimulated.” Her challenge as a clinician, she said, is helping people realise this. Because most hearing loss occurs very slowly, people may not even realise just how bad their hearing has gotten—instead, the songbirds seem to slowly disappear, the falling leaves no longer rustle like they once did and people seemingly refuse to speak as clearly as they once did. The early changes are so subtle many people don't stop to think: Has the world changed, or has my hearing?

The best way to find out? A hearing test. You'll suffer through a few awkward minutes of beeping sounds and strange voices, but then you'll get your answer: The songbirds are still there, and it's time to hear them again.

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