Aug 2020 Healthy Hearing Contributed by Temma Ehrenfeld

My friend Roger Draper, who kindly let me write about him before for Healthy Hearing, lives with a profound hearing loss. Yet he spends hours every day enjoying classical music. He listens with high-quality amplified headphones when home alone, but if he is at a concert or watching an opera at home with a companion, he uses a “music setting” on his hearing aids.

noise cancelling headphonesA good pair of noise-cancelling headphones worn over hearing aids can make it easier to listen to music.

For many people, hearing aids alone can make music more enjoyable. When your hearing begins to decline, you might notice that when a new instrument comes in, you can’t tell whether it’s an oboe or clarinet, for example. You might struggle to hear lyrics. Hearing aids can bring you the sounds you were missing. Hearing aids can also help minimise tinnitus, repetitive buzzes and other sounds generated internally. Tinnitus, which is linked to damage from noise, often afflicts musicians who may have a history of performing in loud venues.

Especially if you have a profound hearing loss, the large dynamic range of music is a challenge. For Roger, even with headphones, it’s still hard to hear soft passages. If he can, “the loud ones will probably be much too loud.” With his hearing aids, they’d be so loud “you’d be evicted from your apartment,” he adds. Music lovers sometimes turn the volume up so high on their headphones they risk more damage, notes audiologist Ruth Reisman, of Northwell Health Lenox Hill in Manhattan.

Speech ranges between 30 and 85 decibels. Music has twice as big a range in volume, about 100 decibels. Music also includes more frequencies than speech. A piano, for example, has about a 40 percent bigger range in frequencies than the female voice.

In the past, hearing aids couldn’t handle those larger ranges without distortions. But they have become much better at processing music in recent years. A conversation with your audiologist about other hearing devices also could make a big difference. Don’t wait to be asked: You may need to bring up the subject yourself, one survey suggests.   “Most hearing aid manufacturers have now resolved the ‘front end problem’ where the hearing aid distorts the normal inputs of music,” Toronto audiologist Marshall Chasin, who specialises in working with musicians, told me.  He recommends listening to music on the same setting you’d use for a conversation in a quiet place.

With older aids, you might lose lower frequencies. Age-related hearing loss, the most common kind, tends to be in the higher frequencies. (Are your grandchildren unintelligible without your aids? That’s why). So hearing aids programmed for conversation target those sounds, which are important for distinguishing “cat” from “hat.” But in music, lower frequencies are often more important.

People also tend to have the most trouble understanding speech in noisy situations, classically a crowded party or restaurant. Hearing aids have settings with features to reduce background noise. However, in older aids, that programming could mistake a sustained chord as noise. In addition, hearing aids are programmed to minimise high-frequency feedback, a squeal or whistle generated by the aid—but in the past could mistakenly suppress pure tones in music that might be an organ or the soaring flute melody in your favourite Mozart.

Then there’s the hearing aid feature called “wide dynamic range compression," which indeed compresses the range in order to boost softer sounds—and so deprives you of the dynamic range the composer and performer intend. But an up-to-date aid shouldn’t have these issues. If you think your hearing aid is distorting music from a music player, radio, or TV, you might experiment with turning down the volume, Chasin suggests. If you have a volume control on your hearing aid, you could turn that up if needed, he says. If you have a mild or moderate hearing loss, you might simply take off the hearing aid.  

Musicians may sometimes miss hearing loss when they listen to music because they are recreating it in their heads, much as Beethoven did when he was deaf, observes audiologist Ruth Reisman, of Northwell Health Lenox Hill in Manhattan. "It is like a sixth sense," she says. 

If you are a performer—singing or playing a musical instrument—hearing aids can alter the sound of your own voice or instrument, an effect called “occlusion.” Sometimes wearing one aid rather than two can solve the problem. You might need a more open ear piece or a hollow earmold, or it might help to lower the low frequency amplifications, Reisman says. 

Tell your audiologist if you have tinnitus, for tips on how to manage it. Other assistive listening devices can help This is where you’ll get the most help now, Chasin says. Note that your audiologist may make it possible for you to test out assistive listening devices before making a commitment.

Amplified headphones can deliver signals more loudly than standard headphones do. A separate headphone “equaliser” allows you to boost low, mid and high frequencies to suit yourself.  

Noise-cancelling headphones may be worn over your hearing aids, so you don’t need to turn the music as high.

A hearing loop provides a wireless signal you can pick up on the ‘T’ (Telecoil) setting when using mobile phones or when you’re inside a cinema, church, concert hall or theatre.

Remote mic - you can pick up live sound in a room by putting the microphone closer to the source.

Streamers - these small devices ferry sound from other audio equipment wirelessly into your hearing aid. Ask your audiologist to enable a streaming program on your hearing aids. Roger listens to musicals or operas with English librettos using a device that broadcasts sound directly from his TV to his hearing aids. “The music doesn’t sound as good as it would if I were listening through headphones, but I can make out the words, which is otherwise an impossible challenge,” he says

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