Hearing poorly and doing nothing can have serious consequences

Our author did the self-test of Apple’s hearing aid Airpods. He now visited the ENT doctor Bernhard Junge-Hülsing to check the results – and to find out more about the important topic of hearing loss. Depending on the study, 14 to 33 million people in Germany suffer from it, some only in one ear, many don’t notice it.

Mr. Junge-Hülsing, apart from loud bars, where it has always been difficult for me, I have no restrictions in everyday life. According to surveys, people come to you late. Why?
Because, unlike glasses, hearing aids are perceived as unsexy and are associated with the concept of age and obtuseness. This is deeply anchored in the German language. The word “stupid” is closely related to “tumb”, which in Old High German means something like ‘dumb, deaf, foolish, simple-minded’. Wittgenstein once said: If you can’t talk about it, you can’t think about it. So our intelligence is a verbal intelligence.

Do your patients come voluntarily, or are they sent by desperate relatives and spouses?
Fifty fifty. There are those who no longer understand things well in the theater, television or in church. But also those who are pressured by their wife or children and are convinced: I actually still hear well, I don’t need hearing aids yet, I hear everything I need to hear.

How advanced is the hearing impairment on average?
Compared to young people with normal hearing, who serve as a reference for our hearing tests, they have usually already lost around 25 to 30 percent in their ability to understand speech.

How dangerous is it if you don’t intervene in time?
Dementia is a particularly great danger. According to specialist literature, this could occur around four years earlier in untreated hearing impaired people. You lose your orientation in space and therefore fall more often. You also have problems when driving because you can’t hear the ambulance or a minor accident. I once had a patient who drove into a glass house while backing up and didn’t hear it. That’s an extreme example, but then he just lost his driver’s license. I’m not against old people driving, but they have to compensate for their poor eyesight and hearing, otherwise they can be a danger to the public.

What is the earliest sign of beginning hearing loss?
If your partner often says: Don’t you understand me? This starts very early! That’s why a lot of people come to me aged 30 or 40 who don’t understand ambient noise very well. They then have three or four percent hearing loss, so it’s not really that bad.

And when should you definitely stop putting off the hearing test?
When you can no longer understand someone, even in a quiet environment. When you only understand the news anchor on television, but no longer the actors in original German series such as “Tatort”, where you can also read your native language on your lips. If something like that doesn’t work anymore, then it’s high time.

Do you then have to go to an ENT doctor or is a hearing aid store sufficient? They also do hearing tests…
The first prescription for hearing aids must be issued by the ENT doctor. And it makes sense that you first look at the cause of the hearing impairment. For example, whether there is a hole in the eardrum or whether someone simply has a lot of earwax. I’ve actually had patients who had been wearing hearing aids for a long time and no longer needed them after I got the earwax out.

Are there other easily remediable causes of hearing loss?
There are also causes that you don’t even think of at first. For example, allergies that cause the ear trumpet to collapse. This is a connecting canal between the tympanic cavity and the middle ear. Then the pressure equalization no longer works if, for example, we take the cable car up a mountain, hold our nose and force air in. If that doesn’t work, it’s like plugging your ear from the inside. Then you should first treat this ear trumpet ventilation disorder. This particularly affects younger people.

What more serious causes could be behind hearing loss that definitely need to be clarified?
Many many. If hearing and balance problems occur on one side, one must think of a tumor. There are chronic inflammations, for example bone suppurations as a long-term consequence of a middle ear infection in childhood, which only appear in adulthood. Ossification of the auditory ossicles, especially the stapes, can occur. Medications, especially cytostatics, can damage hearing. And autoimmune diseases such as multiple sclerosis can also begin with a hearing impairment. I could list a lot more…

But the most common is age-related hearing loss?
Nine times out of ten it is, yes. Although it is a wrong term, because the main cause is not age, but the environmental noise that we are constantly exposed to. Through traffic, for example, or through music that is too loud. That’s why we talk about “environmental hearing loss” today. And it starts earlier today than it did 50 years ago, which is why many people need hearing aids sooner.

What can you do to stop it from progressing? Does it really always have to be a hearing aid, or is hearing training sufficient?
This is a very typical question that my patients always ask. They try to negotiate with me, asking whether a certain diet can help or even hearing training. But unfortunately there’s not much you can do yourself. Of course you shouldn’t continue to expose yourself to a lot of noise, but otherwise you should continue to live your life as before.

But what about listening training? There are numerous apps…
Hearing training for adults only makes sense if you already have hearing aids and then under professional guidance. There are also training courses for young people up to the age of around 14 who have an auditory processing disorder. However, these should only be used in collaboration with a pediatric audiologist and a speech therapist.

The threshold for a hearing test is high for many people. I overcame it with the Airpods and you tested again. Are the results consistent?
They are close to each other, the small difference can also be due to the condition of the day. There are also other self-tests on the internet, both good and bad, the AirPods hearing test is one of the good ones. This development is really a great step forward because such tests require little effort.

But the test did not test my language comprehension, as I have now experienced in your practice. The AirPods only played me sounds, and when I heard something, I was supposed to press the display…
The language comprehension test is just an additional diagnostic tool that we use in Germany. In many other countries, hearing threshold measurement is sufficient, as was the case with Apple’s test.

What does such a test result mean for the many people whose mild hearing impairment is not yet sufficient to indicate the need for a hearing aid? Should they use the AirPods to train for the future, when they might become severely deaf?
For them, Airpods are a good way to get along better in situations such as conferences or lectures. And then maybe a year later you do another self-test. If the result has become worse, go to an acoustician or ENT doctor.

But you can’t prescribe Airpods yet?
No. Although it is an approved medical product, it would have to be listed in the list of medical aids, and they are not yet.

What role do you think headphones will play as a hearing aid in the future?
The market will change completely. Headphone manufacturers, not just Apple, will develop hearing aids with headphones that disappear deep into the ear canal, like products from Sennheiser or the hearing aid manufacturers. More comfortable, technically sophisticated hearing aids are being developed that can be worn sooner. And with advances in the field of AI, it may soon be the case that the television will say: That’s really loud, take a hearing test. These changes will not be limited to hearing aids, but to wearables and household electronics in the broadest sense, including glasses, for example. Who knows whether in a few years we will still be looking through glasses or whether we will all be wearing night vision devices. This will be exciting. I look forward to it, it makes our lives better.