Hearing Loss in Australia
A Brief Hear-Story of Deafness
Deafness and hearing impairments possess a long and ancient history surrounded by misinformation and highly questionable myths.
The earliest written record of hearing loss is believed to date from 1550 BC in Ancient Egypt. The Ebers Papyrus offers a remedy for 'Ear-That-Hears-Badly' by injecting olive oil, red lead, ant eggs, bat wings and goat urine into the ears.
Whether 'Ear-That-Hears-Badly' refers to temporary hearing loss caused by simple wax build up, which may have actually been treatable with olive oil, the Ancient Egyptians were instructed to be kind to disabled individuals, including the deaf.
The history of hearing impairments can also be traced back to Hebrew laws around 1000 BC which dictated that those with deafness and hearing impairments be given limited rights to own property and marry. Although the law protected people with hearing impairments from being mistreated and ostracised by others, they were not permitted to participate fully in religious rituals.
Between 427 and 347 BC, Plato's philosophy of innate intelligence was popular. Plato claimed that all intelligence was present at birth and therefore, all people were born with ideas and languages in their minds and only required time to demonstrate their outward sign of intelligence through speech. People with hearing impairments could not speak and were therefore considered incapable of rational thoughts and ideas.
In 355 BC, Aristotle was reported to have claimed that those who were born deaf were incapable of reason. According to him, people with hearing impairments could not be educated because without the ability to hear, people could not learn. Greek which was spoken in his society was considered the perfect language and all people who did not speak Greek, including people with deafness, were considered Barbarians.
Emperor Justinian the 'Great', who ruled the Eastern Roman territories from 527 to 565, deduced that being deaf and being mute are two different traits and not necessarily always occurring together.
However, between 500 to 1000 AD, during the Dark and Middle Ages (the period of time between the fall of the Roman Empire and the beginning of the Italian Renaissance), deaf adults were the objects of ridicule and committed to asylums because their speech and behavior were viewed as people being possessed by demons.
Teresa de Cartagena, a 15th Century Spanish nun who had become deaf late in life, displayed exceptional ability in overcoming the challenges of her disability. She gained fame as a religious writer and is currently considered one of the earliest feminist writers.
In the 1500s, Geronimo Cardano - an Italian mathematician, physician, biologist, physicist, chemist, astrologer, astronomer, philosopher, writer and gambler - was the first to recognize the ability of the deaf to reason. Cardano developed a set of symbols to teach his deaf son.
• 1550: Pedro Ponce de León is credited as the first teacher of the deaf by developing a form of sign language and successfully teaching speech to deaf people from birth. It is assumed that his methods were followed by Juan Pablo Bonet, who, in 1620, published the first book on the subject of manual alphabetic signs for the deaf.
• 1664: Thomas Willis discovered the role of the cochlea in relation to hearing.
• 1668: Both William Holder and John Wallis, an English mathematician, taught a deaf man to speak "plainly and distinctly, and with a good and graceful tone."
An estimated 10 per cent of the world's population is to some degree, deaf. That is, 700 million individuals, ranging from those who have mild hearing loss and may or may not rely on hearing aids or lip-reading, to those who communicate using sign language and are part of a diverse Deaf Culture.
Deaf Culture is a culture that is centered on sign language and relationships among one another. Unlike other cultures the Deaf culture is not associated with any native land as it is a global culture. Deaf Culture sees itself as a language minority rather than a disability group.
Throughout the years many accomplishments have been achieved by deaf people. For instance, Ludwig van Beethoven was completely deaf for the last part of his life and yet managed to compose and produce some of the greatest music of all time during this period.
Also, despite developing hearing problems at an early age, Thomas Alva Edison became a famed inventor. The cause of his deafness has been attributed to a bout of scarlet fever during childhood and recurring untreated middle-ear infections.
Today, there is strong opposition within Deaf Cultures to the oralist method of teaching deaf children to speak and lip read with limited or no use of sign language in the classroom.
There have been many arguments about whether the manual method (where the teachers instruct the learning of Sign Language as the main way to communicate) or the Oral method (where the teachers make the student learn to speak) is better.
Most people now agree that the Manual Method is the preferred method of Deaf communication. The use of sign language is central to Deaf people as a cultural identity and any attempts to limit its use are currently viewed as an attack on Deaf Culture.
Hearing Aid Technology
Early devices, such as ear trumpets or ear horns were passive amplification cones designed to gather sound energy and direct it into the ear canal. The use of ear trumpets for the partially deaf dates back to the 17th century.
Ear trumpets were used as hearing aids, resulting in a strengthening of the sound energy impact to the eardrum and thus improved hearing for deaf or hard-of-hearing individuals. They were tubular or funnel-shaped devices which collected sound waves and led them into the ear. Ear trumpets were made of sheet metal, silver, wood, snail shells or animal horns.
An ear trumpet
Alexander Graham Bell, a Scottish-born scientist, inventor, engineer, and innovator is credited in 1872 with inventing and patenting the first practical telephone, promotes deaf education and opens a school for deaf people. Bell's father, grandfather, and brother had all been associated with work on elocution and speech and both his mother and wife were deaf, profoundly influencing Bell's life's work. His research on hearing and speech further led him to experiment with hearing devices.
Around 1895, an electrical hearing aid, the "akouphone" was created by Miller Reese Hutchison.
A 1933 ad for early vacuum tube hearing aids.
The first vacuum-tube hearing aid was patented by a Naval engineer Earl Hanson in 1920. It was called the Vactuphone and used the telephone transmitter to turn speech into electrical signals. After the signal was converted, it would be amplified when it moved to the receiver. The hearing aid weighed seven pounds, which made it light enough to be carried.
Marconi in England and Western Electric in the US began marketing vacuum tube hearing aids in 1923.
Other innovations in hearing technology include:
• 1960s: creation of the telecommunications device for the deaf (TDD). This teleprinter was an electronic device for text communication over a telephone line and designed for use by persons with hearing or speech difficulties.
• 1985: The Cochlear Implant was approved for people 18 and older. The cochlear implant (CI) is a surgically implanted electronic device that provides a sense of sound to a person with severe to profound sensorineural hearing loss in both ears.
• 2000s: The development of modern hearing aids which require configuration to match the hearing loss, physical features, and lifestyle of the wearer. This process is called "fitting" and is performed by audiologists. Modern devices also utilize sophisticated digital signal processing to try and improve speech intelligibility and comfort for the user. Such signal processing includes feedback management, wide dynamic range compression, directionality, frequency lowering, and noise reduction.
Causes of Hearing Loss
Hearing loss can be congenital, meaning from birth, or occur as a result of a disease or accident. Some of the diseases that affect hearing include Scarlet Fever, Meningitis, Mumps and Measles. Traumatic skull or ear injuries, exposure to loud sounds, ear pressure problems incurred while scuba diving and more can lead to permanent full or partial hearing loss. Sudden sensorineural (inner ear) hearing loss (SSHL), commonly known as sudden deafness, is an unexplained, rapid loss of hearing either all at once or over a few days.
Hearing loss occurs in one of two areas: a conductive hearing loss, which is due to a mechanical problem within the outer or inner ear known as CHL, or sensorineural hearing loss (SNHL), which has to do with the tiny nerve cells in the ear experiencing injury, disease or malfunction.
Deafness and Hearing Loss in Australia
The use of signing and other modes of communication in Australia did not just begin with the white settlement of Australia. Deaf and hearing impaired people have been and remain present in every culture and society, including indigenous Australian nations.
Many Australian Aboriginal groups have had well-developed sign systems for thousands of years. These sign systems are used in situations where speaking is forbidden or difficult – such as mourning periods, hunting, or communication between different language groups. These sign systems are likely to have also been used with Aboriginal deaf people.
The emergence of deaf people in Colonial Australia began with convicts.
Elizabeth (Betty) Steel arrived on the Second Fleet as a convict in 1790 and is the first recorded European-born deaf person to arrive in Australia. Betty was transferred to Norfolk Island and in November 1791, she married a fellow convict, Irish born James Mackey. Together they successfully farmed a 10-acre leasehold until the expiry of their sentences.
Dealing with Hearing Loss
The historical and often hysterical stigma attached to deafness and hearing loss may work as a deterrent and put people off getting their hearing checked.
While hearing loss may seem insignificant now - something you can deal with by simply turning the TV louder or asking friends to repeat themselves – its impacts are far greater than first thought.
Noise causes sound waves that make our ear drums vibrate. These vibrations are received by hair cells in the inner ear, which flatten according to the frequency and loudness of the sound and stimulate nerves that pass messages to the brain.
Very loud sounds make the hair cells collapse and flatten temporarily, resulting in temporary deafness. This is referred to as a temporary threshold shift and may last hours or longer depending on the degree of noise exposure.
This temporary hearing loss may also be accompanied by a ringing sensation called tinnitus. If this severe noise exposure is repeated over many years, the hair cells in the inner ear become permanently damaged resulting in permanent hearing loss.
Noise-induced hearing loss occurs gradually over a long period of time and unfortunately, hearing loss is permanent. Historically, noise-induced hearing loss is often due to unsafe industrial practices on construction sites or in factories and the music industry.
The most common type of hearing loss is a high frequency hearing loss. When someone is speaking to you, low-pitched vowels can be made out, but high-pitched consonants such as "ss" and "th" are missing. This makes speech sound muffled and hard to understand.
The first sign of noise-induced hearing loss is often indicated by difficulty in hearing high-pitched sounds, such as consonants (e.g. 't', 'd', 's') and the voices of women and children. When more than one person is speaking or there is a background noise, the problem becomes worse.
- Hearing loss can have a negative impact on the ability to learn, socialize and enjoy life.
- Untreated patients are more likely to miss important information in meetings and phone calls, and make mistakes at work.
- Hearing problems can lead to avoidance or withdrawal from social situations, social rejection and loneliness.
- Friends often avoid talking to people with hearing loss because of the difficulty communicating.
- People with uncorrected hearing impairment earn less than people who hear normally
Studies have also shown that the effects of hearing loss are cumulative. Just as muscles grow weak from lack of use, the brain loses its ability to process sounds and recognize speech without regular auditory stimulation (Auditory Deprivation). By the time you finally acknowledge that your hearing loss is real, you may have already lost the full appreciation of sounds and the music you once enjoyed.
Everyone has different reasons for putting off seeking help for hearing loss, from price issues and vanity concerns to preconceived and often outdated ideas of how hearing aids perform.
Today's hearing aids - like all high-tech devices - have come a long way in terms of looks and performance. And independent research shows that hearing aid usage has a positive effect on:
- Earning power
- Communication in relationships
- Intimacy and warmth in family relationships
- Ease in communication
- Emotional stability
- Sense of control over life events
- Perception of mental functioning
- Physical health
Everybody's Hearing is Unique
A clinician determines the requirement for a hearing aid and will help select a device that best compensates for your specific hearing loss. Everybody's hearing is unique, and a hearing device that is appropriate for one person's hearing loss may not be appropriate for another person.
And two hearing devices are better than one. A hearing test determines the extent of hearing loss in each ear. When both ears are impaired, studies have shown that two hearing aids improve comprehension of speech in the majority of listening environments, particularly in the presence of background noise. It also ensures that both ears stay active to reduce hearing deterioration and enhance the ability to localise a sound source. Generally, the benefits of using two hearing aids outweigh the additional costs.
Digital technology has revolutionised the way hearing devices process sound, providing superior listening comfort, speech clarity, and user control. All digital hearing devices are programmable to individual requirements. Generally speaking, digital hearing devices are the most sophisticated amplifying devices currently available.
All hearing devices use batteries. Hearing device owners are able to change batteries in most models and some hearing devices function on rechargeable batteries.
Children and Hearing Impairment
It is estimated that approximately 10% of the Australian population suffer from a range of concentration and auditory disorders, and still, the true prevalence of these disorders is not known. However, in the case of Auditory Processing Disorder (APD), it is estimated to affect up to 3% of all children and it is known to affect more boys than girls.
Auditory Processing Disorder is a hearing disorder in which the ears process sound normally but the hearing centres and circuits of the brain don't correctly process incoming information. This can affect understanding, especially in challenging listening situations such as in the presence of other distracting sound, or when listening to complex information or instructions. APD is thus often referred to as a hearing problem in which “the brain can't hear”. Interestingly, twice as many people have challenges with processing sound than are hearing impaired.
Ageing and Hearing Impairment
"If you put in a lot of effort just to comprehend what you're hearing, it takes resources that would otherwise be available for encoding [what you hear] in memory," says Arthur Wingfield, professor of neuroscience at Brandeis University. "Hearing loss may affect brain structure in a way that contributes to cognitive problems. Cognitive load" is the effort of constantly straining to understand and stresses the brain.
(Hearing Loss and Incident Dementia. American Medical Association 2011. R. Lin, MD, PhD; E. Jeffrey Metter, MD; Richard J. O'Brien, MD, PhD; Susan M. Resnick, PhD; Alan B. Zonderman, PhD; Luigi Ferrucci, MD, PhD)
"Hearing loss is independently associated with incidental-cause dementia. Whether hearing loss is a marker for early-stage dementia or is actually a modifiable risk factor for dementia deserves further study."
"Adults with hearing loss are significantly more likely than adults with normal hearing to develop dementia"
read full article Hearing Loss and Dementia
Current studies are looking into the positive effects that hearing aids have on ageing outcomes-:
"Studying Multiple Outcomes after Aural Rehabilitative Treatment (SMART) is a research study to examine how the use of hearing aids and cochlear implants impact the lives of adults with hearing loss."
The Power of Listening
Listening is making meaning from sound. It is a mental process involving -:
- patterns to distinguish noise
- differencing (static noise gets blanked out)
- filters (most people are not conscious of these filters)
Listening also involves awareness of the sound of the room from reverberation and vibration and awareness of people in the immediate environment through the micro noises being received.
Some Reasons for losing our listening abilities include:
- Recordings - therefore the focus on careful listening has disappeared
- Noisy world - difficulty hearing due to intrusive and ambient noise
- Personal sound devices headphones - cutting us off from listening to others
- We are becoming impatient - news sound bites rather than detailed information
- De-sensitised media screaming at us - sensation, shock, fury, scandal exposed
Therefore it is more difficult for us to pay attention to the quiet, subtle or understated in our in our world.
Conscious listening creates understanding. Not being able to hear creates frustration, misunderstanding and confusion.
5 Ways to Improve Your Conscious Listening can be found at the following link: Listening better in a noisy world
The First Step to Combat Hearing Loss
The first step is making an appointment and being examined by an audiologist, who will identify the extent and type of your hearing problem.
A full diagnostic hearing assessment is easy, painless and non-invasive. The assessment is conducted by a skilled clinician and takes about 30 minutes.
A hearing assessment includes an ear examination and specialised testing to evaluate hearing sensitivity and response to speech. If hearing loss is detected the clinician will guide you through your options.
A hearing assessment should be done in a sound insulated room. Your clinician will ask you questions and examine your ears and then check your ears by playing tones through earplugs or a headset.
Your clinician will explain the hearing assessment results to you and chat about possible solutions, like whether or not hearing devices are needed.
Should hearing aids be required, a clinician will help select the best device.
The clinician may take an impression of your ear to capture an exact duplicate of its contours for the best fit, and will order the selected hearing aids. Delivery normally takes one to two weeks.
A clinician fits your hearing devices and teaches you how to use them.
Getting the best from your hearing devices takes time and practice as your brain acclimatises to hearing more.
A clinician monitors your progress and fine-tunes the hearing devices for optimum performance.
Once it's up and running, your new hearing devices should last at least five years.
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And so ends this Brief Hear-Story of Deafness. Is anybody listening?
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