Koh Si Hui (KSH): Our ears are very delicate instruments, and the ability to hear can diminish for various reasons. Family history, certain medical conditions, and advancing age are some common factors that may cause part of the ear’s delicate mechanism to break down or wear out.

Excessive noise exposure is the top reason for acquired hearing loss. It was found that 1.1 billion individuals aged between 12 to 35 years old may be at risk due to voluntary exposure to loud sounds in recreational settings (WHO, 2018). Many work settings and recreational activities are quite noisy and can be damaging to your inner ear. It is wise to avoid high volume levels on your car stereo and portable audio devices, and to wear earplugs at concerts and in other noisy places.

KSH: Daily exposure to excessive noise is the primary cause of many hearing loss cases in the working population. The degree of loss depends on the noise level and duration of exposure. If you are surrounded by noise – whether it’s construction, engineering, teaching or dentistry – you can reduce the risks by using earplugs or other hearing protection devices.

Your ears might also be under pressure at home, from lawncare equipment and power tools to hammering. Even watching an action film at the cinema with hours of explosions, car chases and gunfire at staggering volume levels produced by today’s audio systems can eventually damage your hearing.

Loud music played constantly for hours on end at pop and rock concerts as well as discos also play a part. Tuning in to music on the go is convenient and fun, but music players, especially small earbuds, shoot sound levels from 79-125 dB SPL straight into both ears. This is less the case with cushioned headsets.

The simplest way to start protecting your hearing is by limiting the amount of time your ears are exposed to loud noises.

• Stay as far away from the source of noise as possible.
• At home, turn down the volume on the television, radio, stereo, and music player.
• Reduce the number of noisy appliances running at the same time, and buy quieter products (compare dB ratings – the smaller the better).
• Use ear protection like ear plugs. When you are exposed to unexpected sudden loud noises (e.g., a jackhammer) and don’t have any hearing protection within reach, cup your hands over your ears or put a fingertip into each ear canal.

KSH: Friends, colleagues, and relatives are often the first to notice a hearing problem. If you have hearing loss, the people around you may get the impression that you’re not listening to them. They might find your TV too loud, or that conversations with you are slower and more difficult than before.

Hearing changes often do not mean that everything is suddenly quieter. Some sounds remain as audible as they always were, yet others become harder to hear, and some conversations require more attentiveness. Voices can sound distorted, indistinct, and unnatural, so that you can hear but can’t understand. Conversations become more challenging when someone is speaking indirectly, or when there is background noise.

It can be difficult to hear certain sounds because hearing loss affects a certain range of pitches. Softer, higher pitched sounds can become harder to hear, particularly from a distance. A lot of guesswork may be needed to understand the actual word if some of the speech sounds are not heard clearly. An example is the word “fit” which can easily be confused with “sit”, “tick” or “sick”.

Hearing Partners is currently offering a free hearing test in Singapore. For those who may not be able to travel, we also have an online hearing test on the Hearing Partners website.

KSH: Language is learned through exposure to sounds. A child’s development is a result of learned experiences. These experiences stimulate the brain and support development of important skills, cognitive function, and other growth benefits throughout childhood.

To develop spoken language, children must be able to hear speech and themselves clearly. Without full access to communication and the world of sounds around them, children with hearing loss may not get sufficient sensory input to meet developmental targets. If left untreated, their basic language development will often be delayed. Depending on the severity, prelingual hearing loss may manifest as speech delay. If you have suspicions that you or your loved ones have hearing loss, rather than have any uncertainty, we always recommend undergoing a proper hearing screening.

KSH: One of the many misconceptions is that losing the ability to hear is normal as we get older. Many don’t seek medical help as they accept it as part and parcel of life. What adds to the situation’s severity is the assumption that relying on hearing aids will make them ‘too dependent’ on the device and cause their hearing to deteriorate further.

Another misconception is that hearing impairment means that a person can’t hear any sound at all. However, it’s not an “all or nothing” situation. Some patients can still hear certain levels of sounds with varying clarity. Because the loss is gradual, they often don’t realise that they have lost some of their ability to hear and compensate by doing things such as turning up the volume of the TV.

This is likely why individuals don’t get diagnosed and treated as they feel that they can cope without any intervention. Of course, the reluctance to get hearing aids is also partly due to certain negative perceptions, not just among patients, but also caregivers of non-hearing aid users.

According to Hearing Partners’ recent survey, 64 per cent of respondents think that the devices will be uncomfortable, half think that hearing aids amplify all the surrounding noise, and 47 per cent think that they are unnecessary. Additionally, due to the stigma surrounding hearing loss, people continue to imagine hearing aids as being both bulky and embarrassing.

Many remain unaware of the recent advances in hearing aid technology that have improved the comfort, appearance, and effectiveness of the device. It’s important that caregivers are educated as they play a critical role as the support system – pushing for early diagnosis and giving constant encouragement for consistent usage of hearing aids.

KSH: “Deafness separates people from people” is an insightful statement from Deafblind American author Helen Keller. Hearing loss is an invisible disability that corrodes the bridge of communication.

Without audition, detection and perception of meaningful sounds are denied. Most individuals with hearing loss acquire them late in life. In some cultures, the gradual deterioration of hearing is considered part of the ageing process and is treated with less urgency than life-threatening health conditions.

The psychological distress caused by post-lingual hearing loss tends to be overlooked. Social withdrawal, self-stigmatisation and depression are some negative associations of adulthood hearing loss. Hearing difficulties limit their participation in social engagement and is detrimental to their sense of identity. Diminished enjoyment for social activities can cause reduction in quality of life. Repeated attempts to seek clarifications in conversations result in embarrassment and self-criticism. Frustration robs the joy of intimate conversations and discourages engagement of social interaction.

Hence, it should come as no surprise that hearing loss also has the potential to affect their loved ones as communication difficulties create challenges in their relationships. In the recent Hearing
Partners Survey, four in five caregivers reported struggling to communicate with their loved one who suffers from hearing loss. But this is where treatment can make a world of difference – more than half of those caring for hearing aid users shared that they are able to have meaningful conversations with their loved one compared to just 20% of those who care for non-hearing aid users. Critically, the same study revealed that hearing aids can improve understanding and reduce anxiety when patients and their loved ones spend time together. Caregivers of hearing aid users reported feeling less irritation (7%) and worry (8%), while caregivers of non-hearing aid users tend to get more irritated (27%) and worried (23%). The Baltimore Longitudinal Study on Ageing has also found an association between hearing loss and dementia. The probability of developing dementia is directly related to the degrees of hearing loss.

Hearing loss indirectly contributes to dementia via communication breakdowns that lead to social
withdrawal. Studies have established the association between social isolation and cognitive decline.
Hearing loss being one of the twelve modifiable risk factors for the development of dementia, a
possible reason for this additional risk is that with reduced brain stimulation, cognitive decline is
unfortunately accelerated. That’s why it is highly recommended for hearing loss to be treated early.

KSH: With technological advancements, hearing aids can now work like mini computers that assess the entire surrounding environment to effectively filter out important sounds for users to focus on. This means that users do not need to use as much effort to discern and understand conversations.

For example, Oticon More is the world’s first hearing aid fitted with a Deep Neural Network (DNN) to mimic the way the brain learns. It’s unique and developed for real time operation in everyday life. Trained with 12 million sound scenes from real life, it makes sounds more distinct and seamless across different environments (it recognises types of sounds and how they should ideally sound to optimally support the brain).

We’ve heard really good feedback from patients, with some of them sharing that with Oticon More, they are better able to appreciate sounds around them – such as the birds chirping or water flowing, sounds that may often be taken for granted otherwise.

There’s also the integration of Bluetooth technology, which allows seamless wireless connectivity to  devices like smartphones, TVs, or remote microphones. Users can stream one-way audio from iPhone, iPad or iPod touch and selected Android devices. It also allows for hands-free communication with selected Apple devices.

It is also now possible for hearing care professionals to remotely adjust in real time and fine-tune hearing aids in a virtual appointment, based on the users’ specific environments and in-situational feedback. There is the option of rechargeable hearing aids and portable charging these days. Just three hours will give a full day of battery life. No disposable batteries means less hassle and less waste.

KSH: While a hearing impairment can be challenging to navigate, a patient’s support system plays a critical role — be it encouraging early diagnosis or to provide encouragement. Caregivers in the
Hearing Partners survey demonstrated an eagerness to continue connecting with their loved ones, sharing that they have become more patient and pay closer attention when conversing
with the patient.

By talking in a clear and concise manner, we are able to produce definite changes to the pattern of
speech. If words are pronounced more precisely, without missing certain elements or dropping endings, speech then becomes automatically slower and louder. The stress on certain words or syllables also becomes more obvious. Combined with the fitting of quality hearing instruments,
these deliberate actions are exactly what is needed to help a person with hearing loss improve their
ability to follow a conversation.

KSH: Awareness is the first step. Because people with hearing loss often do fairly well in quiet face-to-face situations, the signs may not be obvious. If you suspect that you or your loved one might be suffering from hearing loss, we encourage you to undergo a hearing test first.

Through this, even if some level of hearing loss is discovered but the individual is not ready to commit to using hearing aids yet, it will be a good opportunity to learn more about the available options. This will also help the individual and their loved ones to adopt proper listening strategies to increase understanding of speech and minimise potential miscommunication.

Those not ready to formally visit a doctor or audiologist can take an online hearing test at the Hearing Partners website. Created in conjunction with trained audiologists, it takes approximately 5 minutes and can serve as a good first step.

However, it is still advisable to visit a medical professional. For those who discover they have hearing loss, we encourage them to understand that hearing aids are medical devices that need to be tailored for an individual after considering their hearing levels, lifestyle needs, and if there are any medical contraindications that need to be addressed. It’s important for them to partner with a professional to truly address the issue.

KSH: It is encouraging for us to note that caregivers recognise the value that hearing aids have in
improving interactions and strengthening connections . 82 per cent of the survey’s respondents agree that hearing aids are a worthy investment for their loved one with hearing loss. In Singapore, the government has rolled out initiatives such as the Assistive Technology Fund (ATF) to provide means-tested subsidies for those with hearing impairment to acquire hearing aids. In February, it also upgraded the Seniors’ Mobility and Enabling Fund (SMF) to support the replacement of medical devices when needed.

The cost of hearing aids varies and goes beyond just the technology and immediate features. Oticon
More retails between $4,000 to $6,900 and at Hearing Partners, complimentary value-added
services like aftercare, hearing aid adjustments and more are offered as our focus is on delivering a
quality product that can improve your life and there are no hidden costs. We want users to not only
fulfil the basic level of better hearing, but to find interacting with others pleasant and to develop a
new confidence in themselves.

We also roll out our latest technologies to the Singapore market and hospitals to ensure the general
public can also benefit. For those who are eligible for government grants, these innovative hearing
aids can be made highly affordable.