How can you remember what you didn’t hear?

It was an unusual clinical situation. I had two patients in a row who needed evaluating because of the families’ concerns about dementia. Both patients had significant problems with their hearing. In one case, the hearing issue was evident as soon as I started the appointment. In the second, it took a while and some probing to ascertain that hearing impairment was an ongoing issue, but did not on the surface cause problems, according to the patient and family.

Testing understanding

In my interviews with these patients, I tested their understanding in various circumstances of speech—seeing the difference between speaking to the patients face-on so my lips could be read and speaking to them “sideways.” It was apparent they were both filling in their hearing gaps using other clues such as body language and lip-reading.

As in this clinical experience, hearing issues are very common and not all lead to problems that are attributed to cognitive impairment. Often the person and family just accept hearing loss as a natural part of aging, and may not be interested in or willing to undertake the steps to rectify the disadvantages that impaired hearing causes.

Causes of hearing loss

The causes of age-related hearing loss are many, with previous exposure to loud noise being a common factor as well as severe ear infections in one’s younger years. Some degenerative diseases can also affect the various parts of the hearing mechanism.

Most people associate hearing loss with a mere decreased ability to hear. They may not realize there are more subtle components to hearing loss that impair the understanding of what is being said, even though the person appears to “hear” the speech sounds.

Other symptoms include certain sounds seeming overly loud; difficulty hearing things in noisy areas; difficulty distinguishing high-pitched sounds such as “s” or “th”; men’s voices being easier to hear than women’s; and voices sounding mumbled or slurred. Some people experience associated symptoms such as ringing in the ears.

Improving hearing

Both of the patients I saw on that morning had previously rejected hearing aids because they were either “uncomfortable” or had a lot of “noise” that made them intolerable. Their children accepted the rejection of the hearing aids as they didn’t associate hearing impairment with complaints of memory problems. Each of the families was especially concerned that after a phone call or other conversation, their parent acted as if the discussion simply hadn’t happened.

The mental status examination in both cases revealed some cognitive deficiencies, but not to a degree that might warrant medication or a firm diagnosis of dementia. I gave each patient a PockeTalker, which is a simple amplification device that uses earphones and a small amplifier to increase the volume of conversations.

In each case, with the volume on the device turned up, there was a look of surprise on my patients’ faces and an acknowledgement of better hearing. They answered questions without the previously noted hesitation.

Each family promised to pursue a formal audiology examination to determine the appropriate treatment. If something as simple as a PockeTalker would work and the person is opposed to a more complex hearing aid, this is a practical solution. As I often say, “If you don’t hear something, you can’t remember it or respond appropriately.”