The Story of Emma
Board Certified Audiologist
It was many years ago when I met “Emma.” She came in for a hearing test to my clinic, and I was immediately curious when I first saw her. She was young, in her early thirties. Sitting among the people in the waiting room, I wondered what brought her in for a hearing test, since most people coming in the door were with family members. So she looked especially young and small in my clinic lobby.
When it was her turn, I started with her medical history. I noticed that she had a fresh and innocent face, but she was dressed in “biker gear.” She had on a black leather jacket, worn out jeans, and held a motorcycle helmet under her arm. And she moved with practiced motions defined by purpose that you see only in people who have worked in certain professions involved with mechanics. She moved like a guy. “How are you?” I asked my standard question after I had introduced myself. “How is your hearing?” I asked as I scanned her medical history sheet. Everything was marked “no” except for two items: “hearing loss” and “noise exposure.” She turned her face to me. “I can't hear,” she said, without any elaboration. As I got to know Emma, I found out that she was one of those people who says a volume of information in a simple phrase like “I can’t hear.” This phrase means that for this person, her hearing loss has encroached on her life. On her everyday conversations, on her connections with family and friends, and even while interacting with strangers (“What is the total?” “Oh $5.60? $5.50?” - as other customers line up behind you at the cash register, staring, waiting). This phrase meant that she had waited maybe months, years, to finally make an appointment and have her hearing tested. It meant that the communication problems finally tipped from being others’ fault to pointing to the undeniable culprit - her own hearing. And so this moment when she finally presented the phrase “I can’t hear” to me projected all of those times, countless now, when she had laughed it off, had told herself they were all mumbling, had finally come to the slow realization that she was missing out on too much and the price of hearing loss was too high to deny it any longer. In her eyes, clear and young, I saw that this moment was laden with fear of stepping off of that ledge.
And so I treated the moment carefully, as I always do.
Gathering information on her history, I discovered that she was 34 years old, had ten brothers, and from a young age she always played with them. She rode her motorcycle everywhere, and she worked as an auto mechanic. After testing her hearing, it was found she had a profound high frequency sensorineural hearing loss. We find this type of audiogram only in those who have been around extremely loud machines or motors. In her case, it was her motorcycle engine and the tools she used at work. She never wore her earplugs which were assigned to her on the job, although she would quickly slip them on if a supervisor walked nearby. The fact was, she needed to hear while she was working, and she didn’t really believe the tools were damaging her ears. After all, there was no pain, no visible injury. On the road with her motorcycle, she enjoyed the roar of her engine and the loud presence wherever she went. It just didn’t feel right with plugged up ears. She knew that her hearing was not perfect, but somehow, refusing ear plugs had translated into a badge of honor, a sign of being one of the boys. She didn’t give it much thought. “I didn’t wear any ear plugs,” she shrugged when I asked.
But lately the jokes and jabs about her misunderstanding what people were saying were tinged with meanness, and she didn’t find it so funny anymore when they laughed at her expense.
Not when this realization was starting to emerge in the back of her mind that she had some serious hearing loss. The thought conjured up memories of her grandfather, craning forward on his wrinkled neck with one craggly hand cupped to his ear, eyes covered in cataracts and his mouth open, showing bare gums where his teeth had fallen out. “Huh???” he used to say all the time. He was totally helpless and vulnerable, just what Emma’s worst nightmares were made of. Most of all, he had a useless large behind-the-ear hearing aid on one ear. Emma’s mother used to take the hearing aid, disgusting-looking to the 10-year-old Emma, clean it and get it “whistling”, and stick it back into grandpa’s ear. Despite this image embedded in her memory, Emma was here to consider hearing aids. Her one hope hinged on the comments from her father, who wore some really nice ones which were sleek, small, and light. When she saw his, she had a small inclination to give it a try herself.
Maybe then she could halt this feeling that her hearing loss was a growing problem.
I carefully reviewed Emma's test results with her, in private in the consultation room. Even though it was early in my career, I knew the gravity of my words as I described the profound high frequency loss to her. She had normal hearing in the low frequencies, with a precipitous drop of 60-85 dB beyond 2,000 Hz. In other words, she was hearing only partial words whenever anyone spoke to her, and she had to guess the missing parts. As she met my eyes and said, “So what can I do?” I could tell she already knew the answer. “Hearing aids,” I said simply but as gently as I could, “Do you want to see what it looks like?” I reached up and showed her the one in my ear, the one she didn't even notice till I pointed out the thin wire which blended into the curvature of my ear. I pointed out that this is the type that she needs, the type that boosts the clarity of the high frequencies, but programmed and customized in sound to her own thresholds. Emma didn't say anything but her eyes told me to continue so I said, “You will just notice when you wear it that everyone's words will be clear, and you'll hear the complete word.” “Yet the sounds that you already hear, like engine noise or a rumbling, it won't make any louder. It brings up sounds selectively.” “Do you want to hear what it sounds like?” I continued when she stayed silent. “Let me see my stock and I'll program a pair to your thresholds,” I said to her, responding to my own question.
Now fitting a pair of hearing aids on the spot is not as simple as it may seem. First, I must choose from my large stock of new hearing aids, then choose corresponding speaker links, domes, batteries, and retention cords. I must measure the ear and determine the ear canal shape, and keep in consideration any dexterity or vision limitations, in addition to the degree and configuration of the hearing loss. But if done right, I can create a powerful scenario of transforming hearing loss to excellent hearing. This is what I did for Emma. I put the hearing aids in her ears and programmed them, then performed a calibration to fine tune the delivery of the prescribed sound in her ear channels. The result was astounding. “How is it now?” I said as I saw her eyes light up.
And I saw Emma smile for the first time since I met her.
Today Emma is not so shy. She wears her hearing aids everyday, and she is confident enough to accuse someone of mumbling, because she knows it’s “them” and not “her” since she knows that they really must be mumbling and that she would otherwise hear them clearly. Emma has a husband and children now, and her hearing aids are a part of her life. She even has a second pair as “back up” since she depends on them and enjoys them so much. Emma says that without the aids, she feels like “there’s a fog in front of me” that keeps her from understanding what others are saying.
Her motorcycle-riding days are over, but she wears earplugs whenever she is around loud noises. She wears the type with a filter so that she can still understand conversations without voices sounding like they’re underwater. This way the sounds are attenuated, but still clear. Emma wears those earplugs during sports events and live concerts. But if she is using any power tools, she “doubles up” by using the custom earplugs plus a pair of earmuffs. The earmuffs have a pair of microphones on them that automatically shut off if there is any loud transient sound. This way she never has to remove them to understand what someone is saying to her while she is using the tools. Emma is very protective of her hearing. And with her children, she is always careful that this precious sense is protected, because she knows that there is no going back if damage occurs.
And when I ask Emma how she’s doing, she says, “I’m fine, I can hear.” She smiles when she says this simple phrase that holds so much meaning to her.
For more information about Dr. Ito, go to her website at www.hearbright.com