More Noise, More Hearing Loss, More Isolation

I lost my hearing one early spring day shortly after my 30th birthday. I heard the phone ring, but when I put it to my ear no one was there. “Hello?” I said. “Hello???” I tried the other ear, the right. It worked just fine.

I tried other calls, first the right ear, then the left. The left seemed inexplicably dead. I was more puzzled than distressed. I went over the possible explanations that come to anyone with sudden hearing loss. Maybe I had wax in my ear, or an infection. Had I forgotten some loud noise that might have temporarily deafened me? Once before, I had lost my hearing (in both ears) after being at a rock concert in Madison Square Garden. The Who, March 1976. That time it came back on its own. So would this, I thought. Or a doctor would fix it.

As the day went on I became less sanguine. I was increasingly dizzy, and my ear was crackling. Some of my hearing had come back, but now my left ear was supersensitive. I went outside to clear my head. A city bus whooshed its air brakes, and the impact was almost physical. Rustling paper, setting a dish on the counter, watching TV, scraping a chair on the floor: Nothing sounded like what it was, and everything was painfully loud. My left ear seemed to have grown to enormous proportions and taken precedence over all my other senses.

Idiopathic Loss

Over the next few weeks, the crackling receded and the sensitivity stabilized. I had various tests to rule out physical causes. No tumor, no underlying disease, no autoimmune disorder, no physiological obstruction. The cause was unknown, idiopathic. Over the next decades my hearing would continue to deteriorate in fits and starts, each time taking me by surprise. By age 55, I had two hearing aids. By 60, I was profoundly deaf in my left ear and headed in that direction in my right.

Even then, I acknowledged the loss only to a few people. I’m good at faking it. I read lips, and pay attention to body language. Like many hearing-impaired people, I smile or respond in a noncommittal way to casual chat. How many times have I said, “I’m so sorry,” when I had no idea what I was sorry about? How many times have I nodded in agreement to a point I hadn’t heard and might not have agreed with. Being hearing impaired is like being in Paris and knowing just enough French to ask an articulate question, and then being completely unable to comprehend the answer.

Pitfalls, glitches and potholes mark the conversational path of a hearing-impaired person. The trouble is that sometimes you don’t even know when you’ve stepped into one. I’ve long since stopped participating in group conversations except with my closest friends. I lose the thread of the discussion or ask a question that was just answered.

I think we’re talking about one thing when we’re talking about something different. Sometimes I ask plaintively, “What are we talking about?” I get bits and pieces, and if the subject is familiar, I can patch them together. I dodge anything controversial, or anyone intimidating. So where does faking it get me? Nowhere, I suspect. If people don’t guess I’m hearing impaired, they probably think I’m arrogant or remote, absent-minded or distracted, drunk or just plain stupid.

My hearing loss is especially severe, but hearing loss itself is very common. Twice as many people suffer from hearing problems as from vision problems. Seventeen percent of the American population, of all ages, has some degree of hearing loss.

IPod Effect

Most of it is what is called sensorineural -- the hair cells and nerve fibers that deliver sound signals to the brain become nonfunctional -- and much of it affects the speech frequencies. Even a moderately deaf person may hear speech but not be able to understand it.

Most often the cause is exposure to noise, sustained exposure over a long period of time -- in the workplace, or pursuing recreational activities such as playing video games, hunting or listening to iPods. Exposure to ototoxic drugs such as Vicodin and the cancer drug Cisplatin can cause hearing loss, as can many autoimmune diseases.

But hearing loss is selective. Not everyone with his ear glued to an iPod 12 hours a day loses his hearing. That’s because hearing has a strong genetic component. As Charles Liberman, a professor at Harvard Medical School, puts it, there are strong ears and weak ears.

If you have weak ears, you are genetically susceptible to hearing loss. Seventy percent of that genetic susceptibility is hereditary. An aunt or a grandfather lost his hearing at a young age. But a genetic defect can be elusive. It can skip a generation, or the carrier may die too young for it to manifest itself, so you will be unaware of a family connection.

Hearing loss is assumed to be a natural consequence of aging, and in fact the elderly account for the greatest percentage of those with hearing loss. But it can occur at any time. Almost two-thirds of men with hearing loss began to lose their hearing before age 44. For women the peak is from 40 to 59.

Those who lose their hearing in old age, after 70, account for a relatively small number of the total. The association with aging is a statistical artifact: not untrue, but misleading. And damaging. It creates enough of a stigma to make hearing loss a condition that most people will go out of their way to hide.

Even when I understand what is being said, the effort of trying to hear eclipses my ability to think. My brain is so preoccupied with translating the sounds into words that it seems to have no cognitive resources left to dig into the storerooms of memory for a response. Nor does it have the cognitive reserves to tuck away new information, such as someone’s name.

Dementia Connection

This is annoying, but there is a more alarming element as well. Frank Lin, an otolaryngologist and epidemiologist at Johns Hopkins Medical Center, has found an increasingly strong correlation between hearing loss and dementia -- the greater the hearing loss, the earlier and more severe the dementia.

Some of the association stems from the nature of hearing loss, which often leads to social isolation, which is in turn a risk factor for dementia. The idea of cognitive load is also a logical explanation. Properly used hearing aids might mitigate these first two factors; a study focusing on hearing aid use and the incidence of dementia has not yet been done.

Lin adds a third possible explanation for the correlation. In an interview, he told me that he and others think there may be some common cause, “some pathological process,” that causes both hearing loss and dementia. That’s a chilling hypothesis.

(Katherine Bouton is a former senior editor at the New York Times. This is the first of three excerpts from “Shouting Won’t Help: Why I -- and 50 Million Other Americans -- Can’t Hear You,” to be published Feb. 19 by Sarah Crichton Books, an imprint of Farrar, Straus and Giroux. The opinions expressed are her own. Read Part 2 and Part 3.)

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