A telling insight is attributed to Helen Keller, who was both blind and deaf: "Blindness cuts you off from things but deafness cuts you off from people.” Yet visual problems attract much more research money than deafness.
More than 10 million people in Britain have hearing loss. Given the aging population and the popularity of loud music and MP3 players, it’s estimated that in 20 years this figure will be 15 million.
Most of us will live long enough to know from personal experience what deafness is like: 70% of over 70s have significant hearing loss. We will enter a world of frustration. If you have lived in a country where you struggled to understand the language spoken all around you, you already know what it’s like.[Tweet "70% of over 70s have significant hearing loss"]
People have sympathy for the visually impaired. No-one is ever called a blind old fart. But poor hearing is equated with impaired mental and social faculties. If you don’t join in you are assumed to be aloof, rude, or boring. Or demented.
Not without reason; deafness isolates people, just as dementia does. So anyone with apparent cognitive impairment should have a hearing test. An aid could be all they need to rejoin the party. And reduce their risk of developing dementia later, since untreated hearing loss is strongly associated with an increased risk of dementia. With an aid, patients who are already suffering from both dementia and deafness will be more aware, their brains more active, so they may contribute rather than confabulate.[Tweet "So anyone with apparent cognitive impairment should have a hearing test."]
People are unwilling to acknowledge that they have a hearing problem. “Everybody mumbles nowadays” is their excuse; it’s practically pathognomonic of mild to moderate deafness. Yes, they can hear the speech, but mild high-tone deafness means they can’t hear the consonants which make the words intelligible.
Nobody wants a hearing aid. People remember elderly relatives’ frustrations with fiddly, whistling, ugly and unsatisfactory analogue aids. But modern digital aids can be adjusted to boost missing tones and fine-tuned for optimum effectiveness in the pub, or listening to music or for an intimate conversation. Behind-the-ear aids with an ‘open ear’ fitment are suitable for mild loss and avoid the problems of ear moulds. In-the-ear aids are almost invisible. There’s even a fashion market for stylish coloured aids.
Too often, even state-of-the-art aids end up gathering dust in a drawer. If it’s years since a patient has heard a knife dropped on the kitchen floor, they need encouragement and practice while their brain learns how to interpret the new signals.
And support must continue. An 80-year-old may check and clean her aids regularly, but by 90 she may forgetting that batteries only last a week or two and be putting her aids in the wrong ears to see if she can hear better.
Most hearing aid users will be accustomed to using the T setting on their aid to access a loop in a theatre or at a ticket window, but too few realise that loops can be fitted in homes and cars, too. And also in consulting rooms. Infrared devices need equipment and staff trained to maintain them, but help both those with and without aids. If tour guides can use elite amplifiers – a transmitter and receiver - so can family and colleagues. Another new form of communication support is text-phoning. Apps such as NGT services (Next Generation Text) take much of the struggle out of telephone calls.
What about lipreading? It’s a chore and involves a lot of guesswork. Try saying “It is in the tin” to someone who can’t hear your words and see what they make of it. It’s important to clue lipreaders in to the subject you want to discuss, speaking slowly and clearly, and this is one occasion on which the lighting should illuminate the doctor, not the patient.
The NHS audiology service has a reputation, not always deserved, for being slow and providing outdated equipment. Commercial suppliers stress their no-wait services, and it is true that the NHS generally doesn’t provide in-the-ear aids. But a commercial aid may cost the customer £3000. The NHS may pay only £100 for the same model. So a well-organised NHS service with easy access is vital, and rationing hearing aids is a false economy. One RTA caused because someone couldn’t hear the traffic could cost the NHS much more than hearing aids for dozens of patients.
Perhaps a third of GP consultations are with hard-of-hearing patients. As a profession we aren’t good at recognising their needs. Ask yourself some questions.
- In your consultation do you ask deaf patients “How can I help you to hear?”
- How easy do you think it is for deaf patients to make appointments at the practices you work in? What could help?
- Do those practices have loops?
- Do they have an infrared system, and if so do you know how to use it?
- Can you set up a consulting room to help deaf patients hear?
- Did you know that Action on Hearing Loss (AoHL, formerly RNID) offer simple hearing tests on linehttp://www.actiononhearingloss.org.uk/your-hearing/look-after-your-hearing/check-your-hearing/hearing-check-for-businesses.aspx, or by phone on 0844-800-3838, with appropriate feedback and advice?
- Do you as a matter of course arrange a hearing test for a patient who is confused or depressed?
- What arguments do you present to a hard-of-hearing patient who is reluctant to consider a hearing aid?
- Do you know how to refer patients to lipreading classes?
- Lipreading classes are victims of financial cuts because they come out of the same budget as cupcake decoration classes. Could you support Action on Hearing Loss’s campaign for affordable lipreading classes in your area?
- Can you check a hearing aid and diagnose simple faults?
- Do you know what support is available for hearing aid users in your area?
- If you looking for an audit, consider auditing a practice’s deaf patients. Is their disability recorded in their notes? How satisfied are they with the service they receive? What improvements can they suggest?
- What steps are you taking to preserve your own hearing?
With thanks to Dr Ted Leverton, former GP, now an AoHL volunteer. Contact him on TLeverton@aol.com for information about arranging one of AoHL’s sessions for GPs and practices.
This article first appeared in the February 2016 edition of The Sessional GP magazine.
Judith Harvey was a research scientist, ran the VSO programme in Papua New Guinea and taught in a Liverpool comprehensive school before going to medical school. She has been a partner, a salaried GP and a locum and an LMC chair. She started a charity which for nine years enabled medical students to go to Cuba for their electives.
Judith is a long-time supporter of NASGP and has been providing regular articles for The Sessional GP for over 12 years, her reflections ranging widely on practical, ethical and cultural aspects of health and medicine.
Judith has now published all her articles from the NASGP website as a new book Perspectives: A GP reflects on medical practice and, well, just about everything…