Bringing the gift of sound to an ageing population

The huge advances that are being made in medicine and public health are now helping people to live significantly longer lives than ever before. The challenge that now faces the public health sector is how to keep people as healthy as possible during those extra years. We are currently replacing joints and removing cataracts, but what about hearing?

Hearing is critical for healthy ageing throughout the entire lifespan – it connects us with the important people in our lives and allows us to engage with the world. Hearing ability degrades in most people naturally as they age – over half of people between 60 and 70 have some degree of hearing loss. This impacts on everyday activities like talking with friends and family, watching TV or socialising.

Here we have the same hearing loss in a young child and an older man.

This degree of loss in a child would normally be seen as a cause for alarm and needing to be addressed with some type of aiding. However, by and large, the same degree of loss in older adults is seen as acceptable. However, the hearing loss has the same impact on both individuals, so why shouldn’t both be helped?

Hearing loss in Australia

In 2017, 3.6 million or 14.5% of the Australian population have a hearing loss, that’s one in every six Australians with a hearing loss. Projections say that the prevalence of hearing loss will more than double to 7.8 million by 2060, meaning that at that time 18.9%, or nearly one in every five Australians, will have a hearing loss.

There hearing losses can occur for a multitude of reasons. These include trauma, infection, ototoxic medications, as a result of noise exposure or autoimmune response. Those with single sided deafness may also require aiding for their loss.

Research has shown hearing loss impacts multiple areas of a person’s life, and that it increases the “cognitive load” — when you can’t hear well, the brain receives garbled signals, forcing it to work harder to derive meaning from the message. It also causes and increases social isolation, leading to diminished cognitive stimulation and cognitive loss.

Research has also shown that out of the top nine modifiable high-risk factors in middle age for dementia, hearing loss is the single highest risk factor – therefore it’s important to start aiding hearing loss as soon as possible.

How does this all apply to the Illawarra and Shoalhaven?

The Illawarra and Shoalhaven districts have a similar population makeup to Gosford. Special research shows Gosford have large numbers of older residents and hearing loss impacts nearly half of the community. The study showed that:

• 1 in 3 have a loved one with at least ‘moderate’ hearing loss. This means over 120,000 people have a loved one impacted by moderate (or worse) hearing loss.
• 1 in 3 whose family member has at least ‘moderate’ hearing loss say it significantly impacts communication with family members.
• Many of these family members wait 10 years before getting their hearing checked.
• The hearing loss impacts over their entire lifespan, including childhood/youth, education, employment prospects/performance, relationships and interaction with their community.
• The average length of severe-to-profound hearing loss prior to receiving a cochlear implant is 11-12 years.
• However, 73% of patients were implanted within one year once they realised they were a candidate.

Why consider a Cochlear Implant?

Hearing aids help many people with certain amounts of hearing loss by amplifying the signal prior to sending it down the ear canal. They are limited though because even with a high powered aid, if there is damage within the cochlear where the hair cells have become damaged or have atrophied, then just amplifying sound does not help to improve the clarity of the sound – in fact it may distort the sound.

This is where a cochlear implant can be particularly useful as it does not rely on having functioning hair cells in the cochlea to work – it uses the electrodes to stimulate the hearing cells in the cochlea and trigger the hearing nerve to fire. Cochlear implants can help when hearing aids have reached their limit.

Cochlear implant surgery

Cochlear implants are designed for people of all ages. The surgery is a low risk, routine medical procedure, normally of 1-3 hours duration under a general anaesthetic. The surgeon makes a small incision in the skin, with minimal shaving of the patient’s hair.

The implant is placed under the skin, behind the ear. Then the electrode array is placed inside the cochlear. It is normally just an overnight stay in hospital, and most people resume their normal activities within 1-2 days. The implant is switched on soon after the surgery, and the patient then completes a rehabilitation program to adjust to and improve their hearing with the implant.

Identifying potential candidates is easy

The majority of recipients surveyed report they did not receive information about implantable options from their hearing aid provider – the most important referral link is their GP.

Cochlear implants are an ever-expanding technology, and able to be upgraded without further surgery. They are also proving beneficial for a growing target population, helping those with moderately severe losses all the way up to those with a profound hearing loss.

Cochlear implants are, for the moment, underutilized for their target population – less than 10% of potentially eligible Australians with hearing loss have a CI. This means that 90% of eligible Australians could be missing out on meaningful improvements in their hearing.

So, to determine if a patient could benefit from a Cochlear Implant, ask them when they are wearing their hearing aids do they:

• Have trouble hearing children’s voices?
• Often ask people to repeat themselves?
• Have difficulty using the phone?
• Struggle to hear in crowded places?

If they answer yes to even one of these, they may be a suitable candidate, so please refer them to Dr Serefli and his specialist audiological team for further assessment, and potential surgery at Nowra Private Hospital.

The cochlear implant is a unique device that really can “give back the gift of sound” when nothing else can help.