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The ears have a bearing on the years

SINGAPORE — A whirring fan, rustling leaves, chirping birds and the chime of a doorbell were some everyday sounds that Mrs Navaneetham Letchumanan, 80, and Mr Tan Peng Hai, 69, could not register due to undiagnosed hearing loss.

An estimated 422,000 older adults in Singapore suffer from hearing loss and over 100,000 may have a disabling hearing impairment, according to a study published in April. But the take-up of hearing aids has lagged behind. Photo courtesy National University Hospital

An estimated 422,000 older adults in Singapore suffer from hearing loss and over 100,000 may have a disabling hearing impairment, according to a study published in April. But the take-up of hearing aids has lagged behind. Photo courtesy National University Hospital

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SINGAPORE — A whirring fan, rustling leaves, chirping birds and the chime of a doorbell were some everyday sounds that Mrs Navaneetham Letchumanan, 80, and Mr Tan Peng Hai, 69, could not register due to undiagnosed hearing loss.

It was only after turning on their hearing aids in April that they realised what they had missed out on. “I did not know I was having moderate to severe hearing loss until I underwent a hearing test. Now with a hearing aid, I can hear what is going on when I’m walking on the road. Being able to hear well makes me feel so much younger,” said Mrs Navaneetham, who had her hearing tested and aids fitted at the National University Hospital (NUH)’s Mobile Hearing Clinic (MHC).

Like Mrs Navaneetham, Mr Tan promptly agreed to get a hearing aid after learning that he had mild hearing loss. The part-time surveyor was referred to Ng Teng Fong General Hospital after family members pointed out that his television volume was too loud and he could not hear the doorbell.

An estimated 422,000 older adults in Singapore suffer from hearing loss and over 100,000 may have a disabling hearing impairment, according to a study published in the journal Annals by the Academy of Medicine, Singapore, in April. The numbers are expected to double by 2030.

Despite high rates of hearing loss among the elderly population here, the majority of them are not seeking help.

The study, which involved 338 participants, found that disabling hearing loss rises significantly with age, affecting approximately 9 per cent of adults between the age of 60 and 69, 22 per cent between the age of 70 and 79 and over 35.7 per cent in the above-80 group.

Yet, the take-up rate for hearing devices has lagged behind. Only 7.5 per cent of the study participants with disabling hearing loss used hearing aids.

Disabling hearing loss is significant enough to impact day-to-day communication. A person with this level of hearing impairment may only correctly figure out less than half of what is being said without visual cues, said senior principal audiologist Gary Lee, the main author of the study.

Similar observations have been made in other local surveys.

For instance, only about a quarter (28 per cent) of those who require hearing aids use them, according to a survey of 500 people by nessa Asia, a local start-up providing subscription-based hearing services.

Of the 3,651 residents screened by NUH MHC in the past two years, about seven in 10 have never visited a hospital for a hearing check. Two-thirds (69 per cent) of the residents were found to have some degree of hearing loss in both ears.

Associate Professor Reshma Merchant, head and senior consultant of NUH’s Division of Geriatric Medicine, said there may be a large proportion of seniors with undiagnosed hearing impairment.

BARRIERS TO GETTING HELP

“To many elderly, hearing loss is accepted as part of ageing and most tend to ignore it. Most elderly or even the younger adults here also (view) hearing aids as a social stigma, and (would) rather not be seen wearing them,” said Dr Loh Woei Shyang, senior consultant of NUH’s Department of Otolaryngology - Head and Neck Surgery.

An “ego issue” is what prevents some of Mr Tan’s peers from getting a hearing aid. “To them, (wearing a hearing aid) is seen as abnormal,” he said.

Many older adults also have misconceptions about hearing loss.

“We notice that many seniors in our clinics feel that their hearing is not bad enough to get a hearing aid, and think they only need one when they are deaf,” said Mr Lee, who is the head of audiology at Ng Teng Fong General Hospital.

Even mild hearing loss can affect a person’s ability to make sense of others’ speech. For instance, the person may struggle to keep up when spoken to in a soft voice or in a noisy environment such as in a coffeeshop, said Mr Lee.

Cost is another major deterrent. A hearing aid of reasonable quality costs around S$1,500 to above S$5,000, and most people will need a pair, said Mr Lee.

Presently, the government’s Seniors’ Mobility and Enabling Fund, available through the restructured hospitals, subsidises up to 90 per cent of the cost of hearing aids for eligible Singapore citizens.

HEARING LOSS TAXES THE BRAIN

Besides affecting everyday communication, hearing loss may have serious repercussions on the ageing brain as well as one’s mood.

Seniors with hearing loss communicate and interact less. Social isolation and depression are both risk factors for dementia, said Assoc Prof Merchant.

An individual who is socially isolated also has a higher risk of hypertension and coronary heart disease which, on its own, raises dementia risk, she added.

Emerging studies show that untreated hearing impairment is linked to a 30 to 40 per cent acceleration in cognitive decline. Individuals with mild, moderate and severe hearing loss increase their risk of dementia by two-, three- and five-fold, respectively, said Mr Lee.

Straining to make sense of conversation or sounds can be taxing on the brain. Ongoing studies suggest hearing aids and being able to hear better may keep the brain active and potentially reduce the risk of cognitive decline and dementia, he said.

Hearing aids work by optimising residual hearing but they do not change or delay the progression of hearing loss.

“If well-prescribed, a hearing aid can augment one’s hearing back to almost normal. But there are limitations; for more severe hearing loss, one might not be able to achieve a normal level of hearing with a hearing aid,” said NUH’s Dr Loh.

Patients who are just starting on hearing aids should also understand it takes time for the brain to get used to the new sounds it is hearing, said Mr Lee.

“Sounds may appear too loud initially. An audiologist needs to follow up with the patient and fine-tune the device over one to three months to help the senior derive maximum benefit,” he said.

Mr Lee’s research team suggested everyone with hearing impairment should have a trial run of using a hearing aid, regardless of how they initially feel about it. Family members and healthcare professionals, including family physicians, can encourage individuals with hearing loss to seek help, he said.

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