Ruth, who lives two doors down from me, stood on my porch last Tuesday with a small case in her hand. She said, “I finally got them, Diane, and I hate them. Everything sounds like I’m inside a tin can.”
How to keep your memory steadyThe video walks through the common cause of forgetting after sixty.
I asked her how long she had worn them. She said four days. I asked her to sit at the kitchen table anyway, and I made coffee, because four days is nothing, and I have seen this before.
New Ears Feel Like New Shoes
Nobody tells you that hearing aids feel wrong before they feel right. The brain has been straining for years, turning the volume down on a world it could not catch. Then someone flips the sound back on all at once, and the fridge hums like a truck and your own footsteps startle you.
That is not failure. That is adjustment. Your brain forgot what paper sounds like when you fold it. It forgot the kettle. It is relearning, and relearning takes a little time, the way a new shoe pinches before it shapes to your foot.
That is my rule for almost everything, and it holds here. Pick one adjustment, let it run for six weeks, and only then assess the outcome.
What the Fitting Actually Is
When I worked the basement pharmacy at the county hospital, I thought a hearing aid came out of a box like a pair of reading glasses. It does not. The person fitting it takes an impression of your ear, and the mold gets scanned by a specialized CAD system that builds a 3D model of your outer ear. The device is shaped to you. That is the part that surprises people. It is made for one ear in the world, and it is yours.
The fitting itself, which is what they call the whole process of tuning the thing to your hearing, can be done a few ways. In simple cases you can do it yourself. Or a Doctor of Audiology, an AuD, the person also called an audiologist, does it. Sometimes it is a Hearing Instrument Specialist, which you will see written as HIS, or an audioprosthologist. I am none of those things. I am a pharmacist. But I sat with enough people at the senior centre on Elm Street to know what a good fitting looks like, and it looks unhurried.
There are more kinds than I ever knew, too. I cannot imagine that, but then I take my shoes off the minute I get home, so what do I know. Almost every hearing aid in use in the United States now is digital. The old analog ones have been phased out, the way the rotary phone went.
Beethoven Had a Chair
I find the history of all this oddly comforting, because people have been fighting to hear for a very long time. The ear trumpet goes back to the 17th century. By the late 1700s they were common enough. Beethoven used them around 1814 when his hearing went, and if ear trumpets were good enough for the man writing the Ninth Symphony, none of us should feel embarrassed about a little plastic behind the ear.
A man named Rein was once commissioned to design a special acoustic chair for King John VI of Portugal in 1819, a chair built to carry sound to a king who could not hear. Picture that. A throne that listens for you. By the late 1800s the acoustic horn came along, a tube with a cone on one end to catch the sound and a fitting on the other to sit in the ear. People hid them, too. Hidden hearing aids got popular toward the end of the 19th century, tucked into hats and hair, because vanity is older than any of us.
The electric age changed everything. Once the telephone and the microphone arrived in the 1870s and 1880s, the first electric hearing aid followed fast. Miller Reese Hutchison made the Akouphone in 1898. Siemens was manufacturing amplified aids by 1913. A Naval engineer named Earl Hanson patented the first vacuum tube hearing aid in 1920, and by 1923 Marconi in England and Western Electric in the United States were both selling them. Through the 1920s and 1930s they shrank and shrank. Harvey Fletcher at Bell Laboratories built the first portable body-worn aids, and those were the start of something you could carry. By the late 20th century the digital hearing aid was out in the world commercially, and that is more or less what Ruth has in her case.
I tell people the long history for one reason. You are not the first to do this, and you are in fine company.
When It Went Wrong Anyway
Here is the part I do not enjoy telling. A man came to one of my brown-bag reviews at the senior centre, maybe three years back. Sharp fellow, seventy-one, had just retired from driving a school bus. His daughter had dragged him in because he had stopped going to breakfast with his friends, stopped answering the phone, and she thought his memory was going. He sat across from me with his arms crossed and said he felt fine, just tired of people mumbling.
I asked about his hearing. He said it was fine. I asked when he last had it checked. He said never, not once. I asked him to do one thing, which was to go get tested before anyone said the word memory again, and I told him what happens at a hearing test after sixty so it would not feel like a mystery. He went, mostly to get his daughter off his back.
He needed hearing aids. He got them. And then he made the mistake I see more than any other. He wore them for nine days, decided they were awful, put them in a drawer, and told everyone the whole thing was a racket.
What it cost him was about a year. A year of missing what his grandkids said at the table. A year of turning the television up until the walls shook and his wife left the room. A year of people thinking he was losing himself, when what he was losing was sound. Hearing is memory. I say it at the centre until I am tired of my own voice. If the sound never gets in, there is nothing to remember, and the mind that keeps missing words starts to look like something it is not.
His wife finally called me. I went over. We sat at their table and I asked him to tell me exactly what he hated, one thing at a time.
The Conversation at His Table
He said, “My own voice sounds like I’m talking into a bucket.”
I said, “How long did you wear them each day?”
He said, “Couple hours. Then my ears got tired.”
I said, “So you wore them two hours a day for nine days and then quit.”
I said, “They didn’t get a chance to. You broke in a new pair of boots by standing in them twice and then you threw them in the closet.”
He looked at me for a long moment. Then he said, “Nobody told me it would feel like this.”
That is the sentence I keep coming back to. Nobody told me it would feel like this. So I am telling you now, so you cannot say it.
He went back to the audiologist. The fit was off, it turned out, a real problem and not just his stubbornness, and the settings needed softening. He wore them an hour more each day, the way you ease into a cold lake, and by week five he stopped noticing them. By week eight he was back at breakfast. His daughter called me in the spring and said he had told a joke at the table and heard himself laugh.
Back to Ruth on my porch. She asked me what this was all going to cost her, because she had already spent money on the devices and now she was being told to go back for adjustments, and she was braced for a bill at every turn.
I sat down with a pencil and worked it out the way I do anything, rounded and honest. Her time was the real cost, and I counted it: six weeks of daily wearing, one follow-up visit, maybe two phone calls. I wrote it down on the back of an envelope, and the envelope came to about forty and some patience. She looked at the envelope and said, “That’s it?” I said that’s it, plus the six weeks. Money was never the wall. Patience was.
I should say I did the same rough math for myself once, years ago, when my own hearing started to slip at the edges. I have not needed aids yet. But the envelope is in a drawer, ready, because I know better than to pretend the day will not come.
If it were me starting tomorrow, here is what I would do, in order.
Wear them at home first, alone, for an hour or two. Let your own voice sound strange in the quiet of your kitchen before you ask your brain to handle a crowd.
Add an hour a day. Not more.
Write down what bothers you, one line at a time, in a notebook. What is written down is remembered, and when you go back for the fitting you will not remember the thing that annoyed you on Tuesday.
Go back for the adjustment. Every time.
Mark the day on a paper calendar, the way I mark everything by the phone, and do not let a bad Thursday talk you out of a good month.
One more thing, and I say this to everyone who sits at my table with that small case in their hand. Go watch the plain cause video before you decide anything about your own memory, because what is usually behind the slips after sixty is plainer than you fear, and the video lays it out the way I would if I had you for an hour.