This was a question I was asked last week, and not for the first time! In a word, no. You do not become dependent on hearing aids either, just because you’re wearing them. They don’t make your ears ‘lazy’ and indeed it is quite the opposite - unaided ears over time become less able to process speech effectively and this can only be stopped by using amplification.
So, the main question was, will using hearing aids, and therefore hearing at higher volumes, cause damage to my hearing? Old analogue aids amplified at the same ratio across the board, and therefore provided more amplification than necessary for some volumes/frequencies. Digital hearing aids use compression to avoid this, and if set up correctly will only give you the volume you need to hear appropriately. If they were set up incorrectly, constantly blasting you with high levels of volume, then technically yes they could damage your hearing just like any other speaker. We are careful not to do this, and compression means that we carefully use your residual hearing appropriately.
This is also the answer to “why does Sally have her car stereo so loud?”. Because after a certain input level has been attained, my hearing aids stop amplifying any more than what they are set to! So 100 decibels is as comfortable to me as 85 decibels, because my hearing aids only produce the same level of output for both. In a nutshell.
Over time, the same degradation that caused your initial hearing loss will continue to degrade your hearing. This means that when you first get hearing aids you can manage ok without them, but when you’ve been wearing them for ten years, you have been through multiple adjustments and tests and are now receiving more volume. This in turn means that you would feel less able to manage without hearing aids for TV and in group conversations. This is likely to be the reason why people hear that “I’m now totally dependent on hearing aids” from friends. But the point is, sensorineural age-related hearing loss follows a natural progression with or without aids. Sad but very true.
The consequences of not aiding your hearing loss? Take two people aged 60, with the same mild-moderate high frequency loss. Person A wears hearing aids as soon as they are required, as soon as they will benefit. Person B cannot/doesn’t want to wear aids.
At age 75, if we compare the outcomes, Person A is well adapted to hearing digitally, they are using less cognitive effort to hear, they are socialising normally and they get the richness of life. They will be able to easily adapt to their future hearing loss, and continue to distinguish speech from general background noise.
Person B has hearing that is now worse than at 60, but has not been adapting to digital sound. They are having to use increasing effort to make out words, and now really struggle in background noise. They avoid social situations where there is noise and to avoid looking foolish they may avoid using the phone. They keep social chitchat to a minimum, avoid starting conversations that might be difficult to follow, and have given up hobbies that are noisy or where they need to follow speech such as theatre and bowling.
When an audiologist fits these people with aids at age 75, even with identical hearing loss, Person B will have poorer outcomes for picking out speech and identifying words correctly, especially in noise. Person B is likely to have a level of cognitive decline not seen in Person A, and they have a 10% higher risk of dementia than Person A.
These risks and outcomes are all very real, and I see them every day. The research is robust and has been repeated with the same results dozens of times now.
Properly fitted hearing aids offer incredible benefits, not just socially but for your brain. My own mum (and my hearing is the same but 30 years behind) has a progressive loss that mimics age-related loss. She has an audiogram that shows her residual hearing is tiny. She naturally hears sounds only above 90 decibels in frequencies (pitch) 500-750Hz (a fraction of those covered by the speech spectrum). It is impossible to think that she can continue a conversation in a restaurant or use a phone when she only receives the deepest vowel sounds. But she does, because she has been adapting to hearing aids for 40 years, and her brain is still very capable of distinguishing speech. This is someone who, if they got that hearing loss today all in one go, would need a cochlear implant and whose rehabilitation outcomes would suggest never being able to pick out words correctly in anything more than mild background noise.
Sadly, people don’t think about the future, the evidence or their health as much as I would like. It is sometimes difficult as a private audiologist to put this across to someone who is suspicious that you are simply trying to make sales! I understand that, and that is why I advise the most reluctant clients to go to the NHS and have their hearing loss treated, while they decide whether to go private. NHS aids are a good stepping stone and reduce all the above risk factors. Rather than the “earbuds” in magazines or the internet, they are fitted by professionals who ensure they don’t damage your precious hearing.
And when you want something more convenient, better looking and higher performing, please come back to me and we will get you the best performance you can get! But above all, if you are recommended aids please get them as soon as you need them, because the sooner you start the better all your outcomes will be, and you will have a bright future connected to all those closest to you.