By Clinical Professor Catherine Birman OAM*

Everyone has heard of the old saying, “a stitch in time, saves nine”. This is true when it comes to our hearing. The earlier we pick up a hearing loss and manage it with hearing aids or cochlear implants, the better for our brains and quality of life.

It’s even better if we can prevent hearing loss altogether (such as avoiding excessive noise or treating recurrent ear infections), but even if you already have some hearing loss, there are options open to you.

If you or a family member is grappling with this issue you’re far from alone. Currently, about 1.4 million Australians over 65 are affected by some form of hearing loss. That’s one in every three over 65s.

It’s easy to dismiss hearing loss as a natural part of getting older. It can be a hidden problem, as people affected often develop ways of coping and they themselves don’t notice that the hearing is getting harder and harder.

The scientific evidence is very clear on the link between untreated hearing loss and isolation, depression, and dementia. In fact, hearing loss is the largest modifiable risk factor for dementia in middle age and if we treated hearing loss in mid-life, it is likely that we could reduce the incidence of dementia by as much as nine per cent. When you have trouble hearing your friends and family speak, you avoid social situations and lose connections to critical social experiences that keep us mentally well and thriving in older age. You might be physically in the same room with people, but untreated hearing loss can be incredibly isolating – like being locked away from the sea of activity around you. This means your brain doesn’t get the mental workout it otherwise would, and it can cause what’s called ‘cognitive decline’.

This week, we are celebrating Hearing Awareness Week, and with World Hearing Day on 3 March, the World Health Organization (WHO) is keen for people to understand the importance of ‘safe listening’ and caring for their hearing throughout life.

That’s a great prevention message to share with younger family members who might like their Spotify up a little too loud! But it’s also just as relevant if you’re older – and even if you’re having difficulty hearing.

A good way to practise self-care is simply to start asking questions. It’s never too late to start. Below are some common questions older people have about their hearing loss. Do they resonate with you?

You can redefine what’s possible by seeking help for hearing loss. To make a start visit our Hearing Awareness Week page. Other good sources of information on hearing are the WHO newsroom, which has good information about safe listening and for those asking questions about cochlear implants the CIICA website is helpful.

If you’re having difficulty hearing on the phone, in noisy situations, or understanding children’s voices, or your family tells you that you have the TV/radio up too loud: any one of these issues may flag that you are likely to have hearing loss.

For people over 50, having regular hearing tests with an audiologist is very important so that if hearing loss is found, it can be managed in a timely way that slows down any further decline. For some people, hearing aids will address all their needs. For people with severe or profound sensorineural hearing loss, cochlear implants are often more appropriate, giving better hearing.

A cochlear implant is an option to consider when hearing aids are no longer enough. So we can ask the same tell-tale signs of hearing loss questions for those with hearing aids on. If the answer is yes to any one of those questions, then it is worthwhile having further assessment for a cochlear implant. While many people have heard of children having amazing outcomes from cochlear implants, many don’t realise that they are a great option for adults too. In adults, we know that most people who would benefit from a cochlear implant, are not aware that the cochlear implant is a good option for them. Only about 10% of adults with severe or profound hearing loss, who could benefit from a cochlear implant, currently has one.

There are many differences between hearing aids and cochlear implants and the two devices are suitable at different hearing levels. Hearing aids amplify sound but with greater hearing loss the clarity is often poorer. Implantable devices such as cochlear implants provide direct stimulation in the inner ear, making it clearer to interpret speech, and hear in loud environments. Of course, the cochlear implant requires surgery, whereas hearing aids do not. Both require being adjusted to the individual and practice with listening is vital.

Hearing loss can lead to withdrawal, social isolation, depression and anxiety among older people. Better management of hearing loss in middle age and beyond, is beneficial in many ways and much research is happening to clarify the influence on cognitive impairment.

A cochlear implant stimulates the thousands of hearing nerves, known as the cochlear or auditory nerve. The cochlear implant provides access to high-quality, clearer sound. The nerve then sends signals to the brain where it is interpreted as sound. The cochlear implant consists of an internal part which is implanted under the skin via surgery, and an external part which is worn on the outside of the head. Surgery generally involves an overnight stay, but can be day surgery in some cases. The implant is usually switched on one to three weeks later. An audiologist works closely with you to ensure the implant is customised for each person. This support continues and long term cochlear implant users have their cochlear implant “mapped” once a year by their cochlear implant audiologist.

You are never too old for a cochlear implant. In fact, seniors are the largest cochlear implant group, with many even in their nineties undergoing this wonderful lifechanging surgery. A common misconception is that you’re ‘too old’ for a cochlear implant, but the truth is, age is no barrier.

The criteria for a cochlear implant are expanding, however, if you benefit significantly from your current hearing solution, cochlear implants may not be right for you at this time. All people considering a cochlear implant are carefully assessed by the cochlear implant specialised team, with specific testing, education and counselling to work out if a cochlear implant is the best option or not. Talk to a trusted expert about the solutions that might work best for you.

Clinical Professor Catherine Birman OAM is a globally renowned surgeon who has performed more than 1,700 cochlear implant and hearing restorative surgeries for children and adults of all ages. Clinical Professor Birman is the Medical Director of the NextSense cochlear implant program.