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“Wear your hearing aids or your brain will rust”

Martin, Robert L.

doi: 10.1097/01.HJ.0000292405.09805.5a
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Robert L. Martin, PhD, has been in private practice in the San Diego area for 28 years. He holds a doctorate in audiology from the University of Tennessee and formerly was on the faculty at San Diego State University. Correspondence to Dr. Martin at 7750 University Avenue, La Mesa, CA. 91941.

When I first heard the words, “…or your brain will rust,” I felt angry and thought some unscrupulous practitioner was misleading patients. Well, that was 25 years ago and I've now seen many patients who do not want to wear their hearing aids. My feelings on how to deal with these people have changed. Some patients need strong encouragement; otherwise their hearing aids stay in the drawer and family and friends suffer.

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How do you motivate recalcitrant patients who refuse to wear their hearing aids on a regular basis? What do you tell them? Do you use words phrases like “or your brain will rust”?

Some patients expect to hear well even if they don't wear their hearing aids regularly. These are the ones who get my wear-your-hearing-aids speech, which goes something like this:

“You don't hear with your ears, you hear with your brain.”

I then touch the patient's finger with my hand and continue, ''You don't feel with your fingers; your fingers make electricity, which is carried to your brain through nerves. You ‘feel’ with your brain.

''Your ears make electricity that is carried to your brain through your hearing nerves. You ‘hear’ with your brain, not your ears.

''Hearing aid use is like exercise. If you want to get your muscles in shape, you need to exercise them every day.

“Let me ask you a silly question: How well would you dance if you stayed in bed all day, everyday, Monday through Friday. then went dancing Friday night?”

I pause and wait for the patient to respond.

“You would look pretty funny, wouldn't you? Legs have to be used regularly or you can't walk. Same with ears.”

I go on to explain, “Conditioning the auditory cortex of the brain is much like conditioning leg muscles. It's impossible to sit on a couch and drink beer all week and get healthy leg muscles. What you get are a big stomach and weak legs.” I pat my stomach for emphasis.

''When you wear your hearing aids, lots of good things happen. You get used to the feeling of wearing the hearing aids. You get used to all the funny sounds. You start hearing better.

''It takes time for the brain to learn to recognize words through the hearing aids. Learning to listen to amplified sound is like trying to understand people who speak with an unfamiliar accent, like the actors in British dramas on TV. At first, the words seem garbled. But slowly, they become clearer, easier to recognize.

“Wearing hearing aids in noisy listening situations also takes time. It is not easy to listen to one person when lots of other people are talking at the same time. But with practice you get better.”

“Wearing hearing aids even helps short-term memory. If I tell you my name is Dr…ru..p., you'll know you didn't hear the name correctly so it won't register in your brain. But if I say my name is Dr. Grump, you'll think, ‘Wow, that's a weird name!’ and you will probably remember it.”

I conclude, “The more you listen with hearing aids, the better your brain gets at recognizing words.”

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“PRACTICE MAKES PERFECT”

I don't give this speech to all my patients, just those who are complaining about not being able to understand words and have not been wearing their hearing aids. The phrase “Practice makes perfect” embodies much wisdom. We rarely get good at any task without doing it over and over.

It is not obvious to all patients that they need to wear their hearing aids. So we need to encourage them, educate them. The phrase “You need to wear your hearing aids or your brain will rust!” is a simplistic overstatement. Yet it contains more truth than fiction. When a person does not hear sounds, the tonotopical mapping of the cortex in the brain begins to change. The longer people avoid wearing hearing aids, the more difficult it is for them to learn to hear through them.

There are many ways to tell patients that wearing hearing aids improves cortical conditioning. I try to find out what a patient wants to hear, then I stress that wearing the instruments will “help you hear the baseball game on the radio, your grandchild's voice, friends at your woman's club meeting,” etc. In truth, wearing hearing aids improves word understanding in almost all situations, and not wearing them results in an unnecessary loss of speech information.

The act of hearing and interpreting words is much more difficult than most of us realize. Just think about it. Most children are born with normally functioning ears and brain. Yet it takes thousands of hours of practice before the child can hear and understand a sentence like, “Do you want some ice cream or a popsicle?”

When people have poor hearing ability, they also tend to develop poor listening habits. Paying attention to difficult signals is frustrating for them, so they tend to shut themselves off from others and stop trying to hear. But, using hearing aids reconnects these people with family, friends, the rest of the world, and it makes all avenues of communication easier.

If you've discovered a good way to get people to wear their hearing aids, e-mail it to David Kirkwood, editor of The Hearing Journal. at dkirkwoo@lww.com.

© 2004 Lippincott Williams & Wilkins, Inc.