Auditory Fatigue/Listener Fatigue

by Chelle Wyatt

I belong to three hearing loss organizations and they each have something I value (SayWhatClub is closest to my heart). I love my local HLAA chapter for its face to face meetings. A few weeks ago they had Susan Naidu, an audiologist at the University of Utah talk about auditory fatigue or listener fatigue and cognitive energy fatigue. She works with patients in the clinic, trains graduate students to become audiologists and her favorite thing to do is aural rehabilitation therapy. She was happy to talk about auditory fatigue because “it’s a very real phenomenon, it’s a real condition but it’s not discussed much and not researched enough.” It isn’t clinically recognized but many professionals are familiar with it.

Auditory fatigue doesn’t mean people are dumb because they can’t listen, it’s the “energy it takes to fulfill the complexity of listening because listening requires more to go on in your brain in order to comprehend what you’re listening to.” Ian Noon wrote about this in his piece on the Limping Chicken out of the United Kingdom only he called it concentration fatigue. Noon says: “I went to a great conference today. It was riveting and I was hooked on pretty much every word. And then I got home and collapsed on the sofa. I’m not just tired, I’m shattered. I’ve had to turn my ears off to rest in silence and my eyes are burning. I’ve also had about 3 cups of tea just to write this paragraph.”

a picture of a brain in a frying pan with the caption my brain is fried depicts how auditory fatigue feels

Susan introduced us to Kathleen Fuller’s work on hearing loss and cognitive energy. Fuller asks, “How can audiologists better understand and find ways to counteract the underlying factors that cause listeners to decide to quit participating in activities when it takes too much effort to listen? How can audiologists help listeners to strategically deploy their available cognitive capacity in situations where it is hard to listen? How can audiologists prevent listeners from avoiding and withdrawing from social participation because it is too hard to listen?

It’s said we hear with our ears and listen with our brain. Now we add when and how much effort we expend during listening in everyday life depends on our motivation to achieve goals and attain rewards of personal and/or social value.”

Listening takes an effort. It’s not only being able to hear but being able to pull all the components together to communicate properly. It’s being able to understand language, generating an appropriate response and being able to keep it going back and forth to make a conversation. Usually people aren’t just listening either, they are multitasking; washing the dishes, walking, watching TV, etc.

For those with hearing loss it takes even more effort. Not only are they taking in the above but they are trying to decode the message. Add in being visually aware to compensate such as speechreading and body language. The mind races to fill in blank spots in words and conversations which involves guess work. The mental process is “I’m not hearing well enough. I have to do something and physically push the brain to listen better.” After an hour (or less) these people are really tired and experience discomfort, pain and numbness.

What makes listening even more difficult? Noise, it’s the number one complaint for those coming into Susan’s clinic. Trying to filter and ignore noise makes listening harder for hearing people and difficult for the hard of hearing. Even with modern technology in hearing aids such as directional microphones and noise reduction programs noise remains a problem. Restaurants are an example, bars and traffic. (Hearing in cars has never been easy!)

What other things are hard with this much cognitive energy being spent? Remembering things get harder because with so much going on in the mind already, it’s hard to find a place to stash the information. People may have a hard time remembering names because there’s more focus to understand what’s being said. While in a meeting they can be so intent on understanding the words as they are being said that half the meeting information is forgotten.

Because of the intense concentration, hard of hearing employees end up taking more days off. The mental stress affects their bodies causing illness among some. Or to balance out, they stay home evenings and weekends to recuperate, avoiding social activity. For those who don’t work, many tend to withdraw because it’s too much work going to that party, the play or lecture. It’s easier to stay home and watch TV with captions. It’s not worth it in the end, the struggle is too much.

charlie brown lying awake in bed with the caption , "I'm already tired tomorrow.

Mohan Matthen is studying why some hard of hearing people are more successful at socializing than others. He thinks it might be a pleasure factor. When audiologists diagnose hearing loss and fit people with hearing aids they tend to talk about adverse conditions. What if they talked about positive things instead? If a person can exhibit more pleasure in the role of listening they might be more relaxed and less stressed out. Once it becomes pleasurable their listening effort seems to be reduced. No matter how hard it seems, seek listening enjoyment. Make it fun and shoot for positive because the reward will be “I will understand.”

So what helps combat auditory fatigue?

Advocating helps a great deal. What do you need to make this meeting better? CART (live captioning)? Sitting closer to the presenter? Assistive listening devices? One speaker at a time? Don’t talk while multitasking? There’s a lot to be said for planning ahead as well. Think about the environment, talk to the event coordinators, find out if the venue has assistive listening devices such as the CaptiView at theaters or live captioned performances. If you’re going to a lecture/workshop/convention, talk to those in charge well in advance to see what might be set.

Some people report learning speech reading has helped lighten their fatigue. Visiting with people a few at time instead of large groups. Limit interruptions, have a quiet room to talk to family members at large gatherings. Ask for background noises (music or TV) to be turned down or off. Go outside to eat because break rooms usually have lousy acoustics. Take hearing breaks and read instead of watching TV. Arrange for hand signals when conversation needs to be slowed down or when wanting someone to talk louder. Find out what works for you and advocate for yourself. It’s okay to experiment with it all.

More links on auditory fatigue

Studies done on prolonged exposure to audio stimulus (for those who want to go deeper). This phenomenon occurs after an extended period of time listening to speech and happens to hearing people as well. Hearing people have more problems than expected which might be related to an auditory processing disorder. Susan said those with hearing loss all have auditory processing disorders.

Richard Gurgel is studying the relationship of hearing loss and dementia. Are individuals with diagnosed mild dementia experiencing decline in auditory processing? Older individuals who have hearing loss but didn’t have hearing aids showed improvements once aided, not just in quality of life but in skills. People were thinking they had dementia when they didn’t.

Starkey on listening fatigue.

Amplification study. Amplification has limited improvement for those with a steep slope high frequency hearing loss.

Susan recommends the LACE (Listening And Communication Enhancement) Program, it improves listening skills.

More publications by Mohan Matthen on hearing loss and displeasure.

Hearing Aids Ten Hours A Day

Sound WavesWhile I lived in Salt Lake, I wound up shopping around for an audiologist I respected. It took four tries but I found one who knows his programming. About two days before I left for Arizona, I went in and he completely reprogrammed my hearing aids. There was noise again! He did a few adjustments then before I left, he asked me to wear my hearing aids 10 hours a day. He knew I sometimes get headaches from too much noise so told me to take out one hearing aid at a time, trading them off. I needed to get used to sound again. I said I would…

But I didn’t really. I live in a cabin by myself, out in the middle of nowhere. Why do I need to hear nothing? I did wear them every time I went for a walk or I put them in when trying to identify a sound, such as a bird. I wore them the whole time I visited with my parents or came into town or went out of town. But that’s it.

When I went back to Salt Lake City for the SayWhatClub convention, I scheduled an appointment with him for adjustments. Things like engine noises and walking on gravel were just too loud making me cringe. He put the neck loop around me which connected to his computer. I told him I wore my hearing aids more often these days which was true, more than I had been before he programmed them.

“You have been turning it down a lot,” he noted. I agreed.

“But you have not been wearing them 10 hours a day,” he said.

Oh no! My hearing aids tattle on me! I heard about this from another SWC member on my list. So I explained about being in a cabin by myself while he made adjustments.

“I have been wearing them more than I used to,” I said and it felt like a weak excuse.

“You’ve only worn them 90 hours in three weeks. That’s not ten hours a day. You only wear your hearing aids in noisy situations,” he said looking at me, “Like when around people, going to meetings and such, right?”

I only nodded feeling completely busted.

“You need to start wearing them in quiet places, just like your cabin. You need to get used to sound when it’s not bombarding you. You’re not even close to normal hearing yet.”

That perked me up. “I’m not?”

“No, so please start trying to wear them 10 hours a day.”

Not close to normal hearing, that phrase repeated over and over in my head over the next few weeks. My hearing aids are now bearable to me but I’m not close to normal hearing? Some things seems so loud… and it’s not normal yet?

So I’ve worn my hearing aids daily ever since. Some days I hit 10 hours, some days less and some days over ten hours. I wear them a lot more. (They are going to tattle on me if I don’t.) If I want a cochlear implant someday, I need to be dedicated to sound so I might as well start now.

Wearing my hearing aids more has changed my hearing ability. I heard the clanging of a train crossing the other day. I had forgotten completely train crossings made noise other than train itself. Since he reprogrammed them, I am hearing speech better again. When I take my hearing aids out at the end of the day, I’m well aware of how quiet my world is and it’s spooky! When I get back up to Salt Lake in October, I go in for another adjustment. He wants to keep bumping me up little by little to get me back to normal. If I still lived there, he would do it monthly for me.

I’m retraining myself to hearing aids. It’s hard to remember to put them in first thing in the morning when I’m not working. All these years I mainly used hearing aids while at work, to make sure I heard my clients (I’m a hairdresser). There were blow dryers, hair dryers, phones ringing and people talking over all the noise. At the end of an eight hour day, my mind buzzed with noise and I desperately needed to take them out for a break. How strange it is to have them on in quiet places. It’s much more pleasant.

High Frequency Hearing Loss

I have a high frequency hearing loss, diagnosed in my early twenties but it probably started as a teenager. For a long time I didn’t really know what it meant except that I couldn’t hear a lot of bugs or birds anymore. In the late 90’s, I found the SayWhatClub and found out it’s called a sensorineural hearing loss but it took me about another ten years to fully understand my kind of hearing loss. It’s a mixed bag of hearing and hard to describe to others. I hear… but I can’t hear. I hear you talking… but I can’t understand what you’re saying.

It’s like filling in crossword puzzles at the speed of sound.

While reading a book a few years ago, Missing Words by Kay Thomsett and Eve Nickerson, I finally understood why word discrimination is so damn hard for me. In our alphabet, vowels come across in the lower tones while many consonants are in the higher frequencies. The light went on and I know I get only pieces of words now. It’s like filling in crossword puzzles at the speed of sound. Or as I said in another post, conversations turn into the Wheel of Fortune with me racing to fill in the missing letters. No wonder I get so tired, straining to hear people hours on end.  It’s mentally exhausting doing this for any length of time.  And this is with my hearing aids.  After sounds are gone, they’re gone. (Hearing aids aren’t called hearing miracles for a reason.)

I’m lucky enough to live in Salt Lake City now with one of the best d/Deaf and hard of hearing centers in the country. The Sanderson Center continually offers us free workshops and classes to attend. We also hold our local HLAA chapter meetings there and one night, the hard of hearing specialist from the center talked to us about reading our audiograms, something else I never fully understood.

She passed out a childs audiogram with some of the alphabet on it and pictures of noises. Then we penciled in our personal audiograms. She said whatever was above our line, we couldn’t hear well. What’s below the line, we can hear. It took me a minute to understand that since my line drops down. I had to mentally raise the line first to comprehend below the line. Ohhh! The light went on again. Here’s proof of what I hear and don’t hear on a piece of paper.

I have a mild loss in the low tones (it dropped from normal for the first time) and a profound loss in the high frequencies. People like to call it a classic ski slope loss. Since I ski, I tell people it’s a black run (steep slope).  Just look at the wonderful things I get to hear: guns, horns, planes, jackhammers and lawn mowers.  Now look at what I miss: whispers, clocks and many alarms/timers, leaves rustling in the wind, lots of letters in the alphabet and casual conversation.

Our hard of hearing specialist also passed out the speech banana audiogram.  I drew my black run ski slope into it to better understand my hearing.  Now I can exactly what I miss and why word discrimination is such a challenge at times.

Sometimes, pictures are worth a thousand words.  After having this sensorineural hearing loss most of my life, I finally understand what it means.  I can now tell people exactly how I hear.