March 6, 2013

Singing & Hearing Aids

Phonak Audeo IX

When I starting wearing Phonak Audeo IX hearing aids four years ago, I was singing at New York City Opera, having weathered the previous season without them, and with loud invasive tinnitus ringing in my head (see my post on surviving tinnitus here). Of course, that was a trip. I was lucky however. After my sudden onset (ok, not so lucky), I only went a year before I started wearing them. I didn't wait too long: I didn't let my ear muscles go to hell. 

If you've been reading this blog, you have some idea now that listening and singing is an active process. The ear and the voice are indivisible. If the ear cannot hear certain frequencies very well, they won't come out of the larynx. This is, of course, the first law of Tomatis. As such, the two muscles of the ear—the tensor tympani and the stapedius—work in such a way as to be rudders in a sea of sound. They have the ability to zoom in on sound as well as ignore it. This is why the constant drip of a faucet can drive you nuts, and you can also sit in a noisy cafe, lost in a good book, oblivious to everything around you. The ear—like the eye—can focus or defocus.

I thought of this matter of the eye and ear focusing when I was at the Y the other day for a swim. Sometimes I wear my contact lenses and sometimes I don't. When I wear glasses, I leave them in my locker when I go to the pool.  I am near-sided, so everything is a blur without correction. Without it, I don't interact with people very much, nor do I give the life guard my usual "thank you" wave when I leave. Why? I'm too busy trying not to stumble, my head being glued to the floor in front of me. And that's how it is with hearing. Hearing loss changes the way you interact with the world.

What does hearing loss do? It deprives the ear muscles of stimulation. Thus deprived, the muscles lose their ability to navigate the aforementioned sea of sound. What do hearing aids do? Stimulate the ear muscles. Do you see where I am going here? Most people don't know they have a listening problem until their ear muscles can't do their job very well, until "straining to hear" becomes the new normal. When that happens? Denial is often the first response.

"No. This can't be happening. If I do nothing, perhaps it will get better. Maybe I just need more sleep." But it doesn't get better. Bargaining enters the picture, be it with God or simply waiting for a bargain (believe me: good hearing aids aren't cheap), which can waste years, even decades. "It's not that bad. My grandmother had hearing loss and she did ok!" Sure. She did great. She stopped talking on the phone, going to church, and became withdrawn.

By the time most people obtain hearing aids (only 1 out of 7 people who need them wear them), their ear muscles can't do their job very well. Getting hearing aids after all that time? It's like having to run 5 miles, do 50 pushups and 20 pullups after not going to the gym for a decade. The ear is out of shape. Everything is too loud: words are jumbled, background noise is a problem, music sounds like noise, the whole thing is damn annoying.

I didn't have any of these problems. However, I would have done things differently. I would have gotten hearing aids right away instead of waiting a year. As it is, my ENT told me that my hearing loss—which is minor—didn't exactly warrant them. It was just above the borderline. He told me that I might consider it if communication became a problem. The day my husband informed me that my speech was sounding a little funny? A little garbled? That did it. I knew what that meant having been to the Listening Centre in Toronto: I knew that the muscles in my ear were starting to "slip." Of course, I also wanted to find a way to treat my tinnitus. While my hearing aids didn't help with that, my speech snapped back into place immediately after I put my hearing aids in. Why? The aids helped me hear through the cascade of ringing I heard in my head, which had a "masking" effect on my listening ability.

Here's the thing: even with hearing loss, the muscles of the ear can still learn to do their job. They need stimulation to do that. Back to my gym analogy. Say you lift weights, but when you do your pull-ups, you only go half-way up. Of course, your "lats" will never get any bigger or more defined. Why? Your muscles aren't fully contracting. This is not unlike how the muscles in the ear work. Without stimulation, they can't contract. What leads them to contract fully? High frequencies. What are the first sounds to go with age? High frequencies. What do my Phonak hearing aids do? Amplify high frequencies up to 8000 Hz, which is where my tinnitus is loudest. Tomatis talked about "flabby'"muscles of the ear. I believe he was onto something.

Now, I don't think you are going to find many audiologists or ENT's who have this perspective. Most think of the ear as a passive participant in the world of sound. Singers and voice teachers, however, know better. Why? The latter, especially, understand what it means to mold a person's listening ability. It's malleable. If you change the way a person listens to sound, you change the way that person perceives themselves. Singing is a psychological matter, not just a mechanical one.

All this to say: you can sing with hearing aids, and you can sing very well. I am. Really. I am. I record myself at least once a week, and I sound very good for a 54 year old man. My voice isn't wobbling, nor it is dark, woofy and old sounding. Not bragging here, but I still sound very much like the guy on my two recordings on my voice studio website. Why? I like to think I know what I am doing technically, and yes—I sing my scales every day. Have I had my vocal issues? Of course. I've had to learn to sing with my aids, which has been a fascinating experience. It took me a while to get used to them. Now they are as much a part of me as my right arm.

Some things to consider if you suspect you have hearing loss and are a singer.

  1. Get tested! Do it now. Don't wait. Find an audiologist who works with singers. A rare thing perhaps, but they are worth their weight in gold. Start by finding an ENT who works with singers. Ask for a recommendation. 
  2. Get digital hearing aids. Yes. They are very expensive. But they are worth it. Mine are made by Phonak and designed with musicians in mind. They have two microphones. The sound is excellent. Yes. You can find good aids on Ebay, but you will need to find an audiologist who will agree to fit them. You may not, however, be able to return them. 
  3. Get hearing aids that have an "'open port," like the one you see in the photo above. Why? They give you better sound quality. "In-the-ear-canal" hearing aids aren't as good, which leads me to the next point....
  4. Terrified that someone is going to think you are old and that you can't sing well? That someone will see them?  Get over it. Really. I can't say it any other way. I was concerned about this too. But I got over it. Heck. I dealt with being gay and found myself a lot happier. It's that same dynamic. Staying in the closet about hearing loss is self-defeating and ultimately debilitating. The more you let yourself be ruled by this "fear thought," the more you are shooting yourself in the foot. FYI: 9 out out 10 people aren't going to even notice that you have them. Really. I am not making this up. And that 10th person? They are self-aware and won't hold it against you. 
  5. Digital hearing aids will have a "music program" as part of their software. I have this feature turned up. Why? It was cutting off when it reached a certain threshold, one which was too low for singing. You may need to inform your audiologist about this. You may even need to have the music program turned on all the time. Why? You will be hearing high frequencies—a good thing. 
  6. Wear your aids all the time. There is no getting around this. Thinking of them as the car you drive only on weekends is counterproductive. Me? I put them in when I wake up, and take them out when I go to sleep (no...they don't go in the shower or the pool). The only way to get used to wearing them is by wearing them! 
  7. Consider going to a Tomatis practitioner to give your ears a tune up. This will enable you to acclimate to your aids.
  8. Have your aids insured. This typically happens a year after you get them, when the warranty is up. Please don't be cheap and think you don't need it. You do. 
  9. Sing with them! Yes. It's going to be different, perhaps even disconcerting, but it behooves you to get in the swim of things. The more you do it, the better it gets. Listen to music too. Lots of it. Mozart especially, which has been proven to have a beneficial effect. Just make sure you use good earphones, not earbuds, which are not good for your ears. 
  10. Get used to the illusion of sound, that is, the corona of vibration surrounding your head. This is what those with excellent hearing and good vocal technique take as a matter of course. You don't want to smash your voice into the front of your face. Rather, you want to start hearing a clear, vibrant vowel that seems to be at the level of your ears and eyes, upper lip, and projects outwards. 

Having hearing loss isn't the end of the road. You can sing, and sing very well. You can also be a very good voice teacher. The key is to be proactive.