by Neil Bauman, Ph.D.
The parents of a hard of hearing boy wrote:
We had a weird experience this last weekend and wanted to see if anyone else has had something similar happen to them or their child. Our son (age 10) has a mild to moderate hearing loss in his left ear, and a moderate to severe hearing loss in his right ear. He wears 2 hearing aids.
He has always complained that certain loud sounds are physically painful in his ears, particularly high pitched ones. It usually comes up in the context of one of his younger sisters shouting or screaming near him, especially when they do it in the car (a practice we discourage but can’t always prevent). He has complained about it, but it is not the kind of thing that happens often, nor has it prevented him from doing anything he wanted to do, until now.
We took him to see a football game last weekend, an occasion where 110,000 people all get together and scream as loud as they can at the same time. We lasted about ten minutes and finally had to leave the game because he was so miserable. What’s going on with his ears?
This experience of your son’s hearing distress is not weird at all. Actually it is very common in people with sensorineural hearing losses such as your son has.
What is happening is that he is suffering from recruitment. With recruitment, as the sound level increases certain frequencies of normal sounds all of a sudden become much too loud and hurt.
Note that the physical volume of this sound typically isn’t damaging to a person’s ears (apart from the roar at the football game)—so it will not cause more hearing loss, but it does cause pain, and in some people, tinnitus. Both of these sensations are generated in the brain, so think of it as the brain’s psychological response to a real stimulus.
There are three things you can do if you have severe recruitment.
One (and I do this all the time since I have severe recruitment is to yank your hearing aids out when recruiting sounds occur (or just turn them off). In my case, I find that almost no sounds recruit if I am not wearing my hearing aids. Therefore, in noisy situations, I just leave my hearing aids in my pocket. Then I can enjoy whatever activity is going on. Your son may want to try this and see if it works for him also.
Two is to get his hearing aids adjusted properly so they won’t recruit. The problem is that few audiologists really understand recruitment so don’t adjust hearing aids properly for it. Just to prove a point, in all my 55 years of wearing hearing aids, I’ve never had an audiologist test me properly for recruitment except the last one—and this was at my specific request.
The proper way to test for recruitment is to use the audiometer and test each individual test frequency. To do this, the audiologist keeps turning the volume up for that tone until you wince or jump, your eyes blink or you otherwise react to the sound. After the audiologist does this for all test frequencies, then you will know exactly which frequencies cause recruitment.
The next step is to properly adjust his hearing aids. The audiologist needs to set the compression on the bands that cover those recruiting frequencies such that the sound can never come close to, or exceed, the recruiting volumes. When this is done, he won’t have much of a problem with recruitment anymore. (Note that a few people have such severe recruitment that it is beyond the hearing aid’s capability to control it.)
Three, avoid sounds that you know will recruit. This doesn’t just have to be the 100,000 screaming fans in the stands. For example, just setting a glass on the table will hurt me because it sounds so loud with hearing aids on. To a person with normal hearing it is just a quiet “thunk” or “clink.” To me it has always been a very sharp painful sound when I am wearing my hearing aids. Without them on, I hardly hear it either. With my new hearing aids adjusted specifically to control recruitment, I can finally almost stand this sound! (In my case, if I have the hearing aids properly adjusted to control my recruitment, then it degrades speech so much I don’t understand much of what I am hearing—so I tread the fine line between understanding speech and recruitment.)
If your hard of hearing child complains of sounds being too loud (and you know they are not), take his complaint seriously. Your child has recruitment and these sounds are painful to him.
If you want to understand more about recruitment click here to read this article.