THE SOUND OF SILENCE

By Seth S. Horowitz

Published: March 3, 2013

Imagine waking up one morning to find the world unaccountably dim. You turn on the lights and check for the usual suspects like a burned-out light bulb or a particularly cloudy day. Then you notice that the dimness is only in one eye and is interspersed with sudden flashes of bright light. You would probably head to a doctor pretty quickly.

Now imagine discovering that you can’t hear out of one ear. You would probably figure it was because of a head cold or a sinus infection and that your hearing would soon come back. If it didn’t return in a few weeks, you would manage. I can still hear out of one ear, you’d tell yourself. And after all, only old people go deaf. You’d continue about your business, only occasionally wondering why people were mumbling or excluding you from conversations.

Katherine Bouton reveals how deeply deafness and denial are linked in “Shouting Won’t Help,” her memoir of coping with adult-onset hearing loss. A decline in auditory function is almost a default feature of aging, with over two-thirds of adults 70 or older afflicted by at least some hearing loss. But the author is one of the millions of people whose hearing began failing when she was much younger, and she masterfully depicts its effects on her personal and professional life.

The book follows the progression of Bouton’s disability, from her sudden loss of hearing in her 30s to profound bilateral deafness, a “blunt and traumatic” process. “We hear as we breathe – effortlessly – until we can’t,” Bouton writes. Her psychological responses paralleled Elisabeth KÃ1/4bler-Ross’s five stages of grief: denial, anger, bargaining, depression and acceptance. She obsessed over the causes of her deafness: Did she ruin her hearing at that Who concert? Was an autoimmune disorder to blame? A viral infection she picked up on an archaeological dig in Turkey as a young reporter? Or was it more insidious, from “normal” noise exposure to clamorous clubs and bars, frequent haunts of an arts editor living in New York? (Bouton was an editor for the Book Review and other departments of The New York Times.) She minimized the seriousness of her condition, for 20 years, ignoring her doctor’s advice to use a hearing aid. Of the 48 million people with hearing loss in America, only one in seven over the age of 50 uses a hearing aid. Like the author, they don’t want to look old – “a hearing aid is a visible sign of an impairment that has long been associated with aging and mental retardation” – and they’re put off by the price. Insurance companies consider hearing aids discretionary purchases. They’re expensive, ranging from $2,000 to $6,000; very easy to misplace; and sometimes not especially helpful. She eventually accepted a cochlear implant, only to discover that it comes with its own limitations, like an inability to transmit music clearly, a particularly painful loss for an opera and theater lover.

The statistics Bouton cites would be troubling enough if they were just restricted to the adult population. But, as she points out, the costs for children and teenagers may be even higher. “Ears are most vulnerable to noise damage when they’re young,” she writes. The everyday noises of a neonatal I.C.U. might damage the delicate hearing of infants, as might white noise machines designed to help babies sleep. Children are given aggressively loud toys and video games; they’re plugged into MP3 players and surrounded by malls and “restaurants that use noise as stimulus and decor.” Their auditory health can be frustratingly hard to gauge. Is a prelingual child developmentally disabled or unable to hear his or her environment? And treatment can be pricey; cochlear implants for children can run up to hundreds of thousands of dollars and are quickly outgrown.

Bouton delves into new research including gene and molecular therapies and stem-cell-based sensory cell regeneration that are “advancing at a breathtaking rate.” “Within a decade,” she writes, “we may see the beginning of the end of the ravages of sensori-neural hearing loss like mine.” Her interviews with other hearing-impaired people offer fascinating insights into the degree that hearing loss affects individuals, and she unsparingly examines why many of her subjects dealt with their deafness better than she did, even in the cases of a psychoanalyst and a composer whose livelihoods depended on their hearing. Practical tips on living and conversing with the hearing-impaired round out the book. (“If they don’t hear what you’ve said after you’ve repeated it two or three times, don’t say, ‘Never mind, it doesn’t matter.' To the person who can’t hear it, everything matters”; “Speak in a normal voice and articulate as clearly as possible. Shouting won’t help.”)

Bouton’s advice is sound, but the science is occasionally wobbly, probably because she receives conflicting information from audiologists and geneticists, who possess their own vocabularies when it comes to hearing. The confusion highlights how frustrating it can be for a nonscientist to investigate his or her disability.

For an auditory neuroscientist and lover of all things sonic, reviewing this book was not unlike an arachnophobe reviewing a book about breeding spiders. Hearing is our fastest sense, connecting us to our environment more rapidly than sight, smell, taste or touch. Helen Keller considered deafness to be “a much worse misfortune” than blindness because “it means the loss of the most vital stimulus – the sound of the voice that brings language, sets thoughts astir and keeps us in the intellectual company of man.” It’s not just sound that is muffled but emotion and sources of joy: a child’s first words, the rising strings of an orchestra; for me, this was Bouton’s most powerful point. But her memoir is not merely a list of woes. Even as she describes how the loss of hearing changes your perception of the world and others’ perception of you, her interviews and her own moving story emphasize how much “depends on the resiliency and personality of the newly hearing-impaired person.”

(Seth S. Horowitz, an auditory neuroscientist, is the author of ``The Universal Sense: How Hearing Shapes the Mind.'')
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