During my first year in practice, many moons ago, I encountered an unexpected issue with my patients that had nothing to do with my skills or their presenting problems: many of them could not hear me well. I blamed some of it on my remaining accent my tendency to speak fast and mumble, but I also noticed a pattern among those complaining that my voice was too soft: they were disproportionately older and males.

Out of puzzlement and frustration I consulted with an audiologist that I knew. She took some measurements of my voice and analyzed volume and pitch. It turns out that my voice was of normal volume for my gender and size, however my pitch was in a narrow range of auditory frequencies that are lost first in age related hearing loss ( especially in males, who tend to lose the higher pitches first). She told me that for the rest of my life, I would be the "singing canari" of early hearing loss: I would be one of the first person that someone would stop being able to hear.

Her prophetic words have, for better or for worse, turned out to be very true. 

Last year, I decided to turn my soprano monotone voice from a problem into an opportunity. I was doing some research on the long term environmental and modifiable risk factors for dementia when I stumbled upon a landmark, large scale meta-analysis from 2016. Along with the factors that were already suspected ( hypertension, depression, diabetese, smoking etc), was a surprising newcomer: mid to later life acquired hearing loss.

The latter finding was significant in many regards. Hearing loss, it turns out, is not just an annoyance. We already knew it carried a safety risk for the person affected as well as those around them since emergency signals cannot not be heard. Most profoundly and more commonly however, hearing loss is associated with some definite decline in cognitive function over time. It makes sense if you understand how various lobes of the brain interact and provide stimulus for each other. If one of the five senses goes down, that is an enormous amount of normal daily stimulus that is lost as a domino effect to parts of the brains responsible for normal processing and storing of information.

The good news about hearing loss is that it is in many cases correctable with a well fitted hearing aid, thus making hearing loss a dementia risk factor that can be averted ( unlike other risk factors that are more difficult to control). Hearing aid technology has a way to go yet, and the price tag is not very friendly, but if you understand the consequences of not addressing hearing loss, it is still worth the effort and resources.

So back to my little soprano voice and the gents who grumble about it in my treatment room. I now take time to let people know that they are probably experiencing early hearing loss and this is a wonderful opportunity to intervene early.  Some of those folks are ill disposed toward the messenger of unpleasant news, but I am finding out that good science and the specter of everyone's worst aging nightmare is still a powerful motivator to maybe do something about it.