Monday, 13 January 2020

The Importance of Hearing Aids - Getting the message across to CCGs 2020

The Importance of Hearing Aids

Getting the Message Across to Clinical Commissioning Groups

***** On 15th February 2017 Action on Hearing Loss asked me to answer some questions about my experiences of hearing loss on BBC Radio 4’s Woman’s Hour.  Following this I was asked if I would allow Action on Hearing Loss to quote from this blog post in a presentation designed to help people understand hearing loss.  I am really pleased that I seem to be on the right track. *****

The following article was originally written for - and published on - Action on Hearing Loss’s website. https://www.actiononhearingloss.org.uk/community/blogs/our-guest-blog/the-importance-of-hearing-aids.aspx The letters and sounds that someone with ‘mild’ high frequency hearing loss (most often associated with age/noise related hearing loss) might struggle to hear have been removed in an attempt to offer some insight into the difficulties those with impaired hearing might face.  It should be remembered that whilst readers can read and work out meaning at their own individual pace people do not enjoy that luxury in real time verbal conversations.  Lipreading is not a substitute for hearing. Much of it is guesswork - filling in the gaps left by sounds made without moving the lips.  Add the distraction of background noise to the mix and for many the struggle becomes too great.  Isolation, depression and dementia (perceived or real) are very significant threats.

Please read on.  At the end there are a few questions you may like to ponder and answer.

I am a -earing aid wearer wi-- mild to modera-e, -igh -re-uen-y -earing lo--.  I -ave worn digi-al N-- -earing aid- -or --e la-- -our-een year-.  -o -ay --a- --ey -ave -ran--ormed my li-e i- no e-aggera---n.  

Loo-ing ba-- over my -re--earing aid year- I wonder -ow I managed.  A- a middle ---ool -ea--er in charge of the -E de-ar-men- but -ea--ing -al- my -ime-able in -la--room -ubje--- I --ru--led -on--an-ly.  -earing what --ildren were -aying in the gym or on --e -ield wa- a -er-e-ual -roblem and I wa- re-ea-edly -om-laining about --ildren mumbling and --ea-ing indi--in---y in the -la--room.  --a-- mee-ing- were a nigh-mare.  My brain -ad to wor- over-ime to -ry to -ee- tra-- of di--u----ns --at I wa- too o-ten relu--an- -o join in a- I -ould not be -ure wha- -ad been -aid.  Al--ough I did not reali-e i- at --e -ime i- -a- be-ome a--aren- --a- --e --eer e--or- of ma-ing -en-e of -onver-a---n --roughou- --e day wa- what -au-ed me to -lum- into a -oma-li-e -lee- every evening - --u- robbing me of -rue re-- and rela-a-ion a--ivi-ie-.  On o--a-ion- when I --ar-ed wa---ing a -elevi---n -ro-ramme I o-ten had to a-- family member- what had been -aid only to be -old --at I --ould -ay -ull a--en--on.  I rarely -aw --e end- of -ro-ramme-.

I- i- only in re-irement -in-e re-eiving my -ir-- N-- -earing aid- --at I -ully a--re-iate ju-- -ow -ard --e --ru--le wa- during my wor-ing year-.  No lon-er do I need --e -ub-i-le- when wa---ing -elevi---n.  Now I -an enjoy -onver-a---n- wi-- -amily member-, -riend- and a--uain-an-e- wi--out re-ea-edly -aving to a-- for re-e-i---n and -u--ering --e en-uing embarra--men- of --ill no- -aving -eard -ro-erly.  --ere are only -o many -ime- one -an a-- for re-e-i---n and --ere i- alway- --e added worry of ini-ia-ing t-e o-ten u--ered di-mi--ive re--on-e, "Oh! It doe-n'- ma--er." Only re-i-ien-- of --o-e -ew word- will -ruly under--and --e -ru--ra---n --ey -au-e.  --e -on--ant worry about being -il-ered out of --e -rou- whil-- al-o dealing wi-- --e --rain of -rying to --ay -onne--ed i- now -one.  

The --rain on -amily member- and other- --ould not be undere--imated.  A -riend -old me --a- -eo-le wi-- -earing lo-- --ould do -ome--ing abou- i- a- i- wa- e--remely -ru--ra-ing -o have -o re-ea- --ing- -o much.  I wa- an-ry wi-- her a- --e -ime but on re-le---on --e did me a -avour.  -onver-a---n i- de-igned to -low and re-ea-ed re-e-i---n --oil- --e -low.  I- i- diffi-ult to move on when -on--antly moving ba--.  -on-inui-y is di-ru--ed and bo-- --e -earing and the -earing im-aired be-ome -ru--ra-ed.  --i- i- e--a-erba-ed on --e -ele--one - a -om-le-e nigh-mare -or --e -ard of -earing and --o-e -rying to -ommuni-a-e wi-- --em.

Re-irement o--ers relea-e from a li-e-ime of -lo-ely --ru--ured a--ivi-ie- but al-o -re-en-- challenge- o- i-- own. -ow will we ju-ti-y our -ontinued e-i-ten-e in --e world?  I de-ided to be-ome involved in lo-al -a---n--' -om-i--ee-.  Why -u- my-elf --rough --e a-ony o- ye- more mee-ing-?  I am a -ommuni-a-or and I wan-ed -o -on-inue to -on-ribu-e to -o-ie-y.  De--i-e -ur--er de-eriora---n in my -earing my N-- -earing aid- allow me to do ju-- --a-.  Deva--a-ed i- a mu-- overu-ed word --e-e day- but i- -ully de--ribe- -ow I would -eel wi--ou- my -earing aid-.  -o---l out-a-- would not be too --ro-- a de--rip---n.  (I a--ually --ough- one o- my -even -rand--ildren had a -eriou- --ee-- im-edimen- a- I -ould not under--and any--ing he -aid.  --i- -ear -roved un-ounded on-e I re-eived my -earing aid-.)   

A- a wal-er and a -y-li-t I rely on my -earing aid- to help aler- me to -o-en---l -azard-
a--o-ia-ed wi-- tho-e a--ivi-ie-.  In addi---n devi-e- -u-- a- doorbell-, -imer- and alarm- would be inaudible wi--ou- --em.

I -eel driven to -ee- u- --e-igh- again-- any -o-en---l -u-- in N-- -earing -ervice-.  I, and -o many like me, would become -eriou-ly -o--ally i-ola-ed and vulnerable wi-- all --e o--er -roblem-
a--o-ia-ed wi-- bei-- ex-luded from normal everyday a--ivi-ie- --at --o-e wi--ou- -earing -roblem- -a-e -or -ran-ed.

  1. How far did you get?   
    1. If you gave up part way through could you explain why?
  2. How do you feel?
  3. Were you able to read at your normal pace?
  4. Would you like all your reading matter to be like this?
  5. If the answers to 3 and 4 were, “No,” would you welcome help to overcome these problems?
    1. For your convenience the full text of this article with all the gaps filled in is printed below or can be seen here: https://www.actiononhearingloss.org.uk/community/blogs/our-guest-blog/the-importance-of-hearing-aids.aspx
    2. During conversation people with hearing loss rely on their hearing aids to help fill in the gaps.
    3. Without hearing aids whilst the brain struggles to decipher words orally the conversation may be moving on resulting in further gaps in comprehension.  Eventually the effort becomes too great and many are reduced to smiling and nodding - or, worse, total withdrawal.  Isolation.

Hearing loss is a complex issue.  It is not just about turning up the volume. People who seek help  need help.  Please let patients and audiologists decide who will benefit from hearing aids.
Kathleen Hill
Member of:
GP PPG, Wyre Forest Patients’ Group,
NHS Wyre Forest CCG Membership Scheme
Action on Hearing Loss https://www.actiononhearingloss.org.uk/ (Formerly the RNID) Volunteer

Updated 13th January 2020

The Importance of Hearing Aids
Original Action on Hearing Loss Blog Article Posted on: Monday, February 2, 2015 by Lola Olson

I am a hearing aid wearer with mild to moderate, high frequency hearing loss.  I have worn digital NHS hearing aids for the last eight years.  To say that they have transformed my life is no exaggeration.  

Looking back over my pre-hearing aid years I wonder how I managed.  As a middle school teacher in charge of the PE department but teaching half my timetable in classroom subjects I struggled constantly.  Hearing what children were saying in the gym or on the field was a perpetual problem and I was repeatedly complaining about children mumbling and speaking indistinctly in the classroom.  Staff meetings were a nightmare.  My brain had to work overtime to try to keep track of discussions that I was too often reluctant to join in as I could not be sure what had been said.  Although I did not realise it at the time it has become apparent that the sheer effort of making sense of conversation throughout the day was what caused me to slump into a coma-like sleep every evening - thus robbing me of true rest and relaxation activities.  On occasions when I started watching a television programme I often had to ask family members what had been said only to be told that I should pay full attention.  I rarely saw the end of programmes.

It is only in retirement since receiving my first NHS hearing aids that I fully appreciate just how hard the struggle was during my working years.  No longer do I need the subtitles when watching television.  Now I can enjoy conversations with family members, friends and acquaintances without repeatedly having to ask for repetition and suffering the ensuing embarrassment of still not having heard properly.  There are only so many times one can ask for repetition and there is always the added worry of instigating the often uttered dismissive response, "Oh! It doesn't matter."  Only recipients of those few words will truly understand the frustration they cause.  The constant worry about being filtered out of the group whilst also dealing with the strain of trying to stay connected is now gone.  

The strain on family members and others should not be underestimated.  A friend told me that people with hearing loss should do something about it as it was extremely frustrating to have to repeat things so much.  I was angry with her at the time but on reflection she did me a favour.  Conversation is designed to flow and repeated repetition spoils the flow.  It is difficult to move on when constantly moving back.  Continuity is disrupted and both the hearing and the hearing impaired become frustrated.  This is exacerbated on the telephone - a complete nightmare for the hard of hearing and those trying to communicate with them.

Retirement offers release from a lifetime of closely structured activities but also presents challenges of its own. How will we justify our continued existence in the world?  I decided to become involved in local patients' committees.  Why put myself through the agony of yet more meetings?  I am a communicator and I wanted to continue to contribute to society.  Despite further deterioration in my hearing my NHS hearing aids allow me to do just that.  Devastated is a much overused word these days but it fully describes how I would feel without my hearing aids.  Social outcast would not be too strong a description.  (I actually thought one of my seven grandchildren had a serious speech impediment as I could not understand anything he said.  This fear proved unfounded once I received my hearing aids.)    
As a walker and a cyclist I rely on my hearing aids to help alert me to potential hazards associated with those activities.  In addition devices such as doorbells, timers and alarms would be inaudible without them.

I feel driven to keep up the fight against any potential cuts in NHS hearing services.  I, and so many like me, would become seriously socially isolated and vulnerable with all the other problems associated with being excluded from normal everyday activities that those without hearing problems take for granted.
Kathleen Hill
Member of GP PPG, Wyre Forest Patients’ Group,
NHS Wyre Forest CCG Membership Scheme
Action on Hearing Loss https://www.actiononhearingloss.org.uk/ (Formerly the RNID) Volunteer

The above articles and other items concerning hearing loss can be found here:  
Kathleen can be followed on:
Twitter @kathleenlhill

Minor updates 19.06.2017

Please help someone else understand hearing loss by passing this on when you have finished with it.

Wednesday, 8 January 2020

Points made in Staffordshire Survey Jan 2020

Staffordshire Clinical Commissioning Groups are inviting people to give their views in a survey about making difficult decisions.  One of the services being consulted about is Hearing Loss in Adults.  North Staffordshire ceased provision of hearing aids for adults with mild hearing loss in 2015.  I worry that this will spread to the other Staffordshire CCGs.  I filled in the survey and the comments I put in the boxes provided are below.
"As you have stated NICE have said that audiogram thresholds should not be the only factor used to determine whether or not people can benefit from hearing aids.  Hearing loss is complex. Clarity of speech depends on many things including which frequencies the patient has most difficulty with. Patients should be treated individually according to their needs.  One single average dB reading is a nonsense as hearing loss is usually different at different frequencies. People with high frequency loss are likely to have problems with some consonants. Consonants give speech its meaning.  Try this:  

I am a -earing aid wearer wi-- mild to moderate, -igh -re-uen-y -earing lo--.  I -ave worn digi-al N-- -earing aid- -or --e la-t twelve year-. To -ay --at --ey -ave tran--ormed my li-e i- no e-aggeration.  

Loo-ing ba-- over my -re--earing aid year- I wonder -ow I managed.  A- a middle ---ool tea--er in charge of the -E de-artment but tea--ing -al- my timetable in -la--room -ubje-t- I -tru--led -on-tantly.  -earing what --ildren were -aying in the gym or on --e -ield wa- a -er-etual -roblem and I wa- re-eatedly -om-laining about --ildren mumbling and --ea-ing indi-tin-tly in the -la--room.  -ta-- meeting- were a nightmare. My brain -ad to wor- overtime to try to -ee- tra-- of di--u----ns --at I wa- too o-ten relu-tant to join in a- I -ould not be -ure what -ad been -aid. Al--ough I did not reali-e it at --e time it -a- be-ome a--arent --at --e --eer e--ort of ma-ing -en-e of -onver-a---n --roughout --e day wa- what -au-ed me to -lum- into a -oma-li-e -lee- every evening - --u- robbing me of true re-t and rela-ation a-tivitie-.  On o--a-ion- when I -tarted wat--ing a televi---n -ro-ramme I o-ten had to a-- family member- what had been -aid only to be told --at I --ould -ay -ull atten--on. I rarely -aw --e end- of -ro-ramme-. 

That is what someone with mild hearing loss might hear.  Would you like all your printed material written in this fashion?  People with hearing loss have no alternative to hearing that unless they are provided with hearing aids.  The full article can be viewed here:" https://bliss2hear.blogspot.com/2017/01/making-sense-of-speech.html

"Patients should be treated as individuals.  Only they can tell if hearing aids are helpful to them.  One senior audiologist told me that she could have two patients with exactly the same audiogram readings but the impact on their lives could be entirely different."

"NICE states that hearing loss can lead to isolation - depression and accelerated development of dementia.  There is a proven link between hearing loss and dementia and there is currently much research being carried out on this subject.  There is an old saying, "a stitch in time saves nine." Treat mild hearing loss and you could save money in the long run by reducing the need to treat depression and dementia."

"The social impact of hearing loss should not be underestimated.  I give talks and host information stands for Action on Hearing Loss and speak to many people with hearing loss - and their nearest and dearest.  The impact on the latter should not be underestimated. It is extremely frustrating to try to hold a conversation with someone who has difficulty hearing.  If the person with hearing loss has not already isolated themselves other people may do so. I have seen this happen many times. It is very sad to see someone in a room with others but not being involved in the conversation.  Please do not remove these lifelines for those of us who are aurally challenged."

Monday, 27 November 2017

Mark Garnier - You can make a difference.


Dear Mr Garnier,

Open Letter:  You can help make a difference.

How is your hearing?   “I am a -earing aid wearer wi-- mild to moderate, -igh -re-uen-y -earing lo--.  I -ave worn di-ital N-- -earing aid- -or --e la-- eight year-.  To -ay --at --ey -ave tran--ormed my li-e i- no e-aggeration.”  

This is what someone with ‘mild’ hearing loss might hear. Those with moderate or severe hearing loss will hear a more redacted version making that very short extract from my ‘Making Sense of Speech’ document even more difficult to understand.  The full version can be found here: https://bliss2hear.blogspot.co.uk/2017/01/making-sense-of-speech.html

I am one of around 11 million people in the UK who has a hearing loss.  (1 in 6 of the population)  
  • This figure is projected to rise to 15.6 million in 2035.  (1 in 5)  
  • The problem is exacerbated because we are an ageing population and as we age hearing deteriorates.
  • Untreated hearing loss can lead to isolation and depression.  
  • There is a link between hearing loss and the development of dementia.  
  • I wear two digital hearing aids and have campaigned against proposed cuts in services both in Worcestershire and other CCG areas in the country.  
  • My hearing aids have transformed my life.  
  • For many reasons, 60% of those who could benefit from hearing aids don’t have them.  
  • Ideally we need to find a way of curing - or better still - preventing hearing loss.

Action on Hearing loss - for which I am a volunteer - is the largest charity for people with hearing loss in the UK.   https://www.actiononhearingloss.org.uk/about-us/  

How can you help?  
  • We need more government money so that British Scientists can fulfil their research potential.   
    • Your support for increased government funding for UK Scientific Research, particularly hearing loss research, is vital.
  • Please attend the debate on deafness related issues organised by Jim Fitzpatrick MP in Westminster Hall on 30th November 1.30pm - 4.30pm.
    • A brief for this debate can be accessed by emailing info@deafcouncil.org.uk

Thank you for reading this email.  I look forward to your response.

Yours sincerely,
Kathleen Hill
Action on Hearing Loss National Volunteer Award - Passion in Action - Winner 2017

Twitter @kathleenlhill

Thursday, 15 June 2017

Hearing Aids Under Threat - Documents for CCGs


This blog post includes all documents/links I have sent to Enfield CCG.

The first three documents are all posts or adaptations of posts to be found in individual posts on this blog. I have republished them together here for ease of access and to make tweeting the link to them easier and hence more efficient.

If you scroll down below document 5 there are open covering letters I have sent to specific members of Enfield CCG (Unfortunately, some of the formatting has altered in copying and pasting from Google Docs. I have tried to correct it without success.)

Please feel free to use any documents I have written and published on this blog Bliss 2 Hear if you think they may help in the fight to retain provision of hearing aids on the NHS


Document 1


Dear CCG Governing Body  Members,

Proposal to limit NHS hearing aid provision
Open letter to whom it may concern

With reference to your proposal to limit the provision of NHS hearing aids please consider the following:
  • People often do not appreciate the true impact that hearing loss can have on others.
    • 'Mild' hearing loss in itself is a fairly meaningless diagnosis.
      • It depends upon which frequencies are affected.
      • Age related hearing loss tends to affect the higher frequencies.
        • Consonants are voiced at higher frequencies than vowels.  
        • It is consonants that give speech its meaning.
  • The impact of hearing loss is very individual.
    • I have it on good authority from a senior audiologist that two patients could be assessed as having the same hearing loss but that the impact of that hearing loss on those two individuals could be wildly different.
      • This means that measuring thresholds at which people can hear certain frequencies is not enough to determine whether or not someone could benefit from hearing aids. Please see WHO advice here: http://www.who.int/pbd/deafness/hearing_impairment_grades/en/ "Note: While audiometric descriptors may provide a useful summary of an individual’s hearing thresholds, they should not be used as the sole determinant for the provision of hearing aids. The ability to detect pure tones using earphones in a quiet environment is not in itself a reliable indicator of hearing disability. Audiometric descriptors alone should not be used as the measure of difficulty experienced with communication in background noise, the primary complaint of individuals with hearing loss."
    • People can experience more/less success when listening to different people.
      • This is NOT ‘selective’ hearing in the way that is often joked about.
      • It IS ‘selective’ in that different people speak at different frequencies and therefore are more/less understandable depending on the frequencies with which patients have a problem.
      • Eg: People with high frequency loss can often determine men’s  speech better than women’s because men tend to have lower pitched voices than women. There are always exceptions to this, however.
  • The exhausting nature of hearing loss should not be underestimated.  
  • Hearing Loss can lead to people distancing themselves - or being distanced by others - from conversations, becoming isolated, depressed and experiencing accelerated development of dementia.
    • Many people with good hearing become frustrated if asked to repeat things for people who have not heard/understood the first, second and possible subsequent times.
    • Do not assume that those who nod and smile have understood what you have said.  It is highly likely they may be too embarrassed to ask for further repetition.
  • Current advice is that people should seek help with hearing loss sooner rather than later before the difference between noise levels heard with and without hearing aids becomes too great for patients to cope with.
    • Department of Health & NHS England Action Plan on Hearing Loss (23rd March 2015) states that Objective 2 (Page 20) is to “ensure that all people with hearing loss are diagnosed early …… and that they are managed effectively once diagnosed.”  
      • Page 22 states, “Hearing is a major factor in maintaining independence and achieving healthy ageing.”
      • The link between hearing loss and dementia is also mentioned.  There is a  recognised pathway - hearing loss - isolation - depression - dementia.  
    • ‘Managing’ without hearing aids should be actively discouraged.  https://bliss2hear.blogspot.co.uk/2017/01/manage-without-hearing-aids-many-many.html
    • I have spoken with many people who are reluctant to wear their hearing aids.
      • Almost without exception one of the reasons is that they find the world too noisy.
      • Their hearing has deteriorated too much before they sought or were offered help.
  • According to Action on Hearing Loss It takes - on average - 10 years for people to address their hearing loss.  When they finally admit that they need help it is because they NEED help.
    • No one wants to wear hearing aids.
      • There is still a certain stigma attached to wearing hearing aids that has to be overcome by the patient.
      • Those who benefit from and persevere with hearing aids do so because their lives are more tolerable with than without.

I understand that the government is cutting your budget and that savings have to be made. However, please consider the perceived savings you may make - in denying hearing aids to those patients for whom some arbitrary scoring system has determined a level of hearing loss and compare it with the likely expense of dealing with possible health, quality of life and independence problems that could ensue if patients continue along the pathway:  hearing loss, isolation, depression and accelerated development of dementia.

I suffer from hearing loss and whilst there are certain strategies that can be employed to help with speech understanding the overwhelmingly successful one is my NHS pair of hearing aids.  Hearing aids are my lifeline, socially and in my voluntary work.  They will be a lifeline to others, too.

Please allow audiologists - together with their patients - to decide who will benefit from and be fitted with hearing aids.  
Yours sincerely,
Kathleen Hill
Action on Hearing Loss https://www.actiononhearingloss.org.uk/ (Formerly RNID) Volunteer
Member of Wyre Forest Patient Participation Groups (PPGs)
Member of NHS Wyre Forest CCG Membership Scheme
Twitter @kathleenlhill                                 

Updated 15th June 2017    


Document 2


Manage without Hearing Aids?


Many, many times people have told me that they don't need hearing aids because they 'manage' without.  I 'managed' for many years too.



I tried to ensure:

  • I was facing the person/people with whom I was talking
  • I got a seat in the front row at meetings
  • I had my 'better' ear nearest the source of the speech
  • it was not obvious that I was cupping my hand behind my ear

I was oblivious to the fact that there were changes happening in my brain to enable me to understand speech whilst I thought my ears were 'managing'.


I did not appreciate that my brain had to work harder to compensate for the fact that my ears were not working at optimum efficiency. (So that is why I was always so tired in the evenings!)

To understand why the brain has to work harder if you have even 'just mild' hearing loss see ‘The Importance of Hearing Aids - Getting the Message Across to Clinical Commissioning Groups’ attached.


I had no idea that as long ago as 1989 it was suspected that there was a link between hearing loss and dementia.  

Think about it.  
  • How can you store memories of what you haven't heard properly?  
  • How can you recall a memory your brain hasn't stored in the first place?
  • Department of Health & NHS England Action Plan on Hearing Loss (23rd March 2015) states that Objective 2 (Page 20) is to “ensure that all people with hearing loss are diagnosed early …… and that they are managed effectively once diagnosed.”  
    • Page 22 5.10 states, “Hearing is a major factor in maintaining independence and achieving healthy ageing.”
    • Page 10 3.14 states, "There is an association between hearing loss, poor mental health outcomes and dementia in particular (8,10). People with hearing loss often experience isolation and depression with an increased risk of a major depression or a more serious moderate to severe depression."
    • Page 10 3.15  states, "Hearing loss is associated with an increased risk of developing dementia in over 60 year olds. People with mild hearing loss have nearly twice the risk of developing dementia compared to people with normal hearing; and the risk increases threefold for people with moderate and fivefold for people with severe hearing loss (9,10). Hearing loss has recently been independently associated with accelerated cognitive decline and incident cognitive impairment" (7,10).
The full document can be found here:


There is a wealth of information concerning hearing loss here: https://www.actiononhearingloss.org.uk/

Other articles concerning the association between hearing loss, depression and dementia can be found here:







Document 3

I have made a few minor corrections (removal of some letters) in the original of this post. You may wish to access that here: https://bliss2hear.blogspot.co.uk/2016/11/getting-message-across_13.html


The Importance of Hearing Aids

Getting the Message Across to Clinical Commissioning Groups

The following article was originally written for - and published on - Action on Hearing Loss’s website. https://www.actiononhearingloss.org.uk/community/blogs/our-guest-blog/the-importance-of-hearing-aids.aspx The letters and sounds that someone with ‘mild’ high frequency hearing loss (most often associated with age/noise related hearing loss) might struggle to hear have been removed in an attempt to offer some insight into the difficulties those with impaired hearing might face.  It should be remembered that whilst readers can read and work out meaning at their own individual pace people do not enjoy that luxury in real time verbal conversations.  Lipreading is not a substitute for hearing. Much of it is guesswork - filling in the gaps left by sounds made without moving the lips.  Add the distraction of background noise to the mix and for many the struggle becomes too great.  Isolation, depression and dementia (perceived or real) are very significant threats.

Please read on.  At the end there are a few questions you may like to ponder and answer.

I am a -earing aid wearer wi-- mild to moderate, -igh -re-uen-y -earing lo--.  I -ave worn digi-al N-- -earing aid- -or --e la-t eight year-.  To -ay --at --ey -ave tran--ormed my li-e i- no e-aggeration.  

Loo-ing ba-- over my -re--earing aid year- I wonder -ow I managed.  A- a middle ---ool tea--er in charge of the -E de-artment but tea--ing -al- my timetable in -la--room -ubje-t- I -tru--led -on-tantly.  -earing what --ildren were -aying in the gym or on --e -ield wa- a -er-etual -roblem and I wa- re-eatedly -om-laining about --ildren mumbling and --ea-ing indi-tin-tly in the -la--room.  -ta-- meeting- were a nightmare.  My brain -ad to wor- overtime to try to -ee- tra-- of di--u----ns --at I wa- too o-ten relu-tant to join in a- I -ould not be -ure what -ad been -aid.  Al--ough I did not reali-e it at --e time it -a- be-ome a--arent --at --e --eer e--ort of ma-ing -en-e of -onver-a---n --roughout --e day wa- what -au-ed me to -lum- into a -oma-li-e -lee- every evening - --u- robbing me of true re-t and rela-ation a-tivitie-.  On o--a-ion- when I -tarted wat--ing a televi---n -ro-ramme I o-ten had to a-- family member- what had been -aid only to be told --at I --ould -ay -ull atten--on.  I rarely -aw --e end- of -ro-ramme-.

It i- only in retirement -in-e re-eiving my -ir-t N-- -earing aid- --at I -ully a--re-iate ju-t -ow -ard --e -tru--le wa- during my wor-ing year-.  No lon-er do I need --e -ubtitle- when wat--ing televi---n.  Now I -an enjoy -onver-a---n- wi-- -amily member-, -riend- and a--uaintan-e- wi--out re-eatedly -aving to a-- for re-eti---n and -u--ering --e en-uing embarra--ment of -till not -aving -eard -ro-erly.  --ere are only -o many time- one -an a-- for re-eti---n and --ere i- alway- --e added worry of ini-iating t-e o-ten uttered di-mi--ive re--on-e, "Oh! It doe-n't matter."  Only re-i-ient- of --o-e -ew word- will truly under-tand --e -ru-tra---n --ey -au-e.  --e -on-tant worry about being -iltered out of --e -rou- whil-t al-o dealing wi-- --e -train of trying to -tay -onne-ted i- now -one.  

The -train on -amily member- and other- --ould not be undere-timated.  A -riend told me --at -eo-le wi-- -earing lo-- --ould do -omething about it a- it wa- e-tremely -ru-trating to have to re-eat --ing- -o much.  I wa- an-ry wi-- her at --e time but on re-le-tion she did me a -avour.  -onver-a---n i- de-igned to -low and re-eated re-eti---n --oil- --e -low.  It i- diffi-ult to move on when -on-tantly moving ba--.  -ontinuity is di-ru-ted and bo-- --e -earing and the -earing im-aired be-ome -ru-trated.  --i- i- e--a-erbated on --e tele--one - a -om-lete nightmare -or --e -ard of -earing and --o-e trying to -ommuni-ate with --em.

Retirement o--ers relea-e from a li-etime of -lo-ely -tru-tured a-tivitie- but al-o -re-ent- challenge- o- it- own. -ow will we ju-ti-y our -ontinued e-i-ten-e in --e world?  I de-ided to be-ome involved in lo-al -a---nt-' -ommittee-.  Why -ut my-elf --rough --e a-ony o- yet more meeting-?  I am a -ommuni-ator and I wanted to -ontinue to -ontribute to -o-iety.  De--ite -ur--er deteriora---n in my -earing my N-- -earing aid- allow me to do ju-t --at.  Deva-tated i- a much overu-ed word --e-e day- but it -ully de--ribe- -ow I would -eel wi--out my -earing aid-.  -o---l out-a-t would not be too -tro-- a de--rip---n.  (I a-tually --ought one o- my -even -rand--ildren had a -eriou- --ee-- im-ediment a- I -ould not under-tand any--ing he -aid.  Thi- -ear -roved un-ounded on-e I re-eived my -earing aid-.)   

A- a wal-er and a -y-li-t I rely on my -earing aid- to help alert me to -oten---l -azard-
a--o-iated wi-- tho-e a-tivitie-.  In addition devi-e- -u-- a- doorbell-, timer- and alarm- would be inaudible wi--out --em.

I -eel driven to -ee- u- --e-ight again-t any -oten---l -ut- in N-- -earing -ervice-.  I, and -o many like me, would become -eriou-ly -o--ally i-olated and vulnerable wi-- all --e o--er -roblem-
a--o-iated wi-- bei-- ex-luded from normal everyday a-tivitie- --at tho-e wi--out -earing -roblem- ta-e -or -ranted.

  1. How far did you get?   
    1. If you gave up part way through could you explain why?
  2. How do you feel?
  3. Were you able to read at your normal pace?
  4. Would you like all your reading matter to be like this?
  5. If the answers to 3 and 4 were, “No,” would you welcome help to overcome these problems?
    1. For your convenience the full text of this article with all the gaps filled in is printed below or can be seen here: https://www.actiononhearingloss.org.uk/community/blogs/our-guest-blog/the-importance-of-hearing-aids.aspx
    2. During conversation people with hearing loss rely on their hearing aids to help fill in the gaps.
    3. Without hearing aids whilst the brain struggles to decipher words orally the conversation may be moving on resulting in further gaps in comprehension.  Eventually the effort becomes too great and many are reduced to smiling and nodding - or, worse, total withdrawal.  Isolation.

Hearing loss is a complex issue.  It is not just about turning up the volume. People who seek help  need help.  Please let patients and audiologists decide who will benefit from hearing aids.
Kathleen Hill
Member of:
GP PPG, Wyre Forest Patients’ Group,
NHS Wyre Forest CCG Membership Scheme
Action on Hearing Loss https://www.actiononhearingloss.org.uk/ (Formerly the RNID) Volunteer

Minor updates 5th June 2017

***** On 15th February 2017 Action on Hearing Loss asked me to answer some questions about my experiences of hearing loss on BBC Radio 4’s Woman’s Hour.  Following this I was asked if I would allow Action on Hearing Loss to quote from this blog post in a presentation designed to help people understand hearing loss.  I am really pleased that I seem to be on the right track. *****

The Importance of Hearing Aids
Original Action on Hearing Loss Blog Article Posted on: Monday, February 2, 2015 by Lola Olson

I am a hearing aid wearer with mild to moderate, high frequency hearing loss.  I have worn digital NHS hearing aids for the last eight years.  To say that they have transformed my life is no exaggeration.  

Looking back over my pre-hearing aid years I wonder how I managed.  As a middle school teacher in charge of the PE department but teaching half my timetable in classroom subjects I struggled constantly.  Hearing what children were saying in the gym or on the field was a perpetual problem and I was repeatedly complaining about children mumbling and speaking indistinctly in the classroom.  Staff meetings were a nightmare.  My brain had to work overtime to try to keep track of discussions that I was too often reluctant to join in as I could not be sure what had been said.  Although I did not realise it at the time it has become apparent that the sheer effort of making sense of conversation throughout the day was what caused me to slump into a coma-like sleep every evening - thus robbing me of true rest and relaxation activities.  On occasions when I started watching a television programme I often had to ask family members what had been said only to be told that I should pay full attention.  I rarely saw the end of programmes.

It is only in retirement since receiving my first NHS hearing aids that I fully appreciate just how hard the struggle was during my working years.  No longer do I need the subtitles when watching television.  Now I can enjoy conversations with family members, friends and acquaintances without repeatedly having to ask for repetition and suffering the ensuing embarrassment of still not having heard properly.  There are only so many times one can ask for repetition and there is always the added worry of instigating the often uttered dismissive response, "Oh! It doesn't matter."  Only recipients of those few words will truly understand the frustration they cause.  The constant worry about being filtered out of the group whilst also dealing with the strain of trying to stay connected is now gone.  

The strain on family members and others should not be underestimated.  A friend told me that people with hearing loss should do something about it as it was extremely frustrating to have to repeat things so much.  I was angry with her at the time but on reflection she did me a favour.  Conversation is designed to flow and repeated repetition spoils the flow.  It is difficult to move on when constantly moving back.  Continuity is disrupted and both the hearing and the hearing impaired become frustrated.  This is exacerbated on the telephone - a complete nightmare for the hard of hearing and those trying to communicate with them.

Retirement offers release from a lifetime of closely structured activities but also presents challenges of its own. How will we justify our continued existence in the world?  I decided to become involved in local patients' committees.  Why put myself through the agony of yet more meetings?  I am a communicator and I wanted to continue to contribute to society.  Despite further deterioration in my hearing my NHS hearing aids allow me to do just that.  Devastated is a much overused word these days but it fully describes how I would feel without my hearing aids.  Social outcast would not be too strong a description.  (I actually thought one of my seven grandchildren had a serious speech impediment as I could not understand anything he said.  This fear proved unfounded once I received my hearing aids.)   

As a walker and a cyclist I rely on my hearing aids to help alert me to potential hazards associated with those activities.  In addition devices such as doorbells, timers and alarms would be inaudible without them.

I feel driven to keep up the fight against any potential cuts in NHS hearing services.  I, and so many like me, would become seriously socially isolated and vulnerable with all the other problems associated with being excluded from normal everyday activities that those without hearing problems take for granted.

Kathleen Hill
Member of GP PPG, Wyre Forest Patients’ Group,
NHS Wyre Forest CCG Membership Scheme
Action on Hearing Loss https://www.actiononhearingloss.org.uk/ (Formerly the RNID) Volunteer

The above articles and other items concerning hearing loss can be found here:  
Kathleen can be followed on:
Twitter @kathleenlhill

Minor updates 05.06.2017      

Document 4


April 11th 2017
I have not written this document. The original can be found here:


https://audiologyblog.phonakpro.com/what-big-data-tells-us-about-hearing-aid-use-in-adults-with-mild-hearing-loss/

Evidence

“What does big data tell us about hearing aid use in adults with mild hearing loss?”


“Evidence suggests HCPs shouldn't hesitate in fitting hearing aids to motivated patients with mild hearing loss.”


My highlights:


“There is some evidence that hearing care professionals (HCPs) hesitate in fitting hearing aids to patients with a mild hearing loss. For example, the large-scale Marketrak VIII study conducted with US individuals with hearing loss found that 43% of respondents with a mild hearing loss reported that their audiologists had taken a ‘wait and retest’ approach to providing hearing aids (Kochkin, 2012). For those who had visited a hearing instrument specialist, the percentage was similar, at 35%.


This hesitance could be due to a number of factors. The individuals with mild hearing loss may not have indicated a perceived need for an intervention such as a hearing aid, despite seeing a HCP. Alternatively, the HCPs may show reluctance in providing hearing aids due to a perceived lack of benefit from hearing aids for a mild degree of hearing loss.
Our recent study explored the question that when individuals see a HCP and are fitted with hearing aids, do those with a mild hearing loss use hearing aids less or differently than individuals with a moderate degree of loss. We used an international database of 16,766 fittings from 159 clinics in 4 countries and extracted total of 8489 bilateral fittings which contained data on hearing loss and hearing aid use. The hearing aid use values were extracted from the hearing aids’ data logging feature, and hence were an objective measure of use.
The individuals in the database were then divided into groups based on their average hearing loss at 500, 1000, 2000 and 4000 Hz, using both the British Society of Audiology (BSA) and American Speech-Language-Hearing Association (ASHA) descriptors of degrees of hearing loss. Both define mild hearing loss to be an average loss between 25 and 40 dB HL. The BSA describes a moderate hearing loss to be between 41 and 70 dB HL while ASHA recognises a moderate degree to be between 41 and 55 dB HL and a moderately-severe degree of hearing loss to be between 56 and 70 dB HL.
In general, the results showed that hearing aid use was 8.5 hours per day for those with a mild or moderate degree of hearing loss, and 9.0 hours per day for those with a moderately severe hearing loss. There were some differences in use of the left hearing aid (none for the right) but these were minor and would not be deemed clinically relevant.
The pattern of hearing aid use also did not differ between the groups, with 8 to 12 hours of hearing aid use per day being the most common for all hearing loss groups. Similarly the use of hearing aids in different listening situations (quiet versus in noise) also did not vary amongst the groups.
In essence the study showed when individuals attend a HCP and are provided a hearing aid, those with mild hearing loss can be expected to use those hearing aids as much as individuals with moderate degrees of hearing loss. Therefore there is little evidence from this study that clinicians should hesitate in recommending hearing aids to motivated individuals who visit their clinics.
If you would like further information about this study, it is available in the ‘fast track articles’ section of the Journal of the American Academy of Audiology: Timmer BHB, Hickson L, Launer S. (2016) Hearing aid use and mild hearing impairment: Learnings from big data. J Am Acad Audiol.”
“Reference: Kochkin S. 2012. MarkeTrak VIII: The key influencing factors in hearing aid purchase intent. Hear. Rev., 19, 12-25.”
Sent to CCGs who are considering cutting hearing aid provision on NHS by
Kathleen Hill
Action on Hearing Loss https://www.actiononhearingloss.org.uk/ (Formerly RNID) Volunteer
Member of Wyre Forest Patient Participation Groups (PPGs)
Member of NHS Wyre Forest CCG Membership Scheme
Twitter @kathleenlhill  


Document 5


A copy of the Action on Hearing Loss leaflet
'How's Your Hearing?'

https://www.actiononhearingloss.org.uk/~/media/Files/Leaflets/2017/How%20is%20Your%20Hearing_2017.ashx

Open Covering Letters I have written to specific members of Enfield CCG

16th June 2017

Dr Mo Abedi Clinical Chair

Enfield CCG

Holbrook House

116 Cockfosters Road

Barnet

EN4 0DR

Dear Dr Abedi
Proposal to limit provision of hearing aids on NHS
I am writing this open letter to you because:
  • You are the clinical chair of Enfield CCG and have professed that you are “passionate about improving health services and reducing health inequalities in Enfield.”
  • I am a hearing aid wearer and volunteer national campaigner with Action on Hearing Loss.
  • I am including documents that I hope may highlight the difficulties people with even so called ‘mild’ hearing loss will face if your CCG restricts hearing aid provision.
  • In my experience many clinical people are surprised when they read my document ‘The Importance of Hearing Aids - Getting the Message Across to Clinical Commissioning Groups’.
  • I have perceived a need for raising awareness of what it is actually like to have hearing loss.  It is a hidden disability that is much misunderstood.
Please read the enclosed documents before presiding over a final decision about hearing aid services.  If you deny hearing aids to those who seek help many people will be seriously disadvantaged.
Yours sincerely,

Kathleen Hill  
Action on Hearing Loss https://www.actiononhearingloss.org.uk/ (Formerly RNID) Volunteer
Member of:  Wyre Forest Patient Participation Groups (PPGs), NHS Wyre Forest CCG Membership Scheme, https://bliss2hear.blogspot.co.uk/  www.facebook.com/Bliss2Hear/  Twitter @kathleenlhill
16th June 2017

Dr Janet High

Enfield CCG

Holbrook House

116 Cockfosters Road

Barnet

EN4 0DR

Dear Dr High

Proposal to limit provision of hearing aids on NHS
I am writing this open letter to you because:
  • You are a member of Enfield CCG Governing Body and areclinical lead for integrated care for older people (including dementia)”.
  • I am a hearing aid wearer and volunteer national campaigner with Action on Hearing Loss.
  • I am including documents that I hope may highlight the difficulties people with even so called ‘mild’ hearing loss will face if your CCG restricts hearing aid provision.
  • In my experience many clinical people are surprised when they read my document ‘The Importance of Hearing Aids - Getting the Message Across to Clinical Commissioning Groups’.
  • I have perceived a need for raising awareness of what it is actually like to have hearing loss.  It is a hidden disability that is much misunderstood.  There is a link between hearing loss and development of dementia.
Please read the enclosed documents before a final decision about hearing aid services is made.  If hearing aids are denied to those who seek help many people will be seriously disadvantaged.
Yours sincerely,

Kathleen Hill  
Action on Hearing Loss https://www.actiononhearingloss.org.uk/ (Formerly RNID) Volunteer
Member of:  Wyre Forest Patient Participation Groups (PPGs), NHS Wyre Forest CCG Membership Scheme, https://bliss2hear.blogspot.co.uk/  www.facebook.com/Bliss2Hear/  Twitter @kathleenlhill
Published here: https://bliss2hear.blogspot.co.uk/2017/06/hearing-aids-under-threat-documents-for.html
16th June 2017

Deborah Fowler

Enfield CCG

Holbrook House

116 Cockfosters Road

Barnet

EN4 0DR

Dear Ms Fowler

Proposal to limit provision of hearing aids on NHS
I am writing this open letter to you because:
  • You are a member of Enfield CCG Governing Body, Chair of Healthwatch Enfield, member of the governing body of Healthwatch England and have previously supported older people.
  • I am a hearing aid wearer and volunteer national campaigner with Action on Hearing Loss.
  • I am including documents that I hope may highlight the difficulties people with even so called ‘mild’ hearing loss will face if your CCG restricts hearing aid provision.
  • In my experience many people are surprised when they read my document ‘The Importance of Hearing Aids - Getting the Message Across to Clinical Commissioning Groups’.
  • I have perceived a need for raising awareness of what it is actually like to have hearing loss.  It is a hidden disability that is much misunderstood.  There is a link between hearing loss and development of dementia.
Please read the enclosed documents before a final decision about hearing aid services is made.  If hearing aids are denied to those who seek help many people will be seriously disadvantaged.
Yours sincerely,

Kathleen Hill  
Action on Hearing Loss https://www.actiononhearingloss.org.uk/ (Formerly RNID) Volunteer
Member of:  Wyre Forest Patient Participation Groups (PPGs), NHS Wyre Forest CCG Membership Scheme, https://bliss2hear.blogspot.co.uk/  www.facebook.com/Bliss2Hear/  Twitter @kathleenlhill
Published here: https://bliss2hear.blogspot.co.uk/2017/06/hearing-aids-under-threat-documents-for.html
16th June 2017

Litsa Worrall

Enfield CCG

Holbrook House

116 Cockfosters Road

Barnet

EN4 0DR

Dear Ms Worrall
Proposal to limit provision of hearing aids on NHS
I am writing this open letter to you because:
  • You are the PPG representative on Enfield CCG Governing Body.
  • I am a hearing aid wearer and volunteer national campaigner with Action on Hearing Loss.
  • I am including documents that I hope may highlight the difficulties people with even so called ‘mild’ hearing loss will face if your CCG restricts hearing aid provision.
  • In my experience many people are surprised when they read my document ‘The Importance of Hearing Aids - Getting the Message Across to Clinical Commissioning Groups’.
  • I have perceived a need for raising awareness of what it is actually like to have hearing loss.  It is a hidden disability that is much misunderstood.  

Please
read the enclosed documents before a final decision about hearing aid services is made.  If hearing aids are denied to those who seek help many people will be seriously disadvantaged.
Yours sincerely,

Kathleen Hill  
Action on Hearing Loss https://www.actiononhearingloss.org.uk/ (Formerly RNID) Volunteer
Member of:  Wyre Forest Patient Participation Groups (PPGs), NHS Wyre Forest CCG Membership Scheme, https://bliss2hear.blogspot.co.uk/  www.facebook.com/Bliss2Hear/  Twitter @kathleenlhill
Published here: https://bliss2hear.blogspot.co.uk/2017/06/hearing-aids-under-threat-documents-for.html