A 73-year-old man with hearing loss.

DR SHIP: Mr H is a 73-year-old man who has had hearing loss for 8 years. He immigrated to the United States from Taiwan about 40 years ago. He lives in a suburb of Boston with his wife and is retired from work in scientific research. He has Medicare and supplemental preferred provider organization insurance. In 1994, Mr H noticed that he was having difficulty hearing at laboratory seminars and at home. He found it difficult to distinguish consonants, especially d from t and p from b. Unless the topic of discussion was familiar, he had difficulty understanding it. He sought care from his primary care physician, who referred him to an audiologist. Audiometry results confirmed hearing loss sufficient to benefit from a hearing aid, so he began to wear these in both ears. Every 2 to 3 years, each subsequentaudiologyexaminationhasshowedworsenedhearing loss. In 1997, Mr H purchased a new set of hearing aids withamoresophisticatedamplifier.Hismost recent setofhearing aids is digital with a dual control for frequency and volume, which he states improves the quality of sound. Despite using hearing aids, Mr H finds that his hearing is “far from” 100% and that his hearing loss continues to affect his daily life. One-on-one conversations are easier than listening to a group of people. He notes also that his capacity to hear and enjoy music has been dramatically affected. He has difficulty understanding conversation in movies when speakers are not on the screen. When he watches television, he is often alone—he must raise the volume so high that his family leaves the room. His past medical history is significant for pulmonary tuberculosis at age 25 treated with 6 months of drug therapy (specific drug unknown). His current medications include aspirin, 81 mg/d, a daily multivitamin, supplemental vitamin E, and calcium. There is no family history of hearing loss. Mr H quit smoking tobacco in 1967 after 20 packyears. He drinks alcohol socially. On physical examination, Mr H appears healthy. He has no abnormalities of his ears, nose, or throat. He wears hearing aids in both ears. There are no bony abnormalities. Audiology performed in December 2000 showed moderate to severe hearing loss in both ears, with areas of profound hearing loss, especially in the left ear. Mr H wonders what the prospects are for dealing with hearing loss and whether new technologies may someday allow reversal of the problem. MR H: HIS VIEW Unless I am very familiar with the subject that is coming, I quite frequently start losing what I was supposed to understand. I don’t find much difficulty in one-to-one conversation or discussion particularly face-to-face and at a comfortable distance. The most difficult experience is participating in, let’s say, a cocktail party in a large room with a lot of people and background noise. At home, when my wife is in another room, particularly when I have no idea what language she is using or what her subject is, I’m totally at a loss and strictly on my own to figure out the conversation. That disappoints my family members to no end. Actually, all these changes of hearing aids are quite often prompted by the observation of family members. I don’t hear music the same way as I used to. When I listen to the music with which I had been familiar, I just don’t recognize it, and that disappoints me very much. I would like to find some way of putting my two ears in balance so that I can get back to listening to music. But I am pretty much resigned to the fact that I have to choose understanding of people—the language—more than listening to music. I would like to ask Dr Jackler what prospect the profession has of dealing with hearing loss. How will they be able to address it: surgically or with the use of medicine? I am one of those perennial optimists. I’m always hoping that something better will come along, and I would be willing to try if someone tells me that the newer devices are better.