Should you wear hearing aids all the time?

This spring, when I fell ill with COVID-19, I didn’t leave my apartment for six weeks. Neighbors and friends brought me medicine and food and I mostly kept in touch by texting. I spoke to my doctors by phone or video. I didn’t put on my hearing aids while alone or for these calls. I used headphones and turned up the volume. After all, with headphones you can just turn up the volume.

We’ve all heard the jokes about attending video meetings without your pants (or underwear??) and skipping a shower or two. Even if you weren’t sick, how many of us have left our hearing aids in the case?

But, as I soon learned, it’s important to wear hearing aids through your waking hours—even when you’re at home for days during a pandemic. To keep your hearing and brain sharp, the only time you should be removing your hearing aids is for sleeping and activities like showering or swimming.

Uncorrected hearing loss subjects your brain to ‘auditory deprivation’

Most people with hearing loss don’t hear sounds of certain frequencies, usually high ones. If you don’t hear those sounds—because your hearing loss isn’t corrected—your brain adapts.

Imagine a baby who doesn’t have the ability to hear. “If hearing and speech and language are the parents’ goal, we need to get stimulation to the auditory nerve quickly because neural synapses are developing,” explains Catherine Palmer, president of the American Academy of Audiology, a professor at the University of Pittsburgh and director of audiology for its health system. “This is an issue for adults as well. We don’t want the auditory system deprived of sound because over time that can change auditory processing abilities,” she said. Your brain may forget how to hear certain words and sounds, in other words. This is known as auditory deprivation.

You can put yourself back in ‘hearing-loss land’

When I did put my aids on again, for dinner at a table on the street, everything sounded way too loud—much like when I first got my hearing aids 20 years ago and it was excruciating to wear them on the streets of New York. Apparently six weeks was long enough to affect how my brain processes sound.

When we first get hearing aids, we need time to adjust. To acclimate during the adjustment period, hearing professionals usually recommend a person wear their aids a few hours each day, working up to full-day wear. This isn’t easy: At first people describe sounds as too loud. We hear too much background sound and some sounds seem sharp and unpleasant—usually high frequencies we used to miss. Most people adjust in two to three weeks, as our brains adapt to the new sounds and block out sounds like humming refrigerators.

When you take out your hearing aids for prolonged periods, you may feel that it’s harder to hear than it used to be. The difference is the amount of energy your brain puts into hearing. You’ve adapted to a hearing-aid world and your brain doesn’t work as hard at compensating for your hearing loss as it used to.

If you leave the aids off for any length of time during the day—as I did during my prolonged quarantine—your brain will adjust to the new conditions and you’ll either use more effort to hear or withdraw from communication. Some sounds will disappear.

How many hours a day should you wear hearing aids?

I’ll confess once I began working at home years ago, I’ve rarely worn my aids from the minute I got out of bed until the minute I fell asleep. So I asked Dr. Palmer: Is there a minimum number of hours of usage that would keep our brains primed?

Although there isn’t data to answer that question, she told me, audiologists see that people who wear their aids all through their waking hours do better. “The brain isn’t good at trying to listen in two ways—through the hearing loss and through the amplification system. The ear is a doorway to the brain, it doesn’t make sense to have it partially closed part of the day,” she explained.

My own observation is that part-time use has a big cost. I have a friend with profound hearing loss, much worse than mine. When neither of us wears our hearing aids, the difference is dramatic. But we’ve both noticed with surprise that when we are in a noisy restaurant wearing our hearing aids, he can hear better than I can. I thought the aids were the problem. However, now I have a different theory—he’d been wearing his aids whenever he was awake and was getting the full benefit of them. His brain was adapted to a fuller range of sound.

“The ear is a doorway to the brain, it doesn’t make sense to have it partially closed part of the day.”

Hearing loss may increase a sense of isolation

If you don’t wear your hearing aids often enough for maximal brain adjustment, and are staying home often, you may find it harder to relate to people.

Hearing loss can promote compensations like interrupting, monologuing, not talking, or talking too loudly or quietly. These habits make it harder to enjoy conversations or even small talk, especially through masks. You might not feel comfortable on video conference or phone calls.

And if you don’t enjoy conversation, you may withdraw, feel other people don’t like you, and become lonely.

Along with wearing your hearing aids to keep your conversational skills sharp, there are other ways to offset this loneliness. For example, if you get comfortable with video calls, they have the advantage of allowing you to wear a headset and adjust the volume. If your hearing aids are Bluetooth-equipped, you can stream audio from the video call, or if not, wear a headset over your hearing aids.

The same is true of ordinary phone calls. I personally have been texting lots of friends and spending more time on the phone with family. I don’t feel isolated at all.

It might be time to see an audiologist again

If you begin wearing your aids again and the sound isn’t comfortable, you may need to tolerate a period of adjustment. If that doesn’t work, seeing an audiologist is a good idea, since hearing can change over time for anyone. An audiologist can reprogram the hearing aids if needed, and help motivate you to use your hearing aids full-time.

It is safe to get hearing care during the pandemic

Many audiologists are set up for online telehealth appointments. And if you prefer in-person, here’s some advice on how to stay safe at your next hearing care appointment. Some senior living facilities are allowing audiologists to come into their buildings after they have had a temperature check or met CDC rules.

If you can’t hear people through masks and don’t own hearing aids, look into a telehealth or in-person visit with an audiologist.

Chances are you’ve been living with hearing loss. Nearly 27 million Americans age 50 and older have hearing loss, but only one in seven uses a hearing aid. On average, people with hearing aids waited a decade before getting help.

What you may not realize is that even a slight loss carries serious risks: Research at Johns Hopkins University School of Medicine has found that mild hearing loss doubles dementia risk over 12 years. It also raises your risk of falls. Our ears pick up cues as we walk that help us balance. If you have hearing loss, your brain needs to work harder to hear conversation and other ambient sounds and this could interfere with your balance as well. That’s why hearing aids are so important for quality of life.

Don’t take a holiday from hearing

Putting aside hearing aids when you’re home, especially home alone, may feel like you’re giving yourself a break, a holiday from hearing. The costs are hard to see. I didn’t realize that when I went back into the world with my aids, I’d have to readjust like a brand-new wearer.

It’s not fun to take a holiday and return to a pile up of work! This pile-up you can avoid.