Christmas bells they are a’ringing. Oh, the pain they will be bringing!

For people living with hearing loss, holiday parties can be a nerve-racking experience. An audiologist offers tips for more hearing-friendly holiday happenings.

It’s December 24. The house is full of giddy guests and holiday music fills the air. Children squeal with delight as they rip open their presents. The kitchen is bustling. Laughter rings out as people drain and refill their glasses. Conversations weave in and out through the din. The party is in full swing.

But for people with hearing loss, the joyful hustle and bustle of holiday festivities can be a source of stress, discomfort, and frustration. It’s simply... exhausting.

"The holiday season is considerably noisy," said Tony Leroux, a professor at the School of Speech-Language Pathology and Audiology at Université de Montréal. "Often, several generations will gather for the occasion, from small children playing happily with their gifts to elderly grandparents and even great-grandparents, many likely living with hearing loss."

In Quebec, 10 per cent of the population suffers from permanent hearing loss. One in three people over the age of 65 is affected with hearing loss severe enough to impede everyday activities, even simple conversation. That figure climbs to one in two people over the age of 75.

"There are always a few people at any Christmas party who have difficulty communicating even when it’s quiet," Leroux said. "Now imagine how hard it is for them in a lively holiday setting."

High pitches and sibilant speech

Age-related hearing loss mainly involves higher frequency sounds. This means high-pitched or sibilant speech sounds such as s, f, e and u become more difficult to make out. Ambient noise is generally composed of lower sounds and frequencies, which the elderly can still hear. But the constant din of noisier environments tends to mask low-frequency speech sounds, making them more difficult to distinguish.

"Not being able to clearly make out high-pitched sounds is like reading a newspaper with some of the letters missing," Leroux explained. "You generally get the gist of the message, but miss out on the finer points. Removing the lower frequencies compounds the problem-it’s like trying to read that same newspaper through darkened lenses. Understanding anything at all can be an arduous task."

In noisy settings, older adults therefore have to work that much harder to understand conversations. Many just give up - and clam up. It’s exhausting struggling to make out words or asking people to repeat themselves.

"Deafness and, for those with hearing loss, unfavourable acoustic environments, make it difficult to maintain social connections," Leroux said. "And a strong social network is important for cognitive health."

One of Leroux’s research focuses is the effect of industrial and environmental noise on health. "There is a fairly strong correlation between hearing disorders and neurocognitive disorders, and isolation is an intermediate variable of cognitive decline," he explained.

Stresses and strains

"Hearing loss is a stress factor," Leroux said. "When you know that you’ll be in a noisy environment and will miss whole chunks of the conversations, it’s especially nerve-racking."

Compounding that apprehension is the noise itself, which is also a stressor. The body reacts to noisy environments as it would when faced with any other danger signal, triggering a "fight or flight" response that leaves the heart pounding, slows digestion, and causes the adrenal glands to secrete cortisol.

"Think about being in a relatively quiet room where the only sound is the buzzing of a refrigerator," said Leroux. "It’s a soft humming you might not even consciously notice, but when it stops, your shoulders immediately relax and you feel a sense of relief."

Over time, repeated exposure to noise can weaken the immune system, making the body more vulnerable to bacterial and viral infections. "But don’t worry," Leroux added, "a single holiday dinner isn’t enough to do you in."

Various strategies to cope

So how can hosts and guests alike make holiday happenings more enjoyable?

Leroux suggested paying attention to overly dim lighting and too much background music. Lively conversations are the norm at mealtimes, so consider turning up the lights and lowering the volume or turning off the music altogether when at the table. Setting up several small tables instead of a single large one will also help reduce the distance between guests and make it easier for the hard-of-hearing to lip-read. Seat those with hearing loss at the quieter end of the room.

Of course, people who are hard of hearing should remember to let others know they have trouble communicating in this type of situation. "They can ask those speaking to move closer, to speak more slowly, or ask that other sources of noise be cut," Leroux said. "And others need to understand that someone with hearing loss isn’t necessarily withdrawing out of disinterest but out of necessity. Both sides need to be aware."

Wearing a hearing aid can help, but only to a degree. When noise levels are high, the devices just amplify the ambient sound, especially speech, and a conversation with multiple participants may rapidly descend into a raucous cacophony.

Tinnitus

Tinnitus is a form of hearing impairment that affects about 10-to15-per cent of the population. People with tinnitus hear sounds such as a whistling, humming or a hissing noise when no external source is present.

The condition is frequently associated with impaired hearing or hearing loss. Exposure to the noise of large groups during the holiday season increases the intensity of tinnitus, leading to other problems such as disturbed sleep.

"People who have tinnitus also often suffer from hyperacusis or auditory recruitment, conditions that reduce tolerance to loud sounds," said UdeM professor Tony Leroux. "For these people, being in a noisy environment can cause discomfort, irritability, fatigue and headaches."