When you don’t want to miss a thing

Conversing with ease – seeing is believing!

What does “trying hard to listen” look like? Leaning forward, scrunching up our faces, turning our “good” ear in the direction of the speaker, or, in the days of Oliver Twist, inserting a “hearing horn” into one ear while barking, “Say what?!”

As a clinical audiologist, I often work with people who are trying out hearing aids, or other amplification devices, for the first time. My favorite moment is when patients lean back and I can literally see their face muscles relax. At that point, I know that they can converse with ease.

The “effort” that people with hearing loss exert is not just a subjective feeling; it is being investigated extensively, and has been for the past decade.

So, how do we measure effort? Beyond subjective feelings, scientists are looking for some kind of physical response, that would allow for objective comparison between different cases and different patients. One such measurable physical response is pupil dilation.

In the sense that the “eye is the window to the soul”, expanding pupils can be a clear indication of expended effort. Most people know that the diameter of the pupil gets bigger as it gets darker (to let more light in), but research has revealed a direct correlation between pupil size and cognitive effort. In other words, your pupils will be bigger when you perform a more difficult cognitive task than when you perform a simpler one.

In fact, studies have shown that pupil size is sensitive to different acoustic environments. When listening to speech in a noisy environment, pupil size is bigger, indicative of effort. Pupilometry (the measurement of pupil size and reactivity) has also been able to show changes in effort between older adults, or those with hearing loss, to younger people, or those with normal hearing.

One of my colleagues, who also suffers from hearing loss, once remarked, “At first I thought that if I just tried harder, I’d be able to make myself hear better. But when I realized that there are so many areas in my life where I have to try harder, I understood that something as basic as hearing and communicating should NOT be one of them!” When she said this, I saw the quiet, firm conviction in her eyes.

We all want to converse easily with minimum cognitive effort. We all just want to be given the chance to lean back and relax.

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