(47) PD and deafness: "nerve connection breakdowns"?

Poor decision: mask vs hearing aid!

"EARS". As an acronym it could be: to Educate, Advocate & Reduce Stress for caregivers; an Electromagnetic aircraft recovery system; or even an Endangered Animal Rescue Sanctuary. It could also refer to appendages protruding from either side of my head that, together with my brain, detect and analyse sounds. Well, dear reader, let's go with the latter meaning.

Over the past sixty years my ears have been dears but for the last eleven they have left me in tears: my left ear is about 30% functional and my right one about 60%. So, I wore hearing aids during the last five years of my working life and got used to wearing them in public. 

Between 2020 and 2022, during the Covid-19 scare, I always wore a face mask in public. However, the hearing aids and the mask both used my ears as points of attachment. Consequently, they would fight for attachment space, often resulting in the mask becoming entangled with the hearing aid. Due to this entanglement and difficulty using my hands due to Parkinson's Disease (PD), I stopped wearing my hearing aids in public in favour of the mask. But I also spent less time wearing hearing aids at home, so my already poor hearing got worse...sigh! 

By early 2023 I realised I needed an audiologist due to the following: (1) the hearing loss in my left ear had become significant and had started to affect my ability to engage socially; (2) the quality of my music listening and my ability to recognise different instruments and their sounds was deteriorating; and (3) my tinnitus had become more invasive. These three factors were a source of irritation and I needed help! 

My GP referred me to an Ear, Nose & Throat specialist, who requested an MRI scan (to exclude complications, such as a tumor) and then referred me to a reputable audiologist. The word "reputable" is being used in the context of the role of this audiologist. He did not immediately attempt to upgrade my 2017 hearing aid to a 2023 model and spent a few consultations on informed conversations and exercises to improve my ability to identify and to discriminate between a range of sounds.

I'm now a lot more confident because of the aural exercises and increased use of my hearing aids. This has improved my hearing ability, significantly. Recently, I agreed to do a talk to about fifty people at a Parkinson's ZA event. Granted, my left hand's tremors were a distraction (my presentation was recorded) and I spoke more softly than I did five years ago. However, I stood during the 10 minute talk, I spoke without notes, I believe the content was appropriate and was understood by the audience. Progress! Next, I need to work on my voice projection.   

Good decision: wear the hearing aid!

After regularly wearing my hearing aids again, I have started to wonder about my deafness and how it relates to PD. It appears that age-related hearing loss is accepted as fairly normal. Generally, hearing loss is likely to erode one's confidence, but will increase one's cognitive load and social isolation, as I think it has done to me. So, some people are ageing normally while others are not, especially those of us dealing with both PD and deafness. 

Hearing or auditory input, is a sophisticated process of sound entering the ears and then being interpreted by the brain. According to the Dr Sara Mamo (2022) presentation entitled "Hearing and Cognition in Parkinson's" at a conference of the American Parkinson Disease Association (Massachusetts Chapter), recent research indicates that "nerve connection breakdown", like that resulting from the lowered levels of dopamine, also, negatively affects the processing of sound! So both deafness and PD share a common, general weakness, a "nerve connection breakdown". Both have a negative impact on the brain's ability to process signals.  

According to Mamo (2022), generally, "there are [possible] connections between brain changes and auditory processing". Recent research (see the Mamo presentation for references) into hearing loss and PD has been examining areas where specific factors have been accelerating that decline, and some of these are:

• Top-down inhibitory pathways - measured differences between PD participants when they were "on" vs. when "off" medication, measured via electrodes on the scalp;
• Speech perception - related to deficits in speech production (motor processes); and
• Auditory attention - different patterns between PD and Alzheimer's Disease.

Mamo (2022) also raised the issue of barriers to our wearing hearing aids, specifically, four factors relating to the following:

• Cost/Affordability - in South Africa hearing aids cost between R10,000 and R80,000 a pair;
• Access to Services - in South Africa you generally need medical aid and an audiologist - the USA is presently working on a cheaper, "over-the-counter" option to be approved by the FDA;
• Technology Design - these vary from hearing aids (customised in-ear and over-ear), to personal sound amplification devices (generic fit with bluetooth connectability to a mobile phone) to hearing assistive technology (a simple headset amplifier that resembles a Walkman); and
• Awareness & Understanding - three tips to improve communication with the deaf: 1. Get the person's attention; 2. Get face to face; and 3. Speak slowly.

Concluding thoughts

Dr Mamo's YouTube presentation and my audiologist in Durban have both given me (and hopefully you, dear reader) a generous helping of food for thought.

1. If my brain is responsible for my hearing and my inner ear "damage" (in my left cochlea?) is making me deaf, then the brain has to work harder to make sense of all sound in my external environment. So, being deaf means there is a "nerve connection breakdown" that results in additional pressure on the brain's ability to process auditory input, i.e. my hearing.
2. If my Parkinson's Disease is responsible for my generally declining levels of dopamine resulting in my slowness, limb tremors, stiffness and poor balance, then my brain has to work harder to facilitate my being seated, my rising from sitting and any motion. That implies a "nerve connection breakdown" placing additional pressure on the brain's ability to process data from my body. 

Therefore, the "breakdown" in both 1. and 2. above means that there's a sense of continual fatigue in my brain, not unlike a mental fog leading to inefficient cognitive (in my case, inefficient processing) ability! Although it makes sense, it's a sad disconnection in me.

But, there's dessert to accompany our food for thought. It's an informed piece from Jo Gambosi, a US columnist who's sister Bev's poor hearing declined even further after her PD diagnosis. It is a useful reading (with linked resources) in the context of this blog post 47. Till next time...be safe.