Can I ask you a question? Have you ever had trouble hearing someone in a crowded room? - (T. Swift, kinda)
Do you find yourself asking “what did you say?” Huh? Say again?
Perhaps you feel like people speak too softly or mumble?
Noisy places make you a bit uncomfortable but when alone you turn up the volume on the tv or car stereo
These might all be indicators that you have some level of hearing impairment.
I’m willing to bet that as many people who replied yes to one or all of those questions would also say yes to having some neck tension.
No, the two are not always related… except when they are.
We talk a lot about the importance of listening in building relationships with the unspoken assumption that people can actually hear us.
As you read on, you’ll learn that hearing loss impacts a surprising amount of people.
Usually when it comes to physical therapy and the ear – we think of conditions such as tinnitus, dizziness, vestibular dysfunction or temporomandibular joint dysfunction (TMD).
These conditions not only impact us through experiences that we consciously perceive (pain, discomfort, tension, dizziness) they also subconsciously affect how we experience our environment and move through the world.
Most people don’t think about hearing impairments as a contributor to symptoms of neck tension. In fact, it wasn’t until this past year, after working with 3 patients with relatively long-term hearing impairments that I gave it much thought.
Each of these patients came to me with complaints of neck pain/tension. I observed two additional similarities with these individuals. One was their “posture” – how their body oriented in space – specifically their head. The other commonality was the feel of resistance to passive range of motion with neck rotation.
Both of these observations lead me to make the following assumption: hearing impairments can impact movement and perhaps this is a factor in more people than we realize.
Human ears have evolved to capture sound waves. We do this with our pinnae (outer ears). Their shape resembles a cone. This structure helps funnel sound waves into our ear canals. It makes sense that when we strain to hear something (or someone) we employ two common strategies
1) Turning an ear to hear
2) Cupping our ear (to create a bigger funnel)
Both of these strategies demonstrated in the above image
We “turn an ear to hear” – especially when struggling to give ourselves a mechanical advantage. Rotating our neck so that our ear faces the source of the sound decreases the barrier of our heads. This rotation varies in degrees depending on the context and the person. It can have a temporary and over time, more permanent impact, on how we orient our head – both relative to the rest of our body and our environment
He always wondered why his head was rotated and tilted
The increased muscle tone from maintaining this orientation or dissymmetry in movement is a strategy that “works” to help us hear better in the short term but may result in other limitations over time.
Since your brain is always predicting what it needs based on experience. It isn’t surprising that the muscles that help position the head in a more optimal position to hear will maintain a resting tone that is higher.
When the auditory system isn't working properly, balance and coordination issues may arise when the brain receives faulty or partial information. Sensing things are “off” our nervous system may turn up the volume creating increased muscle tension. Our perceived threat to incomplete information about our environment or social connections is a natural response.
I began wondering; how many people experience some level of hearing loss and how else this impacts health and wellness? Additionally, how many people with hearing impairments are falling through the cracks?
The results were shocking to me. I feel it is important to share what I learned.
Hearing loss is a common problem that affects people of ALL ages. According to the World Health Organization (WHO), it is estimated that 5% of the world’s population (approx.. 466 million people) have disabling hearing loss
Hearing loss becomes more prevalent as people get older, with about 1 in 3 individuals over 65 having disabling hearing loss. This ratio increases to 1 in 2 people over the age of 75.
It is a misconception that hearing loss ONLY affects the elderly.
According to data from the WHO, 34 million children worldwide suffer from disabling hearing loss.
Take in these statistics:
If these stats don’t grab your attention then I’d like you to consider the impact of hearing loss. In addition to movement health as discussed in this blog, hearing impairment is linked to both cognitive health and social well-being.
In most school systems hearing is screened in early childhood. This doesn’t happen in middle school or high school on a widespread scale. It most certainly doesn’t happen as an adult until you (or someone close to you) notices an issue.
The problem with this lack of screening and awareness is that often hearing loss happens slowly.
As hearing ability declines we adapt. Whether its via movement and postural changes or reading lips, these adaptive behaviors can occur so gradually that we aren’t fully aware. We also mal-adapt. We get used to the discomfort of not being able to hear others talk when out to dinner, not fully participating in the conversation. For some individuals this leads to social isolation.
If someone can’t hear you there is a high likelihood they won’t say anything – so you won’t necessarily know but communication was also impaired.
Hopefully you are wondering....
The answer: by asking better questions and becoming better observers.
This applies to everyone, not just clinicians. If we suspect a possible impairment then we can educate and encourage people to consider hearing health as part of their overall wellness.
What do I mean by better questions?
While realizing that neck tension and hearing might sometimes be linked, I also realized I wasn’t doing a great job asking the right questions.
Asking about hearing loss is on my intake form. That’s typically how medical providers figure out what further questions to ask. Yet as I scrambled down my rabbit hole of hearing, I asked many of my current patients some form of the following question: “do you ever have any trouble hearing?”
Several said yes. Most had not replied YES on the question of hearing loss because most people don’t think of these two symptoms the same way. For most folks, hearing difficulty does not equal hearing loss. I believe that people associate the word loss with inability. Impairment is likely a better descriptor for many people since it implies difficulty, which more people can relate to.
The words “hearing loss” may not serve as an effective screening question. I think there are better ways to phrase this question.
If the intake form doesn’t lead you to these questions maybe some of these other observations will:
Does the individual ask “what did you say?”
Do they seem to misunderstand you frequently?
Do they rotate their head or look to one side when you are talking? Do they lean in closer when you are talking?
In group settings do they seem to check out of the conversation?
Encouraging people to discuss hearing with their PCP and ask for a baseline hearing test
would be the next step.
Don't always have to blame it on the spouse ;)
While many may deny that their hearing experience is affecting their current life, discussing the potential consequences of hearing loss might serve as a motivator.
Early detection and treatment of hearing loss can help to prevent the development of secondary complications
People with hearing loss may struggle with balance and spatial orientation. This increases the risk of falls. As you may know, falls and mortality are closely associated.
In kids hearing impairments can impact speech development, which affects cognitive, motor and social development. When hearing is impacted brain stimulation is also affected. As we age, this connection between hearing and cognition, with an increased risk of developing dementia.
Untreated hearing loss is also tied to social isolation and depression.
A proper diagnostic evaluation including audiological tests, imaging and other appropriate evaluations by an audiologist or an otolaryngologist is necessary to identify the cause of hearing loss but that should not stop us from being the initiators.
Additionally, gyms and clinics with multiple conversations and background music aren’t ideal environments for many who have even low grade hearing loss. We need stratgies to help them.
check, check, can you hear me?
Here are ways to help individuals who have difficulty hearing:
Turn down the volume of noise – this could be as simple as the music or fans playing in the gym or finding a quiet space in a clinic
Position yourself strategically – when talking to someone that lip reads sit/stand in front of them. With unilateral hearing loss place yourself on their “hearing” side so the individual doesn’t need to constantly turn their head.
Speak intentionally, enunciating your words and allowing for pauses when the patient/client can ask for clarification
Cue with hand signals instead of verbal or other sound cues
We can’t afford to be tone deaf to the impact of hearing loss. There are too many people out there ignoring or unaware of their hearing impairment.
I know this personally.
When my daughter was a baby (13 years ago) I woke up one morning with vertigo – not what you want when you’re caring for an infant. I was diagnosed by my PCP with viral labyrinthitis. Luckily the vertigo resolved in a couple days but what stayed was the perception that my hearing in that ear was affected. It took me 13 years but I finally went and got a baseline test a few weeks ago. It was the fourth time I’d asked my PCP for a referral and I finally went through with the appointment.
Lucky for me the tests showed only a minor difference and the audiologist suggest I come back in a year for a recheck.
Hopefully by raising awareness we can help more people. Perhaps asking better questions about hearing is a start. Maybe there are instances when neck tension is a PT's first clue. Optimal communication includes the not only the ability to be heard but the ability to hear as well.