Hearing aids and Autism

I’ve noticed that some sounds aren’t as clear as they once were, and that other people seem to be hearing things that I can’t, though I don’t struggle with conversation (exception being my friend’s small daughter, who once told me I was deaf!). So, I have been wondering whether hearing aids would be a good idea for me, being autistic.

The reasons that I’m not sure are that I get stressed out by sensory overload, especially acoustic. In any case, I don’t mix much socially and when I do it is usually with just a handful of people and not in noisy or crowded places, which I’ve never liked. I work from home as a programmer, so don’t have workplace environments to consider.

I’d more or less made up my mind not to bother even getting tested, but then I read a post on here (How to convince someone to wear a hearing aid) where a contributor mentioned “all the life saving benefits of being able to hear dangers, hear loved ones. salvage his hearing, delay hearing decay, keep his mind sharp…”.

I was a bit surprised by some of those, which seemed counter intuitive. Like, how will a hearing aid “salvage” my hearing as opposed to just being a kind of sticking plaster? And won’t the amplified sound hitting my cochlea accelerate rather than delay hearing decay? And doesn’t solving the puzzle of imperfectly heard speech sharpen the mind more than just having the answer on a plate?

I’m sure that there must be good answers to these questions and would like to know more. I’d be open to changing my mind if convinced that this is the right move for someone with my kind of brain. Yes, I know audiology professionals could probably answer all this. But I’d rather get it from people who have been there and done it.

I live in Scotland, so have access to NHS, though I could probably afford private if really necessary. I won’t tell my age, but I feel like I’m too young for hearing aids, which I know doesn’t make sense when pre-schoolers wear them, but I think you probably know what I mean. I was diagnosed as autistic only when well into adulthood, so childhood experience of being different without any explainable reason has affected my self-image and made me wary of other kinds of different-ness.

I hope that all this makes sense to non-autistic readers!

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I have a chronic illness, which also includes sensory overload as one of the many symptoms. One advantage that I have found with hearing aids is that if someone visiting us is too loud I can discretely turn my hearing aids down, you don’t have that option with your ears.

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Wow! That’s a great idea!

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Really hard to make a decision without information on how good or bad your hearing is. I would encourage getting your hearing tested and try to mitigate any barriers preventing you from getting tested. No, properly adjusted hearing aids don’t worsen hearing. Basically hearing aids allow the brain to continue to get information from certain frequencies. If no hearing aids, that ability is eventually lost.

Providing more near-normal hearing spectrum by hearing leads to a decreased risk of dementia because your brain is exercised, even in quiet situations. Properly fitted hearing aids (HAs) don’t accelerate hearing loss. The earlier HAs are fitted, the easier it is to get accustomed to them. Using HAs after a long time of hearing loss leads to a harder time getting used to them because, after such a time, the brain is like an unused muscle and has more difficulties processing long-time unamplified sounds.

It’s a risky way of thinking. The less information you have from the world, the greater the risk of brain exhaustion, which could go unnoticed after a short time, but after a full day, it can negatively impact your life. That more necessity of processing is definitely “a sticking plaster”.

I write this as a person who has had hearing loss since I was 4-5 years old and is slightly autistic on the spectrum, but probably in a different way than you. I don’t tend much to experience sensory overload.

I highly recommend to go to ENT (maybe it’s something reversible like wax clog?), proceed with hearing test, like tonal air and bony audiogram, Word Recognition Score in quiet, tympanometry, etc.

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If your hearing test shows that you are in the range for molds, you could kill two birds with one stone… sharpen your hearing when necessary or desired, and then decrease your auditory sensory overload by either muting the aids or playing a relaxation app on your phone through your aids. The same could be accomplished with Apple AirPods Pro 2 if your hearing loss fits their range. Definitely decreases stress!

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Thanks for all these really helpful responses (and keep them coming!). I’m even starting to get excited about the possibility of having hearing aids!

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I am also autistic and was very worried about making the world louder after so many years of noise cancelling headphones trying to make the world quietter and still getting overwhelmed. I’ve found my hearing aids actually help with my auditory sensitivities. Best I can figure it is that I have better signal to noise ratio of useful sound now. I get more overwhelmed by sounds that aren’t providing information but are providing noise, and the cognitive load of trying to understand sounds is reduced now. There are totally still times that I get overwhelmed, take them out, and put my headphones on. But it’s actually better rather than the worse that I expected.

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I have an autistic friend and was discussing this very subject today. She was wearing loop earplugs so as to muffle parts of the world, I was wearing hearing aids so as to amplify parts of the world.
The thing is, hearing aids actually give you quite a lot of control as to what comes in, especially if you have a good seal to the hearing aid. So you can choose to have everything coming full force at you in the face. This is how I work most of the time, because I’m blind and I need all the sound so I know what’s around me.
However, there are times, when I switch my aids to cancel out some or a lot of noise around me and just focus on speakers near or in front of me. You really can make a lot of the world go away if you want. so it might be like wearing a combination of noise canceling headphones with the ability to hear people talking to you. You might actually find it’s the best of both worlds for you. Not to mention you can turn the things down or off if you want.

I will say, one thing to be aware of, things will likely sound a bit sharp, a bit too clear, a bit… different through hearing aids for the first… well I’d say 20 30 days or so. which sounds like a lot, but I’m just telling you this so that if you do try them, you don’t freak out and go oh my god that’s horrible. The brain does learn to adapt and then they just sound normal. Also, if you do try hearing aids, expect to go back to the audiologist and have things changed on them. It is not a 1 and done type situation.

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Indeed, I like that my new cShell, with a 0.6mm vent, will work as an earplug in some circumstances!

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About hyperacusis, despite I know that in autism there could be different mechanisms of it.

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Thank you, that was interesting. Though I most like the suggestion that you and others have made about using BTE aids as deniable earplugs!

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Nice to read. I hate unexpected noise made by drivers of cars with illegally modified exhaust silencers (they give even 120 dB!) at 3:00 AM.

However, you should be aware that if you have good hearing in lower frequencies, you may be more prone to perceive the occlusion effect. I am lucky because, despite having good low-frequency hearing too, I don’t have the occlusion effect.

Your earmold should be placed deeply, resting against the bony part of the ear canal - that helps with that effect.

To create a more effective earplug effect, the ventilation should be long and it’s diameter should be small (possibly <1mm, I’ll receive 0.6mm - pressure vent).

EDIT: I have just seen your audiogram - were you tested in that short time?

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Thanks for your response. No, this was a test done by a phone app, and should probably be taken with a pinch of salt. It was actually the worst case of four tests done with two different apps and two different earphones. All showed normal low tones and varied from borderline normal to worse end of mild in the highs. I’ve gone on the waiting list for a NHS test – ask me about that in 17 weeks!!

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There appears to be a higher incidence of auditory processing difficulty in individuals with ASD and there is also a small but growing set of users with normal hearing who use hearing aids to help manage auditory processing issues. Research supporting this is still pretty limited and weak (but not non-existant), but clinics are starting to play around with implementing it. I think in some cases with ASD, and you can certainly correct me, auditory issues are sometimes less about loud spaces than they are about auditorily busy spaces. All the signals come in over top of eachother and it gets hard to segregate them and attend to the target signal (this can very much be the case as hearing loss progresses, too). Hearing aids can help to boost the targets signal above the other signals, and emphasize/clarify some of the critical pieces of the target signal, and in that way can make things easier. But experience may vary and yes it could go the other way–hearing aids take a bit of practice to get used to.

It won’t do anything to change what is happening in the ear, but it helps to maintain normal organization of auditory brain regions. The brain doesn’t like waste, so when areas are going un-used (for example, the areas that would normally have responded to certain frequencies which you now just aren’t hearing well) those connections will start to down-regulate and other areas of the brain may start to come in and take over that space and disrupt the normal organization of the auditory areas which can then be difficult to get back.

Not if the hearing aids are properly fit.

This is an interesting question that I’m not sure that I have a clear answer to this morning, but I can offer a couple of different angles to try to get at it. Children with auditory processing difficulties sometimes have weak neural synchrony. If you think of the auditory nerve, for example, it is made up of thousands of neurons sending signals to the brain and when functioning well the neurons all send their messages together in a synchonized way to create one big clear signal further upstream in the brain that is easy for the brain to use. Imagine maybe a crowd of people all saying the same thing, but the effect of them all saying it in perfect unison rather than saying it with variable timing–the message is more clearly received with the former situation. Giving these children consistent access to clear, audible speech (say, through the use of a remote microphone system in the classroom) appears to promote the development of better neural synchrony that then generalizes to other situations. Then, rather than spending their energy struggling to hear in class, these children can learn. It IS the case that people who practice listening in complex situations (for example, air traffic controllers, musicians, perhaps school teachers) develop better skills and are better able to decode speech in these situations that people who don’t practice it regularly, but they all also have a sturdy foundation of good neural synchrony and basic auditory processing upon which to base these other skills, and they also aren’t always in these complex situations, they are sometimes in quiet situations with clear speech to reinforce those basics. Individuals with unaided hearing loss are constantly missing out during even basic listening exposures. Now to skip to the side a little bit. . . people with hearing loss do sometimes get practiced at filling in the blanks. It does not appear to be a function of their auditory system, but rather other cognitive areas stepping in to do the work that the auditory system cannot do without access to that missing sound. When these people get hearing aids, this work starts to be done in the auditory system again and other cognitive areas are freed up to do other stuff. So maybe think about breaking your leg and becoming very skilled with crutches–yes it is the case that you develop some strong crutch-using skills, but now your hands are often busier when they might be useful for other tasks and you’d probably prefer to just walk if you could. You might say, “aren’t the hearing aids the crutch?” But in the case of hearing loss the leg (the ear) is never going to get better so you have to make a choice to either crutch it with the hearing aids or with the brain, and maybe you want your brain free for other things. Relatedly, one of the consenquences of hearing loss is fatigue. Having to expend extra effort to fill in the blanks all the time is cognitively fatiguing, and takes away from ones ability to do other things that one might prefer to do. Similarly, if you have normal hearing but auditory processing difficulty, spending time in a busy auditory environment is much more fatiguing than it is for someone with stronger auditory skills. (Note that there are of course other things that can be fatiguing about these busy auditory environments–my ears don’t tend to get tired but my social battery drains very quickly and sometimes those things can be hard to pick apart.)

So in various ways, no, it’s not better to be challenging the auditory system with auditory deprivation all the time.

That all said, it’s probably worthwhile to go get an official assessment. The loss in your avatar is edging out of the grey zone and into the hearing aid zone, but your lows in particular might look way better with a real hearing test.

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I am suggesting only… I don’t know about prices, but maybe basic hearing tests like bony and air conduction tonal audiograms aren’t expensive at all?

17 weeks is much time, and with that basic tests you can skip some steps. Just saying, but not forcing, because I don’t know about all circumstances in your case.

@Neville: Wow that first bit is amazing! Crazy as it may sound to most people I’d be tempted to try HAs even if my hearing turns out in the normal range. Do you have any links to the research you mentioned? And you have hit it on the head with “busy” vis-a-vis “loud”. I know that I have that streak of stubborn determination that will get me through those challenging first months, in fact I relish such challenges! And since making my initial naïve post, I’ve come totally on board with the other points you make. My Master’s was in Machine Learning, in connection with which I studied some basic Neuroscience and Cognitive Psychology, and it now all makes perfect sense. Thanks for such a detailed response.

@Bimodal_user: Good point, I will look into that. But the lost time is not as much as it seems. I have major travel plans during late July and August, so wouldn’t want to start the HA adaptation process until after that. Though yes, a proper audiogram would certainly help refine my options. First though, I need to get totally clear of wax :frowning:

By the way, could wax alone cause the high frequency loss in the audiogram I posted?

Once again, I’m amazed at the support I’m receiving on this forum.

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The NAL-NL3 fillting algorithm will soon be available, which also has a module for people with very mild or no audiometric hearing loss.

See here:

Indeed. The ear canal has to be unclogged before hearing tests.

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Opened it, thanks. Will watch tomorrow. Sounds interesting (if I can manage to understand all the audiology jargon!).

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Here, for example

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