At the moment this picture was taken, I am standing with my kids, bracing with pain but putting on a smile. We were about to take a tour in and around the pyramids of Egypt. It is all so surreal. The sights (and how my limbs are feeling). Ever find yourself asking, “How did I get here like this?” and also, “How will I keep going?”
Several weeks ago, I woke up with a heaviness to my back that transformed to the worst pain I had ever experienced in my life. Back spasms ripped through my right mid and lower back that left me immobile for hours. Adding to my panic was the fact that we were supposed to board a ten hour transatlantic flight the very next day. Will this abate? Should I cancel? These were the thoughts racing through my mind as I navigated the pain. Fortunately, I recalled having muscle relaxers from a previous incident, prescribed by my orthopedist. This medicine, along good old Naproxen, helped me find some function. I limped through the next several days of travel and a hectic sight-seeing schedule. I gave my children the trip experience I promised…but all was not well.
By walking and dragging my right leg (to avoid pain), I realized that my back pain (and now mobility) had worsened. Though I no longer experienced those awful spasms, I was now unable to lift my right leg nor could I bend my back without pain. A visit to my orthopedist sent me to physical therapy where it was assessed that my hip was misaligned. We are now working on a plan to strengthen the muscles around this area and allow the right part of my back and leg to regain strength and function.
Why am I sharing the details of this event, you ask? Because I am a geeky audiologist that cannot stop trying to understand how the body works, especially in relation to hearing. My injury had me thinking about the body and how we compensate for loss (or in my case, for pain).
Many of you come in to see me and tell me that you are doing “just fine” in various listening situations with a *pretty significant* hearing loss and no hearing aids. Now you might be able to figure out what’s happening, likely because you are compensating using visual cues (lip reading, looking at expressions), using context (what they said before and after), and using good old cognition. You are getting by in these situations, yes, but what is happening behind the scenes is that the use of other functions in brain (visual, comprehension, cognition) is taxing those parts and weakening the auditory connections. Over time, the auditory pathways (the speech processing part of the brain) becomes weaker simply because it is not being stimulated (by hearing well). Compensation might provide you with short term gain, but over the long term, it is damaging. Lack of auditory stimulation leads to a drop in speech discrimination (put simply, hearing with clarity).
The science behind all this tells us that when hearing decreases, the brain quickly re-organizes itself to make up for the loss, but this extra work can be mentally draining and may contribute to long-term cognitive problems.
When someone has untreated mild or moderate hearing loss, the brain starts to “rewire” itself. Parts of the brain that normally handle sound (the auditory cortex) begin responding to other senses, like vision (seeing) or touch. This is called cross-modal plasticity — the brain adapting by using the unused “hearing” areas for other purposes.
When people with hearing loss do hear sounds, their brains have to work harder to understand them. Instead of just using the hearing areas, the brain also recruits frontal areas — the parts involved in thinking, attention, and problem-solving. This is why listening becomes more mentally tiring, a phenomenon known as effortful listening.
Because the brain has to put in this extra effort, it uses up more of its cognitive resources (its mental energy or “cognitive reserve”). Over time, this extra strain might help explain why hearing loss is linked to faster cognitive decline or dementia — the brain is constantly compensating, which can wear down its reserve.
These brain changes don’t take years to happen — they can occur surprisingly fast, even within a few months after someone loses their hearing suddenly.
Just as I compensated for my leg pain by limping and avoiding the proper muscles—leading to weakness and more pain—our hearing can weaken when we rely on compensation instead of fully engaging it. Every part of the body is meant to be used, stimulated, and strengthened. Hearing “well enough” today may lead to reduced hearing acuity tomorrow. As I always say, take care of your body so it can continue taking care of you.
