The Quiet Part Loud

The toll of my husband's hearing loss can be invisible—even to me. But a new wave of tech could change everything

By Allecia Vermillion Illustrations by Lincoln Agnew December 5, 2023 Published in the Winter 2023 issue of Seattle Met

In our 15 years of marriage, I’ve seen my husband cry a handful of times. Once, sitting on our balcony in Chicago over a few beers, on the eve of the move that eventually brought us to Seattle. Certainly when he lost his parents. But one moment, back in 2013, caught me completely by surprise.

We kept the lights off in my hospital room at Swedish Medical Center so our newborn son could sleep, uninterrupted, in his clear plastic box. I was ready to take him home—ready to take a proper shower, cut off my hospital bracelet, and tackle this new life with a tiny baby in the mix. My husband, Seth, brought our new infant car seat up from the parking garage. He’d already proved himself a worthy parental partner, hoisting my leg over his shoulder to assist with some of the gnarlier moments in labor. Now he practiced tightening the seat’s straps one more time. But the hospital wouldn’t let us go without one last test.

A young woman wheeled a Pediatrix medical cart in to perform the standard newborn hearing screen. She loosened Silas’s hospital-issue blanket and removed his blue knit cap. Working quietly, she placed one sensor on his forehead, one on his shoulder, and another on the back of his neck. Next came a pair of padded headphones, so large on our son’s head, he resembled a peacefully sleeping little DJ. The technician used these to play whisper-soft sound into his ears. The machinery on her cart measured his brain activity.

Most people don’t notice Seth’s hearing aids—or realize he has hearing loss. 

After a few minutes she told us he had passed his hearing screen. That’s when I heard the sound of crying. Not the infant kind. Across the dark room, Seth’s breathing was ragged. A few sobs escaped before he could dry his eyes and compose himself back into stoicism.

Sure, we were all tired and running on raw emotion. But his tears were my first, my only, clue that Seth had worried our child might inherit the hearing loss that had demarcated so much of his life.

The origin story of Seth’s hearing loss is a little murky. He was born in 1978, a different era for diagnostic technology. According to Seth’s otolaryngologist (a.k.a. an ear, nose, and throat doctor), he has “mixed hearing loss” in both ears. This means it involves two different parts of the tiny symphonic factory that sits on either side of our head.

Just about any hearing loss involves the inner ear. In here dwells our cochlea, a snail-shaped waterbed mattress that’s filled with fluid and ripples in response to the sounds that come from outside us. Tiny receptors called hair cells ride this wave, turning it into electrical signals that our brain can process as sound. If those hair cells get damaged, they don’t grow back. But Seth also has damage in his middle ear, home of the eardrum and three bones that function together as a sort of translator. Looking at images of eardrums online conjures uncomfortable memories of the time I found my mom’s diaphragm when I was a kid.

Seth had frequent, painful ear infections when he was very young. One of his early memories is being constrained on a table at the doctor’s office because the discomfort made him squirm and wriggle. He got tubes in his ears, a common measure for toddlers. As Seth grew, the tubes fell out as planned, but the hole in his left eardrum never healed, which likely caused more hearing issues. It also means he can’t put his head fully underwater. As a kid, he spent summers reading while everyone else was busy jumping into Wisconsin lakes.

Back then, Seth was a hard pass on hearing aids. Most kids aren’t eager to wear something that marks them as different from their classmates. The only person he knew with hearing aids was his grandpa John. Instead, he coped. In the relative quiet of a classroom, Seth recalls, “You can get by, it’s good enough.” He unconsciously learned to twist his left side, his better ear, toward whomever was speaking, sometimes cupping his hand around his ear to filter out extraneous sound. Sometimes kids at school thought it was funny to whisper in Seth’s presence—words that everybody but him could hear.

As a senior in high school, Seth got his first hearing aid. Just one—a little ham-shaped nubbin of beige plastic that sat inside his right ear canal. He could hear a bit better out of that ear. “But it didn’t really make a difference in my life,” he says. Maintenance involved heating a little device in the oven, then putting his hearing aid inside it to dehumidify. This level of fastidiousness is in short supply for most 18-year-old dudes heading off to college (for that matter, so are ovens). He kinda stuck with it for a while, but eventually relegated the device to its case in his dorm room at Northwestern. He didn’t even mention hearing loss in his college applications—documents full of prompts for you to share details about any hardships that might have shaped your young life.

“Getting by” and “good enough” might work on the face of things, but it wedges a layer of invisible misunderstanding between you and the world. Most rational humans are eager to support and accommodate someone with hearing loss. But an aversion to going around requesting special treatment can isolate in imperceptible ways. Seth is a 45-year-old guy with a boyish face who hunts small-batch bourbon bottles like they’re adult Pokémon, gets up for 6am Crossfit, and grills his own fancy cut of meat on his birthday. But in social settings, people who are unaware of his situation tend to overlay their own interpretations onto his actions. A friend once confessed she thought Seth was reserved and arrogant when she first met him; turns out, she was just sitting on his right side. In loud bars, it’s embarrassing, annoying, to say “what?” too often. He resorts to just nodding and smiling, a conversational survival mode that doesn’t exactly showcase the person you might get to know in a quieter room.

You could spend a lot of time with Seth and never know he struggles to hear; that his left ear hears at about 30 percent below the average range and his right one, 95 percent below. These numbers hover at the periphery of our family life. We watch TV with subtitles on (but doesn’t everybody do that with British shows?) and avoid social events that involve big, echoey venues. When we walk or sit, I unconsciously position myself on his left side, next to his better ear. I catch myself doing this to other people, too. We stock up on hearing aid batteries (size 312) the way we do toilet paper and Advil. It’s the bigger, life-altering effects that are harder to grasp.

Seth got his current set of hearing aids in 2018. He had others before. But this pair—with its Bluetooth connection to his iPhone—felt like a cool gadget rather than a badge of otherness. Getting fit for a proper pair of hearing aids, he told me once, changed everything: “This world that you think is the true world can actually be very different” once you hear it better.


Image: Lincoln Agnew

The true world is paying more attention to hearing loss. In October 2022—on my husband’s birthday, as it happens—a change in federal law made it possible to buy hearing aids over the counter for the first time. The move has roots in a couple of large-scale, landmark studies from the early 2010s. Researchers found a strong link between hearing loss (something you can modify) and dementia (something that’s heart-wrenching and expensive). That caught Congress’s attention. To lawmakers, enabling Americans to buy hearing aids sounded vastly preferable to funding a giant amount of dementia care a few decades from now. A bill passed in 2017 directed the FDA to come up with regulations around selling these devices in drugstores and online—no prescription or doctor visit required.

Even if hearing aids seem abstract, chances are they’ll be part of your life at some point. One of the many fun gifts that come with aging is a gradual loss of hearing. A host of other factors might speed that up, from heart disease to loud occupations. There’s no definitive research just yet on how our earbud and headphone obsession affects hearing, but it probably won’t be good. We may well be entering a golden age of hearing loss. But despite rapidly improving technology, studies find only 16 percent of the adults age 20 to 64 who need hearing aids actually use them.

“This is a pivotal moment in audiology,” says Dr. Yi Shen, an associate professor in the department of speech and hearing sciences at the University of Washington. Speaker technology giants like Sony and Bose quickly turned their attention to this potential new marketplace. Startups are devising smoother paths for consumers to adopt all the new tech out there. Shen is also helping develop a remote-learning certificate program so pharmacists, social workers, nurses, and others can advise people on all these newly available over-the-counter devices to put inside your ear.

Search for hearing aids on Amazon and you’ll find hundreds of options, Shen says. Some of them cost thousands of dollars, some of them cost $20—“and they look exactly the same.” Over-the-counter hearing aids might not make that big a difference if there’s nobody at the counter to help customers over the barriers that come with placing these tiny pieces of hardworking technology inside the doorways to your brain.

As my husband can attest, this technology is a pain in the ass. It’s delicate, inconvenient to procure, and costs as much as a stack of laptops. It’s still not nearly as intelligent as a fully functioning human ear. But the true world is a lot smaller without it.

Seth and I met on a dark street just before 5:30 in the morning. I was dragging my butt to the gym with a bunch of other January fitness dilettantes. Seth was heading to his first job out of college at the Chicago Board of Trade. For weeks—then months—we passed each other with a vaguely nodded greeting, the only two humans on the sidewalk. It’s already wild that the person who rounds out my life just happened to be walking past me on a street. Later I would realize, our first few halting attempts at conversation never would have stuck if they hadn’t happened in that hushed, early-morning environment.

Two young kids back in 2006, the year Seth first got real-deal hearing aids. 

In 2017, our daughter passed her newborn screen at Swedish and came home to join the family. When she eventually started preschool, some parental chitchat turned to what we all did for a living. I immediately texted Seth, “One of the dads works at a tech company that makes hearing aids!” To meet someone our own age who spent even one minute a day thinking about hearing loss was like finding the one other person on earth who thought The Wire’s final season had artistic merit. Foolishly, I’d never thought about hearing aids being a form of tech, something a guy with long hair and cool chunky glasses might help advance and disrupt.

That startup is now defunct, but the scene that dad was a part of remains very much intact. It has its roots with one of Seattle’s leading philanthropic families. And also, some chickens.

In 1986, the University of Washington recruited a neurobiologist, Dr. Edwin Rubel, from the University of Virginia. Rubel had recently discovered that chickens could regenerate certain hair cells. You remember—those waterbed-adjacent receptors that turn the mechanical vibration of sound into neural signals the brain can understand. In other words, they’re critical. So Rubel’s discovery was huge. Previously academics and researchers believed that when  hair cells were gone, they were gone—at least for warm-blooded vertebrates. This insight about chickens suggested that a drug to regenerate human hair cells—essentially a cure for hearing loss—might lie at the end of a long research road.

Two years later, Rubel received a call from an attorney representing Prentice Bloedel, a timber baron turned civic benefactor. His wife, Virginia, had experienced progressive hearing loss later in life. The lawyer asked the esteemed researcher, What would you do if you had $5 million?

I first heard this origin story from Dr. Jay Rubinstein. He’s the director of UW’s Virginia Merrill Bloedel Hearing Research Center, which sprang from that $5 million cold call. “She was a very actively social person until she lost her hearing,” says Rubinstein of the center’s namesake. “He just hated seeing what hearing loss did to her.” Rubel originally hung up on the caller; he thought it was a joke.

Now the Bloedel Center’s office on the Lake Washington Ship Canal coordinates between 18 academic departments across UW. Engineers work on hearing device technology. Physicists and applied mathematicians dive into computational sound modeling and algorithms to predict how people might hear under certain circumstances. Neurobiologists study regeneration of hair cells. A pediatric ENT surgeon creates better tools to gauge how babies respond to cochlear implants. When I speak with Rubinstein, he’s wearing a tasteful Hawaiian shirt in solidarity with survivors of the Maui wildfire. He’s very good at distilling complex medical talk into something an English major can follow. He’s also an ear surgeon who has a PhD in engineering. “Part of my job is to explain surgery to engineers, and engineering to surgeons.”

Typically, academics remain siloed in their own departments. Hearing science, says Rubinstein, is among the more multidisciplinary corners of the research world: “We need people with a lot of different backgrounds. And we need technology.” In other words, the logistics of hearing research are as complicated as the logistics of actual hearing.

Seth got serious about hearing aids in 2006. He was about to start business school. For all the loans he was taking out, he decided he damn well better be able to listen to the coursework. His grandpa John had just passed away, leaving just enough money for an engagement ring and a proper set of hearing aids.

This wasn’t going to be cheap. It was Dr. Yi Shen who told me about the saying that pops up in audiologist offices: “For people who live with hearing loss, the largest out-of-pocket item in their household is the car. The second is hearing aids.” Most health insurance doesn’t cover the cost of a device that could restore one of humans’ five fundamental senses. Some states require insurance companies to cover hearing aids for kids; a few even mandate coverage for adults. But the requirements, and benefits, vary—and Washington doesn’t have any laws like this anyway.

Seth got fitted one afternoon in August; that night he went to bed at 6pm, overwhelmed by the new volume of sounds his inner ear was foisting on his brain. Suddenly he could hear clocks ticking, his own breathing. It was a lot. But more sound isn’t necessarily useful sound. Imagine watching a TV that’s really bright and slightly out of focus, he tells me. And you have no choice but to stare at it.

Those hearing aids were sophisticated by 2006 standards, he remembers, “but there was no intelligence behind the microphones.” They couldn’t replicate the ear’s sophisticated processing—its ability to filter out the sound of a car driving by and prioritize the conversation you’re having with a person walking beside you. If someone called out Seth’s name from behind him, chances are he wouldn’t hear—“you’re limited by the way the microphones are pointing.”

In the fall of 2013, one of those hearing aids crapped out. We were weeks away from having a baby, so not exactly delighted by an unforeseen expense. But by then we’d been in Seattle for a few years; Seth’s job at Microsoft had great health insurance and a health savings account that would help cover the cost. Seth’s new hearing aids came with a Bluetooth dongle to wear around his neck—cool at the time, clunky in retrospect. Five years later, when he was eligible for another $2,000 hearing aid benefit, he got his current pair. These had a phone app, which Seth could use to adjust the volume or play music through his hearing aids. Sometimes I come across him folding laundry and laughing at a podcast only he can hear. “Sure, just let me turn on the sound of ocean waves,” he jokes when I want to discuss buying new furniture.

One marriage, two kids, and three sets of hearing aids later.

The day Seth got his latest hearing aids, he visited his audiologist on Broadway and sat in the second-floor office as she tailored the settings based on his audiogram. Together, they tested and reprogrammed until the sound felt right. A month later, he went back for an adjustment.

“It’s this really interesting marriage of art and technology,” says Dr. Melanie Hecker, an audiologist (though not my husband’s) who’s been conducting fittings like this for more than 15 years. Modern hearing capabilities are customizable to the extreme. A technician can reduce or boost certain frequencies or administer the precise amount of correction for someone’s specific hearing profile.

Hecker has traditional brick-and-mortar audiology practices, but she’s also part of the startup scene unleashed by the rise of OTC hearing aids. Her Seattle-based company, Bluemoth, sends customers three sets of prescription hearing aids to try and decide which works best. Yes, she gets a lot of comparisons to Warby Parker. But rather than letting customers just put these devices in their ears and go forth, Bluemoth uses telehealth appointments to fine-tune and adjust, a setup aimed at people who feel intimidated or inconvenienced by the whole “visiting a medical office” situation.

Most people wouldn’t buy a car—or even a couch—without testing it out. Hearing aids cost thousands of dollars, but hardly anyone can try them before purchase. Or, if you do, says Hecker, it’s often in the sterile, quiet setting, with a professional who “typically, like me, is very loud and articulate.”

Correcting someone’s hearing is usually orders of magnitude more complicated than correcting their vision. Put on a pair of glasses or contacts and you can immediately see the benefit—no tweaking required. Plus, the right set of glasses can make you look cooler, more intellectual, more interesting. While audiologists are busy cajoling and coaxing patients to correct one vital sense, optometrists are doling out fashion accessories and forms of self-expression with every eyeglass prescription.

Hecker thinks technology will rehabilitate hearing aids’ rep. They’ll be AirPods, but with bottle service: pristine sound quality and the ability to filter out, or focus in on, whatever’s happening around you. New models (like everything else these days) even have AI. Their tiny microphones might scan 360 degrees, but they can learn to beam toward the right to focus on the voice of someone sitting next to you in the car, then swing over to capture a voice coming from the back seat. The high-end ones can “learn” settings you prefer for loud restaurants and automatically shift into that profile when you show up for your reservation. The rechargeable technology has improved. Soon my ability to help Seth change his hearing aid battery during a long car trip might become obsolete.

“I truly do believe one day,” says Hecker, “wearing hearing aids is going to be the same kind of empowering extension of identity that glasses are now.” But “empowering” doesn’t always describe their presence in our home life.

When each of our kids came home from the hospital, I experienced the supreme exhaustion that comes with overnight feedings. Nothing yanks your senses out of sleep like a newborn’s hungry cry. Each time, Seth slept on, undisturbed, while his hearing aids sat on their special cloth on his nightstand. In those fatigue-addled moments, honestly, it pissed me off. On some brain-crushing night shifts, I looked over at his blissfully unconscious form under the covers and thought, “It must be nice.”

Clearly, it’s not nice. Not at all. In more lucid states, I know this. The physical and emotional weight of hearing loss can be so internal, even your wife doesn’t always offer the support and empathy you deserve. Seth might have been rested, but he felt like an ass when well-meaning coworkers asked him, “Is the baby letting you get any sleep?”

In another less-than-impressive moment, I asked about some bit of marital admin while Seth had his back to me, tying his shoes on his side of the bed. He didn’t respond. “I didn’t realize you asked a question,” he told me. Writing this today is embarrassing, but, in that moment, I was mad. We had enough moments like this one that I’d built up the feeling that my husband could escape to another world full of funny podcasts and private thoughts while I’m left back in reality, the default responder to middle-of-the-night wakeup calls or little kids’ steady stream of daytime needs. As a writer, there’s no more desirable state of existence than escaping into your thoughts. I saw Seth living in his head whenever he wanted to—not thinking about the fact that sometimes, he’s actually trapped there.

In the hospital on the day our son was born in 2013.

This is a man who often unloads the dishwasher and makes coffee before I’m even out of bed. Did I mention he’s usually folding laundry when those podcasts play in his ears? But maybe the clearest proof of Seth’s consideration is that he listened to me air my “can you really not hear me in a quiet room?” grievance and didn’t storm out. I sat next to him, on his left side, and he explained that for him hearing takes a lot of work. When his ears don’t explicitly know they need to turn it up to 11, you might find them in power-save mode.

In loud settings, he sometimes takes “sound breaks,” stepping outside to avoid overwhelming his faculties (okay, sometimes I think he does this just to avoid loud children’s birthday parties). In quiet, though, Seth’s current hearing aids all but erase any distinction between his hearing and mine. The devices are so discreet, 95 percent of the people he interacts with don’t know he has them. But it’s not necessarily positive to downplay the work he still has to do.

When we all masked up in 2020, Seth realized how much he had relied on lip reading. The shift to remote work brought adjustments, too. Last year, Seth finally posted a status message on his Microsoft Teams account at work: “I’m happy to have a call, but please give me a heads up when you would like to chat. I’ll need to switch to my phone headset as I wear hearing aids.” Acknowledging his hearing loss in the public square of a corporate messaging app was both a small act and a giant step. (Though perhaps not as big as allowing your wife to reveal your life in writing.)

“Listen I’m not here to make everybody bend to what I need,” he told me one recent Friday night as we repaired to our couch after a long week. A colleague had called him unexpectedly that afternoon, despite his instructions. He needed to vent a little: “It’s very, very frustrating when I do a lot to interact with the world in a way that is seamless with the world.”

Every other year, Seth visits his doctor for routine hearing tests. They measure the difference between his hearing and that of a typical ear. They also record whether that hearing has diminished since his last visit. So far both right and left are holding steady at the same levels as when we met. Still, I lie awake sometimes, imagining how we would conduct our lives if Seth’s hearing went away entirely. Would we set up some sort of marital Slack channel? Could witty text messages sustain our closeness? They already get us through the workday. When we hug, if I get too close to his ear, it squeals with feedback, like someone adjusting a microphone as their band comes onstage for its set. The sound used to make me retreat. But after all these years I know to tilt my head the other way, and just keep on holding tight.

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