Three of the 13 participants had acquired hearing aids by the time of their interview. These three had worn their aids for two months, and provided feedback on how hearing aids had made a difference. Two participants had noted benefit in some situations more than others. Hearing the television, or conversation in quiet was improved with hearing aiding: “I can hear the telly and if we’re there on our own, I can hear my husband talking to me, you know, I can hear all that” (P29, F, O, G3, N), or in company: “Once I have got my hearing aids in, in general conversation I am fine in a room of people, absolutely fine…If there’s company and there’s sounds [the hearing aids] make it easier for me to listen to somebody. I can hear somebody’s voice, you know. Otherwise if there’s sounds there and I haven’t got it in, I don’t hear the voice very well” (P51, F, Y, G3, N). However, hearing speech in background noise was still problematic: “I struggle in a crowded bar or a pub or anything like that, that has also got music…because then I cannot wear my hearing aids because everything is just way too loud” (P51, F, Y, G3, N). Participant 51 also found the hearing aids helped her deal with tinnitus: “If I put my hearing aids in, [the tinnitus] goes. So it is nice to have some peace and quiet”. However, the third participant, although stating that hearing aids were of general help, still struggled to obtain clarity in hearing speech: “I’ve got some hearing aids which did help, but as I always said, it’s not the volume which I think hearing aids are more designed for, it’s discerning the level of the person’s talking” (P53, M, O, G3, HL). Although there was only a limited time following fitting to gauge the benefit of hearing aids, these devices did improve listening for some participants, particularly where there was a reduced level of background noise; hearing aids also provided some relief from tinnitus.
Participant 7 (M, Y, G3, N) suffered from hyperacusis in a short period during treatment and resorted to his own method to cope: ”I changed my doorbell at home, because it was such a high-pitched noise it annoyed me so much when it came on that I had to change it for a lower tone noise”, and “I would just clap my hands over my ears. I bought some noise
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cancelling headphones, anything to just try to shut everything out in the hope that [the tinnitus] would internally subside. In addition [I started] having the TV turned down”. The hyperacusis for participant 7 subsided so that he is now able to continue with everyday living, including watching the television without encountering pain. However, when
experiencing hyperacusis, it appears that this participant found relief from his hyperacusis by the use of noise cancelling headphones, or changing the pitch of a doorbell to a lower tone following damage to high frequency hearing with his treatment. This younger participant sourced information himself, rather than obtaining advice from a health professional, possibly highlighting a gap in service provision for delivering necessary advice.
Although two participants mentioned being aware of fluid, or pressure in their ears following treatment for HNC, only one described management of his OME. Participant 7 (P7, M, Y, G3, N) referred to advice given by a clinical nurse specialist on how to alleviate his middle ear dysfunction: “…[obtain] a little blue tube, put a balloon on it, pinch nose, blow down it and it does the same thing as trying to pop your ears on a plane, but equalizes the pressure between the balloon and your ears, therefore not damaging it. I was also prescribed
medication to try and get rid of the fluid in the ears as well, and that worked marvellously well over a period of about eight weeks. The popped feeling in my ear went away”. The other participant with OME (P11, M, Y, G3, N) still struggled with his middle ear dysfunction at the time of his interview, and, although he was offered a hearing aid for his affected ear, he declined its use: "I was offered a hearing aid if I wanted one, but I find I can cope without one and I am still hoping for the day that the hearing comes back better than it is now, so I can cope with that, but I was offered a hearing aid if I wanted one”. However, he was still affected by the pressure in his ear: “you just think I wish it would clear, but I know it has not and I cannot do anything about it to make it clear so you just kind of put up with it”. It was not clarified with this participant if he was offered the same advice given to participant 7; it is possible that he was not, and this would indicate variation in service provision.
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All the participants found different ways to adapt to their hearing deterioration and deal with changes in communication and non-speech sounds. Those participants who had Grade 3 deterioration used more widespread solutions compared with those who had Grade 1 change. Lifestyle had a bearing on intiatives made to enhance the understanding of speech, although it was evident that younger participants made more effort than older participants for improving speech communication; it appears that older participants were less inclined to deal with their hearing problems. Assistive devices were generally of use for dealing with aural concerns, however, there were fewer tactics used, and devices available, for dealing with tinnitus compared with hearing deterioration. It appeared that information and
management advice supplied by health care professionals to deal with aural concerns was in some instances variable or inadequate, given that patients searched for their own solutions.
6.3.4 Theme four – Emotional responses to aural change
This theme has four aspects to it: attitude to hearing deterioration; the downplaying of hearing deterioration or tinnitus; the sense of loss; and the experience of isolation through the tendency for patients and those they associated with to withdraw from interaction.