Hearrings

Recently I have been asked quite a lot about Hearrings, an element of my 'former commercial' life which was a project originally conceived out of a discussion of attitudes towards hearing loss. So I thought it might be useful to write a blog post, and to explore whether things have changed in the intervening years.

In 2008 I was invited to explore how hearing aids are perceived within wider society at the national conference of the British Society of Hearing Aid Audiologists (BSHAA). The presentation covered what could be done to challenge misconceptions about hearing aids in the media and how the hearing aid industry could encourage uptake of hearing aids. How could we make hearing aids more ‘sexy’ to the media so that they were discussed more positively and how could the modern benefits of wearing hearing aids be better portrayed?

I covered the history of portrayal of hearing aids in the media such as outlets like the Daily Mail's article about Jodie Foster (a prominent Hollywood actress at the time) being ‘hearing aid shamed’:

The discussion of making hearing aids ‘funky’ started way back in the 1950s. As can be seen at the fabulous Becker Exhibit website there were some ingenious ways in which people have tried to conceal their hearing devices as well as incorporating them into jewellery such as brooches and hair clips. http://beckerexhibits.wustl.edu/did/index.htm

So as a gimmick for the presentation I designed a piece of jewellery that clipped onto my hearing aids. I was old enough to have started my career occasionally fitting NHS body worn hearing aids which utilized a coupling that connected the receiver. I used this coupling on a standard ear mould to clip on a carefully adapted piece of jewellery… the Hearring was born. There was huge interest from the delegates at the conference as to where they could buy them for their customers, so we embarked on the journey of making the Hearring commercially available.

So along with patenting the design and trademarking the name Hearrings, we worked with a designer, Victoria Glynn to create a range of Swarovski crystal encrusted hearts. The strap line was "Changing hearing aids from a necessity into a must have accessory". Designing packaging and promotion seemed to take up an inordinate amount of time and as well as attending the ill fated San Diego American Academy of Audiology congress (where we all got stranded by the erupting volcano in Iceland grounding all flights) interest really grew. We were lucky to be featured in many Fashion pages of magazines and newspapers including a whole page feature in the Independent Newspaper.

Hearrings set out to get people talking and it did... but with the advent of slim tube / receiver in the canal technology and concentrating on my main hearing aid audiology business the whole concept took a back seat and I always said that technology in society, away from hearing aids, was always likely to lead to change in hearing aid perception. So with the advance in bluetooth head phones and the advent of 'hearables' and self fitting hearing devices via iPhones and apps have things changed? Are people queuing up to get fitted with hearing instruments?

In 2019 the Hearing Industries Association (HIA) survey, the MarkeTrak10, measured trends in hearing aid adoption / or non use. For those individuals where hearing aids were recommended to help with a hearing loss but who chose not to wear hearing technology 12% cited “Too noticeable/visible” 12% thought hearing devices were “unattractive” and 11% felt “too young to have hearing aids”. ( https://hearingreview.com/uncategorized/marketrak-10-hearing-aids-in-an-era-of-disruption-and-dtc-otc-devices-2 )

I have to admit being surprised by this data, ten years since we discussed this at the conference it seems that little has changed, however the number of devices fitted continues to grow, so surely this shows that uptake of hearing device use is rising. With the recent move in the US towards over the counter devices or self fitting personal sound amplifiers (PSAPs) it's looking like the traditional hearing aid manufacturers dominating the market may be heading for a shake up, especially in the wake of the Covid19 pandemic where telehealth solutions were the only option for many individuals to access audiological advice. There seems to be a raft of studies looking at the impact of telehealth on Audiology. So has this major societal shift been reflected in the uptake of hearing devices or will people with untreated hearing loss stay in the shadows? I guess "time will tell" and the next few Marketrak studies may be quite revealing. Indeed with PSAPs and self fitting amplification strategies implemented through phone Apps it may be this data will be impossible to obtain as people move from just using earphones to adding in some amplification strategies as their hearing deteriorates... it will become the norm... no big deal...

Back in 2011 the Audira think tank published a blog article about "Why we must never use the ‘S’ word in hearing care" ( https://audira.info/index.php/articles/why-we-must-never-use-the-s-word-in-hearing-care ) whilst Audiologists are encouraged to stop talking about stigma it would be interesting to hear from readers of this blog as to whether or not users of hearing aids in 2022, experience discrimination or dare I say it 'stigma' relating to hearing aids. Often these real life stories are the most revealing of society as a whole. At some point in this blog I will explore whether the lived experience of those born with deafness (or Deafness) are different to those that acquire hearing loss later in life with conditions such as presbycusis.

Certainly " The times they are a-changin' " and as a kid when first fitted with hearing aids I would have loved to have owned a Barbie wearing a hearing aid, who knows maybe I would have also designed her a Hearring or two!

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Some examples of my Hearrings, quite a few nature inspired ones!

Grassroots action for nature recovery

It is well-documented that nature is under increasing pressure, as humans continue to shape their environment to suit their needs in increasingly efficient ways. Much of our wildlife has already been lost from our landscapes, and many species are under threat of extinction as more and more natural habitats disappear every year. There is no doubt that the parish of Holcombe Burnell is incredibly beautiful, and on the face of it, all appears well in our 'green and pleasant land' but scratch a bit deeper habitat fragmentation and the move to the industrialization of agriculture driven by changing farming subsidy schemes has had an impact on our parish, as it has on many other rural parishes in Devon. Coupled to this a change in the social fabric to rural life, with less people going to church (and the associated networking opportunities this used to offer) as well as people working further from home and spending less time rooted to their communities; in the last 50 years life in the countryside has changed, with increased levels of loneliness and mental health issues [1]. My great-grandmother who ran a small dairy herd here, would have known all of her neighbours as all lived locally, most went to church, attended harvest suppers were members of the Mother's Union or WI, sending their children to Sunday School and the local school, eating seasonal locally produced food often bartered and indeed attending each others baptisms, marriages and funerals.

In 2019 I approached our local Parish Council to see whether there was a parish wide map of who owned what land, and whether there was an easy way to engage with home owners and landowners so we could collectively take action in the face of the ecological crisis.

So we drafted an idea for a Parish Nature Warden role which would pull the strands together. After huge support from Holcombe Burnell Parish Council the Parish Nature Warden Scheme (PNWS) was born. The initial aim of the scheme was to work towards connecting habitats at landscape scale, to map the parish, and identify which wildlife species are doing well in our parish and which are in decline, and to talk to landowners about ways of creating ‘nature corridors’ to try and reverse the decline. Somehow along the way someone suggested that if I was going to be at Parish Council meetings to report on the PNWS I may as well become a Parish Councillor, this as it turns out has been really interesting and has given me a real insight into the multitude of social issues that face rural communities.

One of the focus indicator species for our parish are Hedgehogs which have suffered a catastrophic reduction in numbers in my lifetime, and are now classified as vulnerable to extinction [2]. Last year, 5 hedgehogs were killed on just one short stretch of road outside our property in Longdown. If the residents of Holcombe Burnell parish reduced the amount of chemicals used in their gardens, checked bonfires for hedgehogs and created refuges in their garden where piles of sticks and leaves are seen as good habitat for wildlife, rather than a bit of a mess, and farmers changed their land use practices such as leaving larger field margins and looking at replacing some hedgerows, the parish could become a stronghold for hedgehogs. Hedgehogs can travel around a mile in a night, so making sure there are gaps in garden fences (about 13cm diameter – the size of a compact disc - is sufficient) would mean they can travel more freely to find food and a mate, and will help to improve connectivity for hedgehogs across the parish. It's somewhat ironic having visited Poland to see the impressive wildlife green bridges being used by wolves that we have been unable to get a small mammal road sign (the one with the hedgehog on) installed by Devon County Council. We've therefore created and installed ghost hedgehog signs whereby a white hedgehog is placed at the point where a hedgehog has died to raise awareness of the issue.... along with logging the casualty on the Big Hedgehog Map [3].

The parish also has some key habitats for nationally rare species such as the Hazel dormouse and the Glow-worm, so by working together to extend these areas, more people can experience these natural wonders in ‘our backyards’.

Sometimes small actions for nature may seem inconsequential, but the good work of every individual homeowner and landowner in the parish can be linked together to make a big difference for wildlife and our local environment. If this good work can then be replicated from parish to parish, we can create a real life ‘nature recovery network’ rather than just lines on a map, enhancing and restoring the natural environment and wildlife of Devon and in turn connecting people living in the parish to their surroundings, with the increasingly recognised benefits to mental and physical health that being more in touch with nature bring. Could we create a ribbon of 'advocates for nature' across the Haldon ridge, feeding into Devon Wildland with in-depth naturalised knowledge of their local patch?

Unbeknownst to me the people at Action for Climate Teignbridge (ACT) were also setting up a similar scheme, and they have worked hard to create the Wildlife Warden scheme and they have campaigned to get a Wildlife Warden in every parish in Teignbridge, and they are nearly there.... [4] The Devon Local Nature Partnership now have a network of community groups that are taking action for nature across Devon. [5]

There are some great Citizen Science projects to get involved with. Every month I carry out the West Country Rivers Trust CSI [6] monitoring of 4 watercourses in the parish. This measures the phosphate levels, turbidity, total dissolved solids, temperature, depth, width record any wildlife seen and take fixed point photography at each site and over time it is hoped that this longitudinal study will provide information of whether or not our parish's watercourses are changing with climate change. It a wonderful project to be involved with and has enabled me to explore and deeply observe our parish, but also help me to understand the importance of 'water catchment thinking' and how land use and pollution upstream can greatly influence whole ecosystems downstream.

Similarly the Bats in Churches survey was a good opportunity to connect with our local church, and discover the bats use the trees in the churchyard extensively. [7]

We are planning some ‘Nature get-togethers’ and are also hoping we can tap into any local expertise to create a peer-support network so that landowners and others can visit sites within the parish and see what different ‘good for nature’ land management approaches look like, for example nature-friendly farming, meadows and species-rich grassland, native hedgerows and naturally regenerating or planted woodland. The recent Queen's Green Canopy tree planting initiative saw 70 individual homeowners plant Wild Service Trees across the parish.

We are also looking to organise nature enrichment walks for the mental health and well-being of the wider parish community, and we liaise with our local school to encourage children living in the parish to ‘get out into nature’ so that they learn to value their local natural environment. I was fortunate enough to create a Sensory Garden at the local Primary School and to take part in a 'Tree Assembly' where we talked about the importance of trees and the children planted a tree to commemorate the Queen's platinum jubilee.

We want to identify wildlife / human ‘pinch points’ within the parish and explore ways to mitigate these, such as the excellent work done by the Barn Owl Trust, so residents are encouraged to report wildlife road casualties so that trends can be measured and identify where action needs to be taken.

In the words of Dr Seuss in The Lorax: “Unless someone like you cares a whole awful lot, nothing is going to get better. It’s not.” I think one of the big challenges for the existing nature conservation charity sector model is that by giving 40 quid a year individuals feel that it's 'job done' and that someone else is going to solve the problem. This example of the 'bystander effect' has also been seen in people's response to action (or inaction) to the climate crisis [8].

There is much that we can all do to help nature to recover and flourish in the parish, in these times of increasing eco-anxiety it is important to empower our local communities to encourage them to take action as well as creating a new rural social movement to bring people together not only for the benefit of nature but for the very communities themselves.

Whilst I am not an ecologist, I am rooted in this place and have a passion for the wonders of nature, in our backyard.

Links:

[1] Long working hours and lone-working key factors leading to loneliness in farming, study shows. University of Exeter. Research News:

https://www.exeter.ac.uk/news/research/title_886496_en.html

[2] The State of British Hedgehogs 2018 PHTS & PTES:

https://www.hedgehogstreet.org/wp-content/uploads/2018/02/SoBH-2018_final.pdf

[3] Big Hedgehog Map:

https://bighedgehogmap.org/

[4] ACT Wildlife Warden scheme:

https://ww.actionclimateteignbridge.org/

[5] Wild About Devon DLNP:

https://www.devonlnp.org.uk/get-involved/wild-about-devon/

[6] Westcountry Rivers Trust CSI- Become a Citizen Scientist

https://wrt.org.uk/project/become-a-citizen-scientist/

[7] Bats in Churches

https://batsinchurches.org.uk/

[8] How the bystander effect can explain inaction towards global warming

https://blogs.lse.ac.uk/businessreview/2020/01/07/how-the-bystander-effect-can-explain-inaction-towards-global-warming/#:~:text=The%20bystander%20effect%20refers%20to,Darley%20%26%20Latan%C3%A9%2C%201968).

Control, change, Health & Nature

Thinking back to where the interest in integrating nature connectedness and tinnitus management began, two patients that I saw in my Audiology practice spring to mind; Claire and Liam*.

Claire presented with normal hearing but sudden onset persistent tinnitus. She was referred to me by the ENT Consultant as she was finding it hard to cope with the intrusiveness of her tinnitus.

Claire loved to walk. She had a special hill on the Quantocks where she would sit and watch the buzzards soar and the hues of the heather change colour with the seasons. But when her tinnitus started she felt a horror that she couldn't leave her tinnitus behind and that the tranquility of her special place was lost. Claire described feelings of grief. A grief for the loss of silence. Claire stopped walking.

We talked about this and discussed the potential mechanisms of tinnitus and this put her mind at rest as she had previously had difficulty in articulating to her family how much impact the tinnitus was having.

We talked about that impact. Tinnitus 'per se' had not stopped her from walking, in the same way as a leg injury might have, but the lack of control and feelings of her inability to change her condition led to the feelings of loss and grief.

Together we devised a programme of reconnection. We looked at using nature to maintain the joy in her life and over time Claire returned to her 'sit spot' and used it as a place to unwind and returned to her daily walks, which helped her physical and mental health. The intrusiveness of the tinnitus faded into the background.

A combined approach and habituation meant that Claire could now live well with her tinnitus.

Liam came to see me to have some hearing aids fitted, to help him to hear in noisy meetings and conferences with his high pressured job. Liam was very distressed by his tinnitus and felt that his hearing loss was the "least of his troubles". Liam, a dad of two boys had recently moved to the edge of the Somerset Levels for a quieter life living in the country. However for Liam the move had seemingly magnified his tinnitus. When he was living in town his tinnitus 'blended in' with the near constant traffic noise and was less intrusive and bothersome. Living on the edge of a sterile landscape with minimum birdsong and natural sounds, Liam's tinnitus had 'ramped up' and depression had set in as he had undertaken an expensive house move only to have tinnitus become an "ever present monster" that loomed large in his life, the more Liam thought about it. And Liam thought about it a lot.

After fitting hearing aids Liam was encouraged to visit a local wooded community space and get involved in a community group. A combined approach and again habituation meant that the impact that the tinnitus had on Liam's life greatly diminished. Liam felt that he could "control his tinnitus" by using his hearing aids and tapping into nature.

These aspects of change and control are hugely impactful on the ability of an individual to rehabilitate and live well with any long term health condition. As has been shown by Sirios et al (2006) [1] individuals that hold the belief that they can control ones own health showed less depression and had a greater sense of well-being. However, there are many health conditions where the sporadic nature and unpredictability of the onset of their symptoms can make it hard to live as enriched life as they would like.

As my interest in Rewilding has grown and to hear it's many vocal opponents citing concerns about loss of rural identity and the criticisms from neighbours that our land looks messy, these health and social themes of change and control are ever present again. One of the interesting features of Rewilding is that by allowing nature to take the lead and reducing human's control over the ecological processes many people feel anxiety and seek to resist change- to maintain the status quo- to maintain the internal locus of control.

'Locus of control' is the degree to which people believe that they, as opposed to external forces (beyond their influence) have control over the outcome. To surrender your internal locus of control of your land and trusting in nature takes a huge leap of faith.

When we now work with nature connectedness embedded in our tinnitus programmes, the wilder land, it's nature rich environment and 'living soundscape' (eg birdsong, tree noises, water flowing etc) inspires awe and joy, and is the most valuable resource for sound enrichment which is central to helping individuals to live better alongside their health condition.

* The names of the individuals have been changed to maintain confidentiality.

Reference:

Sirois FM, Davis CG, Morgan MS. "Learning to live with what you can't rise above": control beliefs, symptom control, and adjustment to tinnitus. Health Psychol. 2006 Jan;25(1):119-23.

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