“You Have Selective Hearing”

My friends & family have been saying it for at least 3 years: “You have selective hearing”. It comes with love, mostly, and sometimes with a little exasperation. I hear the television from across the house and miss the question asked right beside me. I answer the thing that interests me, then say sorry, what, to the thing that comes after it. From the outside it looks like a choice. It looks like I tune in when I want to and tune out when I don't.

It isn't a choice. I want to explain what is actually going on, because the truth is both more ordinary and more interesting than the joke.

Two things are happening at the same time. The first is age. The second is my heart.

The age part is shared by nearly everyone who reaches my decade. The ear gives up the high notes first. Consonants live up in those high notes. The s and the f and the th and the sh. Vowels live lower, and they carry most of a word's volume. So you can hear plainly that a person is speaking and still not catch what they said. A restaurant is the hardest place of all, because the background noise sits right on top of the frequencies I have already lost. Turning up the volume helps less than you would think. The problem was never loudness. It was clarity. This is not an illness. It is the warranty running out on a part that has done a lifetime of honest work.

Then there is my heart. I was recently diagnosed with heart disease, and there was little drama in that sentence. It runs through my family like a thread you can follow from one generation to the next. We knew it was coming, and we planned for it. The medications were in place before I needed them. The diagnosis felt less like a shock than a calendar appointment I had booked a long time ago.

Here is the part I did not expect, and the part worth understanding if someone you love is going through the same thing. The heart and the ear are far closer than most people know.

Deep in the inner ear sits the cochlea, a structure about the size of a pea and shaped like a snail shell. Inside it are thousands of tiny hair cells, and those cells do the real work of hearing. They take the vibration of sound in the air and turn it into a signal the brain can read. They are also some of the hungriest cells in the body. For their size they burn through an enormous amount of energy, and they need a steady, rich supply of oxygen carried in the blood to keep doing it. Starve them even a little and they falter.

Now the catch. Most organs are fed from several directions at once. If one vessel narrows, a neighboring vessel takes up the slack. The cochlea has no such luck. It runs on a single small artery with no backup line and no second route in. Whatever reaches it is all it gets. That makes the inner ear one of the most exposed places in the whole body to anything that touches the circulation. High blood pressure, narrowed arteries, thickened blood, a heart that pumps with a little less force, all of it lands here, and it lands here hard.

The damage does not announce itself. There is no pain and no warning. It shows up as a person who keeps asking you to repeat yourself. Who loses the thread in a noisy room. Who hears that you are talking but cannot quite assemble the words. From the outside that looks like distraction or stubbornness. Underneath, it is often a small organ running on a thin supply line, doing its best with what gets through.

This is why doctors increasingly look at the two together. The ear can be an early window onto the heart. Hearing that fades faster than age alone would explain is sometimes the first visible sign that the circulation is struggling somewhere you cannot see. The connection runs both ways. Trouble in the heart turns up in the ears, and trouble in the ears can point back to the heart. If a parent or a spouse is suddenly missing more than they used to, it is worth mentioning to their doctor, because the ears may be reporting on more than the ears.

So my hearing is not simply old. It is old, plus a circulatory system that is now part of the story. The two stack on top of each other. Age takes the high notes. The heart thins the supply the rest depends on. Put them together and you get a man who hears the television fine and loses the sentence spoken at his shoulder.

So if you love someone whose hearing has started to drift, here is what actually helps. Get their attention before you start. Face them when you talk, because we all read lips more than we realize. Do not call out from another room. Do not compete with the television. None of it is hard, and all of it works.