{"type":"rich","version":"1.0","provider_name":"Transistor","provider_url":"https://transistor.fm","author_name":"Under Load","title":"Hearing loss, listening effort, and dementia: a doctor's reading","html":"","width":"100%","height":180,"duration":892,"description":"Karla said people were too loud. Everyday voices suddenly felt overwhelming after doctors put small tubes in her eardrums.\nOur youngest had spent years struggling to hear us and tell us what she needed. She’s six now, and I’ve finally felt ready to write about it.\nThis episode follows her progress, our doubts about a bilingual kindergarten, and the conversations I want people to be able to follow at work and at home. My wrestling ears make an appearance too, along with an expensive pair of custom earphones that finally stayed in.\n### In this episode\n- Karla’s glue ear and the long wait for answers.\n- A study of middle-aged adults with normal standard hearing tests, and what their pupils suggested about effort after listening in noise.\n- The difference between hearing-related fatigue and the need to recover from a working day.\n- What employees with hearing loss said made video meetings easier to follow.\n- The ACHIEVE trial’s overall result and its often-quoted 48% subgroup result, with the comparison and limitations explained.\n- Practical questions for a hearing appointment, and Karla starting first grade.\n### Written edition and subscription\nFind Under Load and subscribe at [andreheeg.com](https://www.andreheeg.com).\nAll 16 references are included in the written edition.\nUnder Load is the Sunday edition of The Upward ARC, written by Andre Heeg, MD, DDS, on executive health, longevity and sustained performance.\n### Key sources\n- [NICE guidance on glue ear in children](https://www.nice.org.uk/guidance/ng233/chapter/Recommendations) and [adult hearing assessment and care](https://www.nice.org.uk/guidance/ng98/chapter/recommendations).\n- [MacKeith and colleagues, 2023](https://doi.org/10.1002/14651858.CD015215.pub2): the Cochrane review of ventilation tubes for children with glue ear.\n- [Zink and colleagues, 2025](https://doi.org/10.7554/eLife.102823): listening effort in adults with normal standard hearing tests.\n- [Holman and colleagues,...","thumbnail_url":"https://img.transistorcdn.com/D6GUGKGhv_DEKkMXOUaw9zVKHR_WqCVlo9ECODchftY/rs:fill:0:0:1/w:400/h:400/q:60/mb:500000/aHR0cHM6Ly9pbWct/dXBsb2FkLXByb2R1/Y3Rpb24udHJhbnNp/c3Rvci5mbS8wODc1/MzQxYzZmMTk4MDBl/ODhhM2E4NWIwYTFj/OWExOC5wbmc.webp","thumbnail_width":300,"thumbnail_height":300}