Karla said people were too loud. Everyday voices suddenly felt overwhelming after doctors put small tubes in her eardrums.
Our 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.
This 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.
### In this episode
- Karla’s glue ear and the long wait for answers.
- A study of middle-aged adults with normal standard hearing tests, and what their pupils suggested about effort after listening in noise.
- The difference between hearing-related fatigue and the need to recover from a working day.
- What employees with hearing loss said made video meetings easier to follow.
- The ACHIEVE trial’s overall result and its often-quoted 48% subgroup result, with the comparison and limitations explained.
- Practical questions for a hearing appointment, and Karla starting first grade.
### Written edition and subscription
Find Under Load and subscribe at [andreheeg.com](https://www.andreheeg.com).
All 16 references are included in the written edition.
Under Load is the Sunday edition of The Upward ARC, written by Andre Heeg, MD, DDS, on executive health, longevity and sustained performance.
### Key sources
- [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).
- [MacKeith and colleagues, 2023](https://doi.org/10.1002/14651858.CD015215.pub2): the Cochrane review of ventilation tubes for children with glue ear.
- [Zink and colleagues, 2025](https://doi.org/10.7554/eLife.102823): listening effort in adults with normal standard hearing tests.
- [Holman and colleagues, 2021](https://doi.org/10.1177/23312165211052786), [van Leeuwen and colleagues, 2022](https://doi.org/10.1097/AUD.0000000000001127), and [Gussenhoven and colleagues, 2017](https://doi.org/10.1177/2331216517692304): fatigue and recovery outcomes across different study designs.
- [Marsja and colleagues, 2026](https://doi.org/10.1177/10519815251398498): interviews about access to video meetings for employees with hearing loss.
- [Ferguson and colleagues, 2026](https://doi.org/10.1002/14651858.CD012023.pub3): hearing aids for adults with mild to moderate hearing loss. [Ohlenforst and colleagues, 2017](https://doi.org/10.1097/AUD.0000000000000396) reviewed the separate outcome of listening effort.
- [Lin and colleagues, 2023](https://doi.org/10.1016/S0140-6736(23)01406-X): ACHIEVE, which tested hearing care against health education in older adults.
- [Cantuaria and colleagues, 2024](https://doi.org/10.1001/jamaoto.2023.3509): the observational Danish study of hearing loss and later dementia.
- [NIDCD guidance on noise-induced hearing loss](https://www.nidcd.nih.gov/health/noise-induced-hearing-loss).
### About the audio
Andre reads the written newsletter, adjusted for speech. Reference numbers are omitted from the recording; the written edition carries the citations.
AI assisted with research, drafting and adapting this piece for different formats. I chose the argument and examples, reviewed the evidence, edited the final text and take responsibility for every published claim.
This episode is general information and does not replace an assessment by your own clinician. If your hearing suddenly worsens over three days or less, seek medical assessment within 24 hours. [NICE guidance](https://www.nice.org.uk/guidance/ng98/chapter/recommendations).