If you’ve ever used Apple Health, you have probably tracked your step count at some point. You may also sometimes track your sleep, resting heart rate, blood pressure and even blood glucose. These numbers are a part of our longitudinal health — something we can measure, compare over time and ideally act on. However, most people could not give you an equivalent number for their hearing.
That gap was the focus of a recent seminar from the Cochlear Center for Hearing and Public Health, held on Sept. 24, featuring Molly Sheehan and several researchers from the Hopkins Center for Communication Programs (CCP). The seminar centered on the “Hearing Number,” a public health effort built around a deceptively simple question: What would change if hearing became something we routinely measured throughout our lives, rather than something most people only address after it has already become difficult to hear?
The Hearing Number is based on the four-frequency pure tone average, or PTA4, a clinical measure that averages hearing thresholds at four frequencies important for speech. In practical terms, this metric represents the softest speech sounds a person can hear in each ear. A lower number indicates that the person can hear softer sounds. The measure is already used by hearing specialists around the world.
Though the technical metric itself is well established, the mission of taking this information from the audiologist’s office and practically applying it in everyday life is a new approach. For Sheehan, that requires changing not only how hearing is measured, but how people talk about hearing health. Hearing is often framed as a binary: someone either has normal hearing or has “hearing loss.” The problem is that this language can make hearing feel like a concern reserved for older adults, rather than a capacity that changes throughout a lifetime.
“We believe that hearing is due for rethinking,” Sheehan said.
That goal begins by approaching hearing like sleep or blood pressure: as something worth understanding before it reaches a crisis stage. The accompanying new Hearing Number app allows adults to complete a short screening for each ear using compatible headphones. The developers accounted for tuning differences across 39 headphone models from 19 manufacturers. Additionally, the app is available in 10 languages and does not collect users’ personal data. Since the app’s launch, it has reached roughly 100,000 downloads.
One of the key design decisions was linguistic rather than technological in nature. The app does not label a result as “bad” or “worse,” nor does it portray itself as providing a medical diagnosis. Instead, it only claims to offer a snapshot of what someone can hear at that specific point in time. As the presentation moved through the app’s design philosophy, this distinction became explicit.
“We never frame hearing as a loss. It’s framed as what you’re able to hear at that time.”
Meanwhile, August Summers, a team leader at the CCP, introduced the program’s broader approach to public health communication: starting with a focus on the people whose behavior a program hopes to directly impact. This entails identifying the program’s audience, understanding their existing beliefs and treating their experiences with value.
Erica Nybro, who works with the CCP, illustrated this point using one of its malaria projects in Guyana. Instead of deciding from afar how these miners should be taught about the disease, the team brought them into the design process. Working together, they created a character and a jingle about malaria prevention that spread through the target communities. The campaign was associated with an increased use of insecticide-treated nets, treatment seeking and knowledge of malaria symptoms. Still, the lesson learned went beyond the campaign: having more data does not mean experts will automatically know how people will respond.
The CCP is now hoping to make the same impact on the hearing and hearing-impaired community. Its team interviewed health departments, industry representatives, nonprofits, clinicians and Hopkins experts to understand where hearing communication succeeds and where it breaks down. Those conversations revealed a wide range of potential audiences, from younger people exposed to loud music to caregivers watching parents experience cognitive decline. They also exposed persistent misconceptions: that hearing decline is simply inevitable with age, that hearing aids restore hearing the way glasses correct vision or that hearing difficulties matter little beyond basic inconvenience.
The barriers are just as varied. Some are structural. For example, adults are not routinely screened for their hearing in many health settings, while people in rural areas may have to travel significant distances to reach an audiologist. Other barriers are social. Hearing devices can carry associations with aging, disability and vulnerability. Cost matters too, although stakeholders disagree over whether price alone explains low uptake of hearing care or whether expectations, perceived benefit and stigma play a bigger role in shaping whether people seek and continue treatment.
Yet, these interviews also revealed a limit to the Hearing Number initiative. Stakeholders often wanted the number paired with functional questions. Can you follow a conversation in a crowded restaurant? Are certain voices harder to distinguish? Are you asking people to repeat themselves more often?
“Your lived experience is very important,” Nybro concluded.
Two people with similar Hearing Numbers may have very different experiences. A screening result can prompt someone to pay attention to this aspect of their health, but it cannot replace a full audiological evaluation or solely explain how their hearing is affecting their life.
That tension between measurement and meaning was emphasized by the seminar. During the discussion, one of the presenters reflected on how a number becomes useful only when someone can connect it to something tangible.
“If it’s matched with a reality of a deficit or something in their own life, it’s going to be very powerful.”
The Hearing Number, then, is not just another metric to add to a dashboard, but a new way into a conversation. For younger adults, that may center on protecting hearing at concerts or while using headphones. Later in life, this may mean monitoring changes in hearing and knowing when to seek care. The campaign aims to promote treating hearing as a “life-course issue” rather than an intervention that begins only when something has gone wrong.
This is logic we already accept for steps, sleep or blood pressure. The question raised by this seminar is whether hearing metrics could become just as essential — not simply as a measure of what someone has lost, but as pragmatic information that helps them with their next decisions and actions.
Source: www.jhunewsletter.com
