SINGAPORE – Madam Oh Lee Hoon was 32 when she lost her hearing suddenly.  

It was an ordinary Sunday morning, when she woke up to see her toddler son running towards her. However, she could not hear a thing, even though she could see his lips moving. 

Just the day before, she had visited the general practitioner with a fever, cough and body aches.

Medical tests at a hospital that Sunday showed she had a viral infection so severe that the nerves in her ears were damaged, causing her to turn deaf overnight, she tells The Straits Times. 

Living life in silence for Madam Oh, whose children were then aged one to six, was devastating. 

Picking them up from school became scary as she could not hear what was happening around her. She often received “death stares” from cyclists, when they thought she was not making way for them on purpose, despite them ringing their bells.

She also could not stop brawls among her children, and they did not always have the patience to write down their feelings to communicate with her.

She tried hearing aids, but all she heard through these were loud banging noises.

In desperation, Madam Oh tried to end her life, but stopped when she saw her children pleading with her. 

In 2002, a general practitioner, who was treating Madam Oh’s daughter for a fever, introduced her to a doctor who does cochlear implant surgery at Tan Tock Seng Hospital.

Madam Oh underwent the surgery for her left ear, and after six years, the first words she heard were: “Madam Oh, can you hear me?”

“I remembered crying for a long time before I was able to speak and express my gratitude to the doctor,” says Madam Oh, who works as a cash processor at a transport company.

Madam Oh’s favourite pastime is watching Hong Kong singer Jacky Cheung’s music videos. 

World Hearing Day on March 3 raises awareness about the importance of hearing health and highlights the impact of hearing loss on individuals, communities and societies, as well as encourages early detection and intervention for hearing problems. 

Cochlear implant surgery is typically recommended for people who have severe to profound hearing loss and do not benefit significantly from conventional hearing aids.

The cochlear implant is a device which is implanted into the inner ear and restores hearing. It bypasses damaged or non-functioning parts of the inner ear and directly stimulates the auditory nerve, allowing people to perceive sound signals and understand speech.

Doctors tell ST they have seen an increase in the number of people with hearing loss and those getting cochlear implants in Singapore in recent years. 

Between 2012 and 2022, Dr Ho Eu Chin, a senior consultant at The ENT Clinic at Gleneagles Hospital and Mount Elizabeth Novena Hospital, has seen at least a 100 per cent increase in patients seeking and receiving cochlear implants.

In particular, he has noticed more younger adults and the elderly requesting help when hearing aids are no longer adequate. 

Singapore’s rapidly ageing population is among the reasons for the spike, say experts. 

Historically, Dr Ho says children aged about one to four made up the majority of patients undergoing cochlear implant surgery. But adults and the elderly now form the largest growing segment, due to birth rates declining and lifespans increasing, he notes.

Better awareness of hearing loss and greater acceptance of the use of hearing devices have also led to more seeking help, he adds.

Dr Vanessa Tan, a consultant at Singapore General Hospital’s department of Otorhinolaryngology – Head & Neck Surgery, says more patients are checking their hearing.

One reason is increased awareness of the link between dementia and hearing loss.

According to a 2020 report by The Lancet medical journal, a person with hearing loss has a higher chance of developing dementia.

At National University Hospital’s (NUH) department of Otolaryngology – Head & Neck Surgery, consultant Goh Xue Ying says there is an increasing trend in the elderly seeking medical assistance for hearing loss.

In particular, the number of cochlear implant recipients above age 50 increased from 8 per cent before 2019 to 35 to 60 per cent over the past two years.

Experts foresee a steep increase in older patients undergoing cochlear implant surgery.

“The older population in Singapore is getting better educated and more technologically savvy, and hence more open to this life-changing intervention,” says Dr Goh. “Also, with older adults being more socially and economically active than before, hearing health becomes important for them to maintain their active lifestyle.”

Older people are more prone to hearing loss due to a combination of factors, including exposure to loud noise over time, and age-related changes in the auditory system.

As people age, they may experience degeneration of the delicate hair cells in a part of the inner ear called the cochlea, which are responsible for detecting sound vibrations and transmitting them to the brain. 

This age-related deterioration, known as presbycusis, can lead to a gradual decline in hearing sensitivity, notes Dr Yuen Heng Wai, a senior consultant at the Ear Nose Throat, Head & Neck Surgery Clinic at Mount Elizabeth Medical Centre.

The ear, nose and throat specialist surgeon has seen a 10 per cent rise in cochlear implant surgery in 2023 compared with 2019.

Dr Yuen is also seeing more people between the ages of 30 and 50 requiring cochlear implant surgery. Typically, these patients develop severe hearing loss from conditions such as sudden hearing loss, genetic hearing loss and chronic ear infection. 

“With social distancing, virtual meetings and mask-wearing arising from the Covid-19 pandemic, communication and conversation for people struggling with hearing loss became a huge challenge,” says Dr Yuen.

People who had hearing loss and were already struggling, or those who were not aware they had a problem, were now acutely aware of their hearing issues, driving them to seek medical attention, he adds. 

Karate instructor Patrick Teo, 60, had been living with tinnitus, often described as ringing in the ears, after he underwent treatment for nose cancer in 2002.

Mr Patrick Teo’s quality of life suffered when his hearing deteriorated such that his wife had to communicate 
with him via text messages, even when they were home. ST PHOTO: KEVIN LIM

At 50, he gradually lost his hearing in his left ear and later began using a hearing aid. As his hearing became weaker, it became less useful. 

In 2022, he started wearing a hearing aid for his right ear too, after it became blocked after a bout of flu. 

Mr Teo – who has been teaching karate for 38 years and is president of the World Karate Organisation’s Singapore branch – says his wife, who also practises the martial art, had to stand beside him to repeat students’ queries to him.

As his hearing deteriorated, his wife had no choice but to communicate with him via text messages, even when they were home.

Frustrated, he searched for help online and came across cochlear implants. In 2023, he underwent cochlear implant surgery on his left ear. 

Though speech and other sounds from the cochlear implant sound different from normal hearing, Mr Teo, who has two grown children, is grateful that he is able to hear now. 

He continues to wear a hearing aid for his right ear, which now has about 70 per cent of hearing.

Mr Teo underwent cochlear implant surgery in May 2023. ST PHOTO: KEVIN LIM

Dr Yuen says those who are eligible for cochlear implants have severe hearing loss and are not benefiting from hearing aids. 

“Most of the time, they have stopped using their hearing aids and think nothing is going to work for them. They struggle with their daily hearing tasks and efforts. If this continues, they will begin to lose some language skills and their enunciation will be affected,” he adds. 

As a result, they will be increasingly isolated, withdrawn and disengaged, and may develop depression and dementia.

Both Madam Oh and Mr Teo use an app on their smartphones to control aspects of their hearing device, such as the volume levels, and to monitor the battery status. The external sound processor can be removed for charging.

Since the surgery, Madam Oh has resumed her hobby of listening to songs by her favourite Hong Kong singer, Jacky Cheung.

Mr Teo now easily communicates with people, including his 85-year-old mother. 

“I couldn’t hear her well because of my weak hearing and because she spoke softly, but now it’s much better,” he says.

Cochlear implant v hearing aids

Hearing aids and cochlear implants are both devices that address hearing loss, but they work in different ways and are suitable for different types of hearing loss.

A hearing aid is an electronic device that can be worn inside or behind the ear. It amplifies sounds in the environment, including speech, so these become louder and clearer to the person.

Doctors say hearing aids are typically used for people with mild to moderate hearing loss.

These are non-invasive and can be fitted and adjusted by audiologists to suit a person’s hearing needs. While hearing aids do not restore normal hearing, they can significantly improve the user’s ability to hear and communicate. 

NUH’s Dr Goh says hearing aids can cost between $1,500 and $6,000 for each ear. 

Funds such as the Seniors’ Mobility and Enabling Fund, as well as the Assistive Technology Fund, may cover the cost substantially if the patient is eligible for subsidies.

Cochlear implant surgery, on the other hand, is typically recommended for people who have severe to profound hearing loss and do not benefit significantly from conventional hearing aids, says the Ear Nose Throat, Head & Neck Surgery Clinic’s Dr Yuen.

The cochlear implant is a device implanted into the inner ear during a surgical procedure. It restores hearing.

There are two main components of the cochlear implant system: the external sound processor and the internal implant. 

Dr Yuen explains that the external sound processor is worn on the skin and, most of the time, hidden by hair. It receives sounds and converts them into signals.

The signals are then transmitted via the internal implant to stimulate the hearing nerve directly, bypassing the damaged part of the inner ear known as the cochlea. The brain then interprets these signals as sound. 

The surgery is done under general anaesthesia and takes two to four hours.

About a month after the surgery, Dr Yuen says the patient usually undergoes a few sessions of rehabilitation, known as auditory-verbal therapy for children and aural rehabilitation for adults. 

“In hearing loss, when the hearing part of the brain is not stimulated, it ‘goes to sleep’. It needs to be awakened to recognise sounds and speech,” he adds. 

On average, patients generally regain about 70 per cent of their original hearing, says Dr Yuen.

Cochlear implant surgery costs about $30,000 to $40,000 a ear, says Dr Goh. 

Healthcare schemes and subsidies such as MediSave and MediFund may cover a substantial portion of the cost for eligible patients. Private health insurance may also fund costs associated with cochlear implants.