Why this is the number one test of a successful home
During winter, however, the tables turn. As the days grow shorter, we lose almost a third of the 14 hours of daylight that we enjoy in the summer months and, sometimes, experience a corresponding fall in mood.
With scientific evidence increasingly pointing to the detrimental effects artificial light can have on our sleep and mood, it makes sense to light our residential spaces naturally wherever possible. Melbourne-based architect Antony Martin says natural light is the number one element he looks for in a dwelling.
'My most important test of a successful house is when you walk in and there is never a light on during the day because there is well-balanced natural light,' he says.
More than a simple matter of illumination, Martin says natural light has properties that artificial sources struggle to emulate.
'Natural light levels are constantly varying,' he says. 'It is quite imperceptible to the naked eye, but it's very different to artificial light, which is constant throughout the day. There is an emotional attachment that comes with it. You may not be aware of it but the colour of it changes throughout the day.'
At its most basic, the sun appears higher in the sky in summer and lower in winter. For Australians, northern light is the most desirable because it is the most consistent and can be most effectively managed all year round by setting windows and eaves at appropriate levels. The least desirable summer aspect is to the west towards the setting sun which, as it appears lower in the sky, can heat up interiors to uncomfortable levels.
But Martin says it's not without its appeal.

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The Age
4 hours ago
- The Age
Noisy restaurants, muffled voices: How hearing loss creeps up on us
Loud noise travelled everywhere with Daryl Holmes. When he drove by, you could hear his car radio blaring. At dinner, he shouted. At night, his wife couldn't sleep over the roar of the TV in the loungeroom. Any time she spoke to him from just a few feet away, he'd shoot back, 'What did you say?' Fifty years earlier, he'd been driving cranes in the steel industry. Then he'd worked in mines. He'd never worn ear protection, despite the cacophony of clangs, rumblings and the odd explosion that were part of a day's work. So the signs ought to have been obvious. But by the time he was 73, Daryl had gone years without acknowledging his fading hearing. In fact, people take five years, on average, to get a test after the first signs of trouble. 'You muddle along because you don't understand the impact,' he tells us. 'I was walking around in sublime ignorance.' At least one in six Australians has a hearing problem. Most are 70 or older, by which age half of people have hearing difficulties. Restaurants become too loud to hear the soft voices of grandchildren. Conversations become stilted and awkward. Our ears are remarkable organs. Damage to their inner workings can't be reversed. That damage can influence other areas of our health too. 'What we're now seeing over the last 10 to 20 years of research is that hearing loss has got such a strong knock-on effect on so many aspects of wellbeing,' says Barbra Timmer, president of Audiology Australia. So how do we hear? What goes wrong with hearing as we age? And how can we get it back? First, how do we hear? Sound cannot exist in the vacuum of space because it needs a medium such as air to carry the vibrations known as sound waves. But in Earth's atmosphere, particles are always vibrating and making sound, whether humans can hear them or not. Sound is measured in frequency, or hertz, which are the number of vibrations the sound causes in a second. Higher pitches vibrate at a greater frequency than lower pitches: a note from a violin, for example, can soar higher than a cello because the instrument has short, thin strings that vibrate faster. Generally, humans can hear between 20 and 20,000 hertz, but the most sensitive range of our hearing is between 2000 and 5000 hertz (a smoke alarm is 3100 hertz). Many animals have higher upper limits – up to 67,000 hertz for dogs, 79,000 hertz for cats and 150,000 hertz for dolphins. Pigeons, on the other hand, are most sensitive to low frequencies called 'infrasounds' of just 0.5 hertz, which scientists think might help them navigate by detecting, for example, far-away breaking waves in the ocean. Humans' outer ears, called 'the pinna' from the Latin for wings, are skin-covered cartilage structures that work like radar dishes to collect sound vibrations. (We can boost the effect by cupping our hands behind our ears to make the catchment area bigger.) The outer ear funnels sound into a 2.5-centimetre-long canal lined with earwax, a mixture of oil and dead skin cells that help prevent unwanted particles reaching the middle ear. The middle ear's job, says Wayne Wilson, an associate professor of audiology at the University of Queensland, is to resolve a problem: sound waves travelling through air, which is low-density, must also make their way through the much denser fluid in the inner ear (more on that in a moment). 'Each ear has about 12,000 outer hair cells and 3000 inner hair cells ... Those little hair cells become Grand Central Station for hearing.' Wayne Wilson, associate professor of audiology at the University of Queensland So, as sound reaches the middle ear, it shakes the eardrum, a cone-shaped disc about the size of a fingernail, which passes the vibrations along to the three smallest bones in the body – the malleus (hammer), incus (anvil) and stapes (stirrup) – which work as a lever system to amplify the vibrations. The final bone, the stapes, has a footplate that presses against a tiny oval-shaped opening, covered in a thin layer of tissue, that forms a window to the inner ear. The journey from larger eardrum to smaller footplate concentrates the vibrational energy into this tiny area – a bit like delivering a one-finger punch – so that hardly any sound is lost as it enters the fluid of the inner ear. The sound reaches the cochlea (Latin for snail shell), a pea-sized spiral cavity that holds the essentials for converting sounds into signals for the brain. Inside it, fluid waves ripple along a ribbon called the basilar membrane, which has various widths and stiffnesses that vibrate to high, middle or low frequencies – much like an in-built piano keyboard. On top of the membrane is our 'organ of Corti', the sensory core of the cochlea, named after the Italian anatomist Alfonso Corti, who discovered it in 1851. The vibrations from the basilar membrane cause thousands of microscopic hair cells inside the organ to bend. Each ear has about 12,000 outer hair cells, which amplify sound, and 3000 inner hair cells, which release neurotransmitters. As Wilson puts it: 'Those little hair cells become Grand Central Station for hearing.' From there, neurotransmitters excite nerve cells that send signals to the brain that become the sounds we hear. What's presbycusis (or, why can't you hear any more in rowdy restaurants)? Presbycusis – from the Greek for old hearing – is one of the most common forms of hearing loss. It affects about one in three people aged over 60, and more than 80 per cent over 84. 'It's something that starts, unfortunately, from about age 40,' says Audiology Australia's Barbra Timmer. 'It creeps up on us; it's not like one day we wake up and suddenly we've lost a lot of hearing.' 'After too much wear and tear, they're all smashed and bent. Some of them have been ripped out of the cell completely. It looks like a cyclone has gone through.' Wayne Wilson, associate professor of audiology at the University of Queensland Its causes are many: genetic differences that express themselves as we age, wear and tear from exposure to noise, our diet, the use of certain medicines that can damage the hair cells of the inner ear, called 'ototoxic' drugs, which include some antibiotics, diuretics and chemotherapy agents. The result of any or all of these is damage to the hair cells in the cochlea – particularly the outer hairs – so sound is no longer amplified as it was when we were younger. Some fish, reptiles and birds can regenerate hair cells inside the cochlea, but damage is irreversible for humans. What does this degeneration look like? 'Take an electron micrograph of a healthy set of hair cells, and you see these lovely stiff hairs sticking up. Think of several rows of fence posts, all perfectly in position,' says Wayne Wilson. 'Now imagine taking a giant wire brush and scrubbing it over the fence posts. That's what we see in the electron micrograph. After too much wear and tear, they're all smashed and bent. Some of them have been ripped out of the cell completely. They're all skew-whiff, not facing in the right direction. It looks like a cyclone has gone through.' The first sounds to go are high frequencies, hence the difficulty for older people in hearing the higher pitched voices of children. Words with sounds of higher frequencies might become harder to understand, says Timmer. 'So the word 'six' we might hear as 'fix' – both 's' and 'f' are high-pitch consonants, and so we might not be able to pick that up.' Low-frequency background sounds are a particular issue because they mask high frequencies. Restaurants with ambient hubbub or music that are decked out in hard surfaces, for instance, cause noise to ricochet and echo. For audiologists, hearing loss can be either mild (difficulty with soft and distant speech), moderate (can hear almost no speech at a conversational level), severe (can't hear any speech at a normal level) or profound (may only be able to hear very loud sounds). The term 'hard of hearing' generally refers to people with mild to severe hearing loss. Many common ear conditions can affect hearing too: one in 10 adults can develop otosclerosis, which causes bones in the middle ear to become stuck together and unable to pass on sound vibrations. It tends to affect people from their 20s to 40s (and is surgically correctable with a prosthesis). Then there's the ringing that affects 10 to 15 per cent of people, called tinnitus, and diplacusis, which causes pitch to be heard differently in each ear. In early life, genetics lead to about one in every 1000 babies being born in Australia with some hearing loss. Children are also prone to ear infections, in part because the narrow passage that equalises pressure and drains fluid from the middle ear – the Eustachian tube – is still developing. If untreated, repeated infections can cause hearing problems. What's the impact of hearing loss on your health? Daryl Holmes' favourite pastime is to be with his team on the bowling green at a local club in Newcastle. Just a few months ago, before he got help with his hearing, he found his game wasn't as good. 'It was inconsistent. Sometimes I'd play a bowl that I was really proud of but you'd be thinking, with the next two or three, what have I done wrong?' He would arrive home exhausted. 'I'd be sitting on the chair and my wife would say, 'You've got to go have a sleep before dinner.'' Indeed, one consequence of mild hearing loss is fatigue – from straining to listen. Some people get by because they fill in the blanks – like reading a sentence with several letters blurred. But the effort involved often means rerouting cognitive resources that would otherwise be in reserve or used for other tasks, says Barbra Timmer. When people say, 'I seem not to remember the gist of conversations as much' it's a possible sign that the energy spent on remembering is being diverted for hearing. Researchers are looking into a link between hearing loss and dementia. A report by the Lancet Commission on dementia in 2024 found people addressing their hearing loss – among other factors such as hypertension, physical inactivity, diabetes, obesity and depression – had the potential to reduce the risk of dementia by 40 per cent. While there is an association between hearing loss and dementia, it is not a proven cause, says Julia Sarant, leader of the University of Melbourne's Hearing Loss and Cognition Program. 'There are other things at play too,' she tells us. 'An example could be hearing loss causes social isolation for a lot of people, particularly if they don't do anything about it because they lose their ability to communicate, and that causes reduced brain stimulation, and that causes reduced cognitive reserve.' 'I was just beginning to withdraw because I couldn't hear the conversations, I couldn't be part of them. But I refused to allow that to happen.' Surgeon Michael Bruce Vascular surgeon Michael Bruce was in his 50s when he began to have difficulty hearing patients. 'I always had the ability to come up with a quick quip, that was part of who I was, and I found that was all slipping away,' says Michael, now 73. (Asked what type of surgeon he is, he replies, 'a competent one'.) He found work conferences, social gatherings and dinners with friends a challenge. 'I was just beginning to withdraw because I couldn't hear the conversations, I couldn't be part of them,' he says. 'But I refused to allow that to happen.' Hearing loss is associated with many other health risks: there's a 47 per cent greater likelihood of people having depression, according to an Australian review of dozens of studies. Another study concluded that 40- to 69-year-olds with mild hearing loss were three times more likely to fall over in a 12-month period. And studies have found a relationship between cardiovascular health and hearing loss, although again there isn't any known causal link. 'One of the things that we have seen in the past with hearing loss is that it was very much seen to be a sensory impairment; something that was sort of inevitable later on in life,' says Timmer. 'Yes, it is a sensory impairment, but the impact from hearing loss is much bigger than we've known in the past.' What is noise damage, and how do you protect yourself? In the 1960s and '70s, Michael Bruce drummed in a four-piece rock'n'roll band called the Whatchamacallits. His highlight was making it on to television talent show Brian and the Juniors. 'We were pretty ordinary but did all right,' he says. 'I'd certainly do it all again.' Still, Michael would lie in bed after a gig and think, I can still hear the cymbals. 'I can see now that it was damaging my ears,' he tells us. 'And you just don't even think about those things at the time. The damage didn't really declare itself until 30 years later.' For health purposes, noise is measured in decibels and time frames. In Australia, occupational health and safety regulations define a 100 per cent noise dose as being exposed to 85 decibels (dBA) for eight hours – roughly the equivalent of someone speaking in a raised voice. From there, every three additional decibels halves the amount of time someone should be exposed to the noise: 88 dBA, or equivalent to heavy traffic, for four hours; a lawn mower around 91 dBA for two hours. In short, says Wayne Wilson, 'It can be OK to listen to really loud sounds if you listen to them for only a very short period of time every day. It is dangerous to listen to very loud sounds if you are exposed to them continuously for an entire day.' Loading In 2010, SafeWork Australia surveyed 4500 people and found 28 to 32 per cent of the Australian workforce were likely to be exposed to noises higher than 85 dBA, especially in manufacturing and construction, perhaps unsurprisingly. Employers are required to try to eliminate the source of the noise, to use engineering controls, to rotate employees and to provide hearing protection. (Workers exposed to potentially ear-damaging substances such as solvents and heavy metals face additional risks.) Overall, studies have found musicians are 20 to 60 per cent more likely than the general population to have hearing loss. Some of those at highest risk can be pit orchestra musicians (those who play in lowered 'pits' for shows, musicals and ballets) who, without ear protection, can be four times more likely to have damaged hearing than the general population, says Sarah Swann, an audiologist at the University of Melbourne. 'A lot of these instruments – especially brass instruments, but flute or the piccolos in the woodwind instruments as well, and percussion for sure – you can safely be exposed to those for about 15 minutes before you start to be at risk of damage.' 'You go out for that big party on Friday night and you binge on that sound exposure, in one event, you've given yourself an 800 per cent dose.' Wayne Wilson, associate professor of audiology at the University of Queensland And music fans beware, wearing headphones with the volume turned up past halfway for prolonged periods can harm hearing. 'If you love your loud music, you can listen to it – just really control the time you spend listening,' says Wilson. Nightclubs and concerts pose a particular risk. 'We often talk about people who binge listen,' says Wilson. 'Even if you are conscious and you're trying to protect your hearing – you do well during the day, you wear hearing protection at work, and you only listen to your music for a little while – and then you go out for that big party on Friday night and you binge on that sound exposure, in one event, you've given yourself an 800 per cent dose.' Not everyone sees not hearing as a negative, though. Rather than use 'deaf' as a medical term, experts tend to refer to the cultural and linguistic identity of the deaf community: people with a wide range of reasons for hearing loss, including those who can't have their hearing restored or choose not to. In the 2021 census, more than 16,000 Australians said they used Auslan (Australian Sign Language), which uses hand, body and facial expressions to communicate words and phrases. How can hearing be restored? Daryl Holmes didn't expect much to be amiss when he had his hearing checked last year. The test, called an audiogram, typically assesses hearing from 250 hertz of sound to 8000 hertz. 'The reason why we test that range is because that covers the speech range,' says Emma Scanlan, principal audiologist at Hearing Australia. Daryl found himself having to guess many of the words, so an audiologist handed him a pair of hearing aids. 'It truly was transformative. I knew straight away that there was a significant difference,' he says. 'And my son said it within that first week, 'Dad, you're not talking really loud.'' His bowling has even become more consistent – his team, the Cardiff Falcons, recently came third in a state competition, their best result since the 1950s. Loading The battery-powered devices amplify sound to make the vibration the ear receives bigger and to ensure the damaged hair cells in the inner ear register it. People with greater hearing loss might also use a remote microphone that, for example, can be positioned in front of different people at a dinner party. If the inner ear is severely damaged, another option is for surgeons to install a cochlear implant (Professor Graeme Clarke famously developed the multichannel implant in Melbourne). The device, which is also battery-powered, sends electrical impulses into the cochlea to bypass the damage and set off a reaction that stimulates the auditory nerve so the brain can interpret the sound. 'We only offer a cochlear implant if they've got a 75 per cent chance or better of hearing better.' Claire Iseli, Royal Victoria Eye and Ear Hospital Claire Iseli, an otolaryngologist at the Royal Victorian Eye and Ear Hospital who implants the devices, says they can be life-changing, but only about 10 per cent of people eligible for them get the surgery. 'We've found the biggest barriers are people feeling like they might be too old and just assuming that we wouldn't offer surgery to someone in their 70s or 80s. And actually, that's not true, that's the majority of our patients,' she says. (The surgery can be done under a local anaesthetic if the patient isn't fit enough to undergo a general anaesthetic.) Two years ago, Iseli had a 91-year-old man tell her he wanted the implant so he could date again. 'I put a cochlear implant in and at his first check-up he'd already had three dates. Last time I saw him he was 93. And he's got a partner now.' The surgery comes with some risks, injury to the facial nerve and dizziness among them. It isn't reversible and can result in people losing the last bit of their biological hearing – their hearing comes only via the implant. 'That's where the process is very structured,' says Iseli. 'We only offer a cochlear implant if they've got a 75 per cent chance or better of hearing better.' In 2018, after about 15 years of wearing hearing aids, Michael Bruce was training for a provisional pilot's licence but couldn't hear air-traffic control or the other pilots out of his left ear. 'I really loved the flying. So I went to my audiologist, and I asked if there was anything else that could be done. She said the only thing left to try is a cochlear implant.' Spurred by his desire to be 'an active member of society', he received the implant and kept training for the licence. Then his right ear began to deteriorate. He's hoping his second implant, which he had in December, will mean he can obtain the licence, 'a childhood dream'. Doctors said the fact that Michael had worn the hearing aids had helped him exercise his auditory nerve and stop it from atrophying, making him an ideal candidate for the surgery. While hearing aids can sound disproportionately loud at first, the implants can involve a bigger adjustment – Michael says other people initially sounded like they were talking to him 'from Mars'. 'But, at the three-month mark, with my left, my hearing perception went from about 30 per cent to 92 per cent, and three months on the right side went from 31 to 88 per cent.' Music sounded more organic when he had hearing aids; now it sounds a little tinny. 'Although you miss out on different things, the words are so much clearer now. There were words to songs I always got wrong. It hasn't taken music away from my life or anything. In some small way, it's probably enhanced it.' He still drums at home on an electronic kit that he hears via bluetooth to the implants. 'If you're getting ignored all the time, resentment has got to be there. When I went to get the hearing test, [my wife] said, 'I'm really glad you're going.' ' Daryl Holmes It's not all about technology, though. Back to that restaurant where you're straining to hear. 'What's the best position for me to be sitting in? I want the light to be on other people's faces. And don't be sitting near the kitchen,' says Scanlan of Hearing Australia. Or plan to avoid noisy venues altogether. 'Don't have too high expectations of yourself either. Communication is a two-way thing. If someone wants to speak to you in a challenging environment, if they come right up to face you or bend your way, that's the best chance you've got of being able to take part in the conversation.' If you don't hear what someone says, Scanlan recommends not saying, 'What?' but repeating back the parts of the conversation you did hear. 'And what you're doing in that situation, as a person with hearing loss, is saying, 'I'm paying attention, but I'm just struggling.' I have seen that make a really big difference to people's relationships.' Daryl Holmes agrees hearing loss caused friction with his wife: 'If you're getting ignored all the time, resentment has got to be there,' he says. 'When I went to get the hearing test, she said, 'I'm really glad you're going.'' In March, Daryl visited the Sydney Opera House as part of a group of people with hearing loss. They trialled new technology – used for the first time globally in a cultural institution – that broadcasts live performances from the stage via Bluetooth technology to people wearing compatible hearing aids. On stage were a string ensemble and a singer. 'It was like the music of the violins was floating across the floor,' Daryl says. 'I closed my eyes, and I was actually in tears because I felt it's the clearest thing I have ever heard.'

The Age
4 hours ago
- The Age
A half-match transplant was Ismaeel's only option. His parents jumped at it – they had been here before
When Javeria and Usman Ahmad's newborn son Ismaeel was diagnosed with a rare genetic immunodeficiency disorder, they rushed to proceed with a bone marrow transplant from Usman, even though, as a parent, he was only a 'half match', bringing added risks. Their first son, Zakariya, had died at just 15 months of the same condition – severe combined immunodeficiency (SCID). 'They spent six weeks looking in the donor registries around the world, and we couldn't find anything better than a 30 per cent match,' Javeria said. She was preparing to donate when Zakariya's condition deteriorated. A shortage of bone marrow donors is causing problems for Australians, particularly those from diverse backgrounds. Like many, the only option for the Ahmad family, who have Pakistani heritage, was a partial match from a relative. Donation advocates hope the now-widespread availability of cheek swab testing will encourage more young people from all ethnic backgrounds to become donors. Registering, previously only available via a blood draw, is now as simple as returning the cotton swab sample by mail, resulting in a potential match for a current or future patient. Usman donated through a process similar to giving blood. He returned to work the next day, while Javeria sat with Ismaeel as the stem cells were administered via his chest. 'I was just holding him on my lap as the cells went in,' she said. 'The procedure itself was quite uneventful.' It was also a success. Ismaeel is now an active 10-year-old who loves soccer and basketball, and regularly tops his class. He will probably receive fortnightly antibody infusions from donated blood plasma for the rest of his life, but his parents, from Sydney's west, hope he won't need another transplant, though there's always the chance.

Sydney Morning Herald
4 hours ago
- Sydney Morning Herald
Noisy restaurants, muffled voices: How hearing loss creeps up on us
Loud noise travelled everywhere with Daryl Holmes. When he drove by, you could hear his car radio blaring. At dinner, he shouted. At night, his wife couldn't sleep over the roar of the TV in the loungeroom. Any time she spoke to him from just a few feet away, he'd shoot back, 'What did you say?' Fifty years earlier, he'd been driving cranes in the steel industry. Then he'd worked in mines. He'd never worn ear protection, despite the cacophony of clangs, rumblings and the odd explosion that were part of a day's work. So the signs ought to have been obvious. But by the time he was 73, Daryl had gone years without acknowledging his fading hearing. In fact, people take five years, on average, to get a test after the first signs of trouble. 'You muddle along because you don't understand the impact,' he tells us. 'I was walking around in sublime ignorance.' At least one in six Australians has a hearing problem. Most are 70 or older, by which age half of people have hearing difficulties. Restaurants become too loud to hear the soft voices of grandchildren. Conversations become stilted and awkward. Our ears are remarkable organs. Damage to their inner workings can't be reversed. That damage can influence other areas of our health too. 'What we're now seeing over the last 10 to 20 years of research is that hearing loss has got such a strong knock-on effect on so many aspects of wellbeing,' says Barbra Timmer, president of Audiology Australia. So how do we hear? What goes wrong with hearing as we age? And how can we get it back? First, how do we hear? Sound cannot exist in the vacuum of space because it needs a medium such as air to carry the vibrations known as sound waves. But in Earth's atmosphere, particles are always vibrating and making sound, whether humans can hear them or not. Sound is measured in frequency, or hertz, which are the number of vibrations the sound causes in a second. Higher pitches vibrate at a greater frequency than lower pitches: a note from a violin, for example, can soar higher than a cello because the instrument has short, thin strings that vibrate faster. Generally, humans can hear between 20 and 20,000 hertz, but the most sensitive range of our hearing is between 2000 and 5000 hertz (a smoke alarm is 3100 hertz). Many animals have higher upper limits – up to 67,000 hertz for dogs, 79,000 hertz for cats and 150,000 hertz for dolphins. Pigeons, on the other hand, are most sensitive to low frequencies called 'infrasounds' of just 0.5 hertz, which scientists think might help them navigate by detecting, for example, far-away breaking waves in the ocean. Humans' outer ears, called 'the pinna' from the Latin for wings, are skin-covered cartilage structures that work like radar dishes to collect sound vibrations. (We can boost the effect by cupping our hands behind our ears to make the catchment area bigger.) The outer ear funnels sound into a 2.5-centimetre-long canal lined with earwax, a mixture of oil and dead skin cells that help prevent unwanted particles reaching the middle ear. The middle ear's job, says Wayne Wilson, an associate professor of audiology at the University of Queensland, is to resolve a problem: sound waves travelling through air, which is low-density, must also make their way through the much denser fluid in the inner ear (more on that in a moment). 'Each ear has about 12,000 outer hair cells and 3000 inner hair cells ... Those little hair cells become Grand Central Station for hearing.' Wayne Wilson, associate professor of audiology at the University of Queensland So, as sound reaches the middle ear, it shakes the eardrum, a cone-shaped disc about the size of a fingernail, which passes the vibrations along to the three smallest bones in the body – the malleus (hammer), incus (anvil) and stapes (stirrup) – which work as a lever system to amplify the vibrations. The final bone, the stapes, has a footplate that presses against a tiny oval-shaped opening, covered in a thin layer of tissue, that forms a window to the inner ear. The journey from larger eardrum to smaller footplate concentrates the vibrational energy into this tiny area – a bit like delivering a one-finger punch – so that hardly any sound is lost as it enters the fluid of the inner ear. The sound reaches the cochlea (Latin for snail shell), a pea-sized spiral cavity that holds the essentials for converting sounds into signals for the brain. Inside it, fluid waves ripple along a ribbon called the basilar membrane, which has various widths and stiffnesses that vibrate to high, middle or low frequencies – much like an in-built piano keyboard. On top of the membrane is our 'organ of Corti', the sensory core of the cochlea, named after the Italian anatomist Alfonso Corti, who discovered it in 1851. The vibrations from the basilar membrane cause thousands of microscopic hair cells inside the organ to bend. Each ear has about 12,000 outer hair cells, which amplify sound, and 3000 inner hair cells, which release neurotransmitters. As Wilson puts it: 'Those little hair cells become Grand Central Station for hearing.' From there, neurotransmitters excite nerve cells that send signals to the brain that become the sounds we hear. What's presbycusis (or, why can't you hear any more in rowdy restaurants)? Presbycusis – from the Greek for old hearing – is one of the most common forms of hearing loss. It affects about one in three people aged over 60, and more than 80 per cent over 84. 'It's something that starts, unfortunately, from about age 40,' says Audiology Australia's Barbra Timmer. 'It creeps up on us; it's not like one day we wake up and suddenly we've lost a lot of hearing.' 'After too much wear and tear, they're all smashed and bent. Some of them have been ripped out of the cell completely. It looks like a cyclone has gone through.' Wayne Wilson, associate professor of audiology at the University of Queensland Its causes are many: genetic differences that express themselves as we age, wear and tear from exposure to noise, our diet, the use of certain medicines that can damage the hair cells of the inner ear, called 'ototoxic' drugs, which include some antibiotics, diuretics and chemotherapy agents. The result of any or all of these is damage to the hair cells in the cochlea – particularly the outer hairs – so sound is no longer amplified as it was when we were younger. Some fish, reptiles and birds can regenerate hair cells inside the cochlea, but damage is irreversible for humans. What does this degeneration look like? 'Take an electron micrograph of a healthy set of hair cells, and you see these lovely stiff hairs sticking up. Think of several rows of fence posts, all perfectly in position,' says Wayne Wilson. 'Now imagine taking a giant wire brush and scrubbing it over the fence posts. That's what we see in the electron micrograph. After too much wear and tear, they're all smashed and bent. Some of them have been ripped out of the cell completely. They're all skew-whiff, not facing in the right direction. It looks like a cyclone has gone through.' The first sounds to go are high frequencies, hence the difficulty for older people in hearing the higher pitched voices of children. Words with sounds of higher frequencies might become harder to understand, says Timmer. 'So the word 'six' we might hear as 'fix' – both 's' and 'f' are high-pitch consonants, and so we might not be able to pick that up.' Low-frequency background sounds are a particular issue because they mask high frequencies. Restaurants with ambient hubbub or music that are decked out in hard surfaces, for instance, cause noise to ricochet and echo. For audiologists, hearing loss can be either mild (difficulty with soft and distant speech), moderate (can hear almost no speech at a conversational level), severe (can't hear any speech at a normal level) or profound (may only be able to hear very loud sounds). The term 'hard of hearing' generally refers to people with mild to severe hearing loss. Many common ear conditions can affect hearing too: one in 10 adults can develop otosclerosis, which causes bones in the middle ear to become stuck together and unable to pass on sound vibrations. It tends to affect people from their 20s to 40s (and is surgically correctable with a prosthesis). Then there's the ringing that affects 10 to 15 per cent of people, called tinnitus, and diplacusis, which causes pitch to be heard differently in each ear. In early life, genetics lead to about one in every 1000 babies being born in Australia with some hearing loss. Children are also prone to ear infections, in part because the narrow passage that equalises pressure and drains fluid from the middle ear – the Eustachian tube – is still developing. If untreated, repeated infections can cause hearing problems. What's the impact of hearing loss on your health? Daryl Holmes' favourite pastime is to be with his team on the bowling green at a local club in Newcastle. Just a few months ago, before he got help with his hearing, he found his game wasn't as good. 'It was inconsistent. Sometimes I'd play a bowl that I was really proud of but you'd be thinking, with the next two or three, what have I done wrong?' He would arrive home exhausted. 'I'd be sitting on the chair and my wife would say, 'You've got to go have a sleep before dinner.'' Indeed, one consequence of mild hearing loss is fatigue – from straining to listen. Some people get by because they fill in the blanks – like reading a sentence with several letters blurred. But the effort involved often means rerouting cognitive resources that would otherwise be in reserve or used for other tasks, says Barbra Timmer. When people say, 'I seem not to remember the gist of conversations as much' it's a possible sign that the energy spent on remembering is being diverted for hearing. Researchers are looking into a link between hearing loss and dementia. A report by the Lancet Commission on dementia in 2024 found people addressing their hearing loss – among other factors such as hypertension, physical inactivity, diabetes, obesity and depression – had the potential to reduce the risk of dementia by 40 per cent. While there is an association between hearing loss and dementia, it is not a proven cause, says Julia Sarant, leader of the University of Melbourne's Hearing Loss and Cognition Program. 'There are other things at play too,' she tells us. 'An example could be hearing loss causes social isolation for a lot of people, particularly if they don't do anything about it because they lose their ability to communicate, and that causes reduced brain stimulation, and that causes reduced cognitive reserve.' 'I was just beginning to withdraw because I couldn't hear the conversations, I couldn't be part of them. But I refused to allow that to happen.' Surgeon Michael Bruce Vascular surgeon Michael Bruce was in his 50s when he began to have difficulty hearing patients. 'I always had the ability to come up with a quick quip, that was part of who I was, and I found that was all slipping away,' says Michael, now 73. (Asked what type of surgeon he is, he replies, 'a competent one'.) He found work conferences, social gatherings and dinners with friends a challenge. 'I was just beginning to withdraw because I couldn't hear the conversations, I couldn't be part of them,' he says. 'But I refused to allow that to happen.' Hearing loss is associated with many other health risks: there's a 47 per cent greater likelihood of people having depression, according to an Australian review of dozens of studies. Another study concluded that 40- to 69-year-olds with mild hearing loss were three times more likely to fall over in a 12-month period. And studies have found a relationship between cardiovascular health and hearing loss, although again there isn't any known causal link. 'One of the things that we have seen in the past with hearing loss is that it was very much seen to be a sensory impairment; something that was sort of inevitable later on in life,' says Timmer. 'Yes, it is a sensory impairment, but the impact from hearing loss is much bigger than we've known in the past.' What is noise damage, and how do you protect yourself? In the 1960s and '70s, Michael Bruce drummed in a four-piece rock'n'roll band called the Whatchamacallits. His highlight was making it on to television talent show Brian and the Juniors. 'We were pretty ordinary but did all right,' he says. 'I'd certainly do it all again.' Still, Michael would lie in bed after a gig and think, I can still hear the cymbals. 'I can see now that it was damaging my ears,' he tells us. 'And you just don't even think about those things at the time. The damage didn't really declare itself until 30 years later.' For health purposes, noise is measured in decibels and time frames. In Australia, occupational health and safety regulations define a 100 per cent noise dose as being exposed to 85 decibels (dBA) for eight hours – roughly the equivalent of someone speaking in a raised voice. From there, every three additional decibels halves the amount of time someone should be exposed to the noise: 88 dBA, or equivalent to heavy traffic, for four hours; a lawn mower around 91 dBA for two hours. In short, says Wayne Wilson, 'It can be OK to listen to really loud sounds if you listen to them for only a very short period of time every day. It is dangerous to listen to very loud sounds if you are exposed to them continuously for an entire day.' Loading In 2010, SafeWork Australia surveyed 4500 people and found 28 to 32 per cent of the Australian workforce were likely to be exposed to noises higher than 85 dBA, especially in manufacturing and construction, perhaps unsurprisingly. Employers are required to try to eliminate the source of the noise, to use engineering controls, to rotate employees and to provide hearing protection. (Workers exposed to potentially ear-damaging substances such as solvents and heavy metals face additional risks.) Overall, studies have found musicians are 20 to 60 per cent more likely than the general population to have hearing loss. Some of those at highest risk can be pit orchestra musicians (those who play in lowered 'pits' for shows, musicals and ballets) who, without ear protection, can be four times more likely to have damaged hearing than the general population, says Sarah Swann, an audiologist at the University of Melbourne. 'A lot of these instruments – especially brass instruments, but flute or the piccolos in the woodwind instruments as well, and percussion for sure – you can safely be exposed to those for about 15 minutes before you start to be at risk of damage.' 'You go out for that big party on Friday night and you binge on that sound exposure, in one event, you've given yourself an 800 per cent dose.' Wayne Wilson, associate professor of audiology at the University of Queensland And music fans beware, wearing headphones with the volume turned up past halfway for prolonged periods can harm hearing. 'If you love your loud music, you can listen to it – just really control the time you spend listening,' says Wilson. Nightclubs and concerts pose a particular risk. 'We often talk about people who binge listen,' says Wilson. 'Even if you are conscious and you're trying to protect your hearing – you do well during the day, you wear hearing protection at work, and you only listen to your music for a little while – and then you go out for that big party on Friday night and you binge on that sound exposure, in one event, you've given yourself an 800 per cent dose.' Not everyone sees not hearing as a negative, though. Rather than use 'deaf' as a medical term, experts tend to refer to the cultural and linguistic identity of the deaf community: people with a wide range of reasons for hearing loss, including those who can't have their hearing restored or choose not to. In the 2021 census, more than 16,000 Australians said they used Auslan (Australian Sign Language), which uses hand, body and facial expressions to communicate words and phrases. How can hearing be restored? Daryl Holmes didn't expect much to be amiss when he had his hearing checked last year. The test, called an audiogram, typically assesses hearing from 250 hertz of sound to 8000 hertz. 'The reason why we test that range is because that covers the speech range,' says Emma Scanlan, principal audiologist at Hearing Australia. Daryl found himself having to guess many of the words, so an audiologist handed him a pair of hearing aids. 'It truly was transformative. I knew straight away that there was a significant difference,' he says. 'And my son said it within that first week, 'Dad, you're not talking really loud.'' His bowling has even become more consistent – his team, the Cardiff Falcons, recently came third in a state competition, their best result since the 1950s. Loading The battery-powered devices amplify sound to make the vibration the ear receives bigger and to ensure the damaged hair cells in the inner ear register it. People with greater hearing loss might also use a remote microphone that, for example, can be positioned in front of different people at a dinner party. If the inner ear is severely damaged, another option is for surgeons to install a cochlear implant (Professor Graeme Clarke famously developed the multichannel implant in Melbourne). The device, which is also battery-powered, sends electrical impulses into the cochlea to bypass the damage and set off a reaction that stimulates the auditory nerve so the brain can interpret the sound. 'We only offer a cochlear implant if they've got a 75 per cent chance or better of hearing better.' Claire Iseli, Royal Victoria Eye and Ear Hospital Claire Iseli, an otolaryngologist at the Royal Victorian Eye and Ear Hospital who implants the devices, says they can be life-changing, but only about 10 per cent of people eligible for them get the surgery. 'We've found the biggest barriers are people feeling like they might be too old and just assuming that we wouldn't offer surgery to someone in their 70s or 80s. And actually, that's not true, that's the majority of our patients,' she says. (The surgery can be done under a local anaesthetic if the patient isn't fit enough to undergo a general anaesthetic.) Two years ago, Iseli had a 91-year-old man tell her he wanted the implant so he could date again. 'I put a cochlear implant in and at his first check-up he'd already had three dates. Last time I saw him he was 93. And he's got a partner now.' The surgery comes with some risks, injury to the facial nerve and dizziness among them. It isn't reversible and can result in people losing the last bit of their biological hearing – their hearing comes only via the implant. 'That's where the process is very structured,' says Iseli. 'We only offer a cochlear implant if they've got a 75 per cent chance or better of hearing better.' In 2018, after about 15 years of wearing hearing aids, Michael Bruce was training for a provisional pilot's licence but couldn't hear air-traffic control or the other pilots out of his left ear. 'I really loved the flying. So I went to my audiologist, and I asked if there was anything else that could be done. She said the only thing left to try is a cochlear implant.' Spurred by his desire to be 'an active member of society', he received the implant and kept training for the licence. Then his right ear began to deteriorate. He's hoping his second implant, which he had in December, will mean he can obtain the licence, 'a childhood dream'. Doctors said the fact that Michael had worn the hearing aids had helped him exercise his auditory nerve and stop it from atrophying, making him an ideal candidate for the surgery. While hearing aids can sound disproportionately loud at first, the implants can involve a bigger adjustment – Michael says other people initially sounded like they were talking to him 'from Mars'. 'But, at the three-month mark, with my left, my hearing perception went from about 30 per cent to 92 per cent, and three months on the right side went from 31 to 88 per cent.' Music sounded more organic when he had hearing aids; now it sounds a little tinny. 'Although you miss out on different things, the words are so much clearer now. There were words to songs I always got wrong. It hasn't taken music away from my life or anything. In some small way, it's probably enhanced it.' He still drums at home on an electronic kit that he hears via bluetooth to the implants. 'If you're getting ignored all the time, resentment has got to be there. When I went to get the hearing test, [my wife] said, 'I'm really glad you're going.' ' Daryl Holmes It's not all about technology, though. Back to that restaurant where you're straining to hear. 'What's the best position for me to be sitting in? I want the light to be on other people's faces. And don't be sitting near the kitchen,' says Scanlan of Hearing Australia. Or plan to avoid noisy venues altogether. 'Don't have too high expectations of yourself either. Communication is a two-way thing. If someone wants to speak to you in a challenging environment, if they come right up to face you or bend your way, that's the best chance you've got of being able to take part in the conversation.' If you don't hear what someone says, Scanlan recommends not saying, 'What?' but repeating back the parts of the conversation you did hear. 'And what you're doing in that situation, as a person with hearing loss, is saying, 'I'm paying attention, but I'm just struggling.' I have seen that make a really big difference to people's relationships.' Daryl Holmes agrees hearing loss caused friction with his wife: 'If you're getting ignored all the time, resentment has got to be there,' he says. 'When I went to get the hearing test, she said, 'I'm really glad you're going.'' In March, Daryl visited the Sydney Opera House as part of a group of people with hearing loss. They trialled new technology – used for the first time globally in a cultural institution – that broadcasts live performances from the stage via Bluetooth technology to people wearing compatible hearing aids. On stage were a string ensemble and a singer. 'It was like the music of the violins was floating across the floor,' Daryl says. 'I closed my eyes, and I was actually in tears because I felt it's the clearest thing I have ever heard.'