Hearing aids in video games and real life
Hearing aids in video games and real life
Ruminations on audio accessibillity tech and life in interactive mono
Back in 2022, I lost nearly all of the hearing in my right ear and some, but not all, of the hearing in my left due to an attack of Sudden Sensorineural Hearing Loss. It was completely random — the doctors think it had something to do with a COVID-19 infection I picked up earlier in the year. Medical research has suggested there is a connection there, particularly among young adults (I was 26).
Of course, this kind of thing completely changes your life in myriad evolving ways. My social confidence is completely shot, and there’s a new mountain of mental strain that coats every interaction that I used to take for granted. Subtitles or Closed Captions are a permanent fixture now, in meetings and any media that I consume. Thanks to the NHS, I have a hearing aid in my right ear, but I recently learned that my left ear has deteriorated enough that I need one on the other side, as well. Regardless, they don’t help me much. The unique part about it is that hearing loss usually occurs on both sides at once, whereas I have an imbalance between the two. It’s commonly referred to as Unilateral Hearing Loss, SSD (single-sided hearing, not to be confused with solid state drive) or ‘Mono Hearing’.
The most difficult part about all this is that the severe loss in my right ear means that most of the input I receive arrives flat. I struggle to parse the directionality of speech among other external sounds, and have a head shadow that obstructs and warps frequencies. Because our brains are cool, humans are typically able to suppress external stimuli and single out a voice in a group conversation, especially in a busy environment. It’s called the cocktail party effect, and I’m sure you can understand why. But because of my hearing loss, all the noise in the room is at the same level, so it takes an exhausting amount of brain effort (even with hearing aids) to focus on the conversation, and hear who is talking. You don’t know what you’ve got til it’s gone. (Joni Mitchell never lies).
The other thing to know about me is that I play a lot of video games. And, you know, accurate hearing can be important to the enjoyment of a competitive game like Counter-Strike or a survival horror adventure like Alan Wake 2. Footsteps at the bomb site, or a Taken garbling in your ear about the autofiction. You know the score.
In the first lecture of a documentary filmmaking course I took at university, the professor screened two short film examples. One had perfect visuals but noticeably poor audio. The other had crystal-clear audio but the visuals were wishy-washy. Everyone in the class preferred the latter, and a salient point was made. All this to say, I appreciate the importance of sound design, and would consider myself an audiophile, both before and after the cochleae trauma.
Of course, my hearing loss hasn’t stopped me from playing video games. It’s my job, after all. I’ve just had to adapt to help mitigate the defecit. Thankfully, the games industry has matured since I was a kid, and most contemporary releases feature accessibillity options that suit my needs, thanks to the hard work of legends like Morgan L. Baker et al. At Gamescom earlier this year, I was thrilled to find ‘Mono Audio’ toggles, even in the preview builds of games like Atomfall.
When I noticed that other games didn’t feature such settings, this also led to a series of rewarding conversations with developers, who were keen to hear me explain my experience (and let me yap about the importance of audio accessibility). Particularly in my consulting work, my disability (can I call it that?) has opened up a new route by which I can help shape a game’s development, which is a cool silver lining.
Gaming with unilateral hearing loss
Like the inventory of a LucasArts adventure game, there are various technologies and rubber chickens with pulleys in the middle that I can tinker with to bolster my hearing and enhance my enjoyment of video games. I’m going to do a whole post on accessibillity options, but for now I’d like to focus on external technology.
For example, there’s the 2E1 Headphones, created by Biblos Geek. They’re essentially a pair of Pro Ears noise-blocking over-ear headphones, usually worn by construction site workers. Except one of the ears is completely hollow, and the other side has both audio drivers in the same cup. One driver is closer to your ear, and louder, and the other is quieter, and staggered. The intent is that your brain will begin to parse the variation, and be able to detect sound cues from either side in one ear.
I’ve used the 2E1 in games like Counter-Strike 2, Black Ops 6 and more… and yeah, it works! The custom nature of the technology means that it comes at a cost, but I’m certainly more aware than I would be with a typical pair of headphones. So if that matters to you and you have the means, go ahead. Mine were a very generous gift. As far as getting them working, on PC I plug them into my Scarlett 2i2 interface, or on console, the jack slots into the bottom of a PS5 or Xbox controller.
For the Nuketown lifers maining Black Ops 6 right now, I’d also like to nod towards the Multiplayer Field Upgrade, Acoustic Amp, a “Personal audio amplifier that makes enemy footsteps louder for a duration." A VHA (virtual hearing aid) that is, understandably, a pretty good pick for the loadout of any player with hearing loss.
But sometimes you don’t want to wear headphones. Your ears get sweaty, and all the input can be overwhelming, especially while wearing hearing aids. Mine spit out feedback at the slightest cup movement, which gets frustrating fast, and my tremendous tinnitus can be exacerbated. Respect to the free hearing aid I got from the NHS, but it’s by no means comparable to a human ear, so the sound quality is, to borrow some netslang, potato-quality. Imagine a really tinny, poorly-bluetoothed version of In The End by Linkin Park blaring out of your phone in the early 2000s. What if one or both of your ears had the same sonic qualities?
You can buy better private hearing aids, of course, but last time I went to an external audiologist they quoted me £6000 for a pair, which is a remarkable amount of money just for the privilege of being able to communicate and engage in social reality. Some might say money is no object when it’s your health on the line, but what if you don’t have that money? This is one of the more abominable facets of our modern healthcare systems.
Pods, mods and plastic props
Anyway, for those of you who can’t or don’t want to wear headphones, there are still options. I use the relatively-affordable Creative Pebble desktop speakers, and angle them towards my bad ear, which works pretty well. I also want to highlight the Live Listen system, if you have an iPhone. When enabled, this turns your phone into a handheld speaker and sound amplifier.
It’s great if you’re in a busy setting and can’t hear someone - just Bluetooth a hearing aid to the phone, then hand it to your interlocutor and ask them to speak directly into it. Unfortunately, this isn’t much use for me because of the lacking audio quality of my hearing aid, and the severity of my hearing loss. At home though, you can also place your iPhone in front of a sound source (like desktop speakers, mentioned earlier), and you’ll be able to beam the sound to your aid from further away thanks to Live Listen. Perfect if you want to relax and play games while far away from your monitor.
And not to completely harp on about Apple, but the AirPods Pro 2 (while rather expensive) can be an astute purchase to help with SSD. Even without the official Hearing Aid functionality (which is not available in my country yet), you can still plug an Audiogram into the settings and tune the pods to your specific hearing loss. In a pinch, I find the Transparency mode to be an easy way to lift my hearing, especially in difficult communication scenarios. It can get confusing, especially with a hearing aid on the other side, but it’s better than nothing.
If I’m playing a story-focused game and want immersion, my preferred setup is to have my hearing aid active in my right ear, then slip an AirPod into my left ear, and place my iPhone next to the desktop speakers and activate Live Listen. I was replaying the story mode of GTA V recently, and, in lieu of a hearing aid in my left ear, it helped me pick out more of the soundscape and dialogue amid the chaos of a typical mission.
Also, I recently went to Daiso and bought a plastic phone holder for a couple dollars. There’s no technology involved, but it’s constructed in such a way that it amplifies sound. Nature’s speaker, you could say. I find this to have myriad uses throughout the day. It’s great for mobile gaming and watching YouTube, of course, but I also tend to take it in the bathroom when I’m showering so I can better hear my Spotify playlists.
That’s all I’ve got for now, but as I start to figure out more of what works for me, and pick up my second hearing aid, I’m sure I’ll be back with more tips and insights on this sort of thing.
Let it be known that I’m going to start writing about and highlighting good audio accessibillity in games, and sharing my experiences as a gamer with hearing loss, with the hopes that we can lift the tide even further. I hope you’ll tune in and listen to what I have to say. The World Health Organization projects that by 2050, 1 in every 10 people will have disabling hearing loss, so it’s not exactly a niche issue.
Alright, take care, folks, keep those volume levels low, and remember to get an audiogram if you’re ever worried about your hearing. Oh, and if you experience a sudden loss in hearing, contact or visit your nearest A&E, GP or ENT immediately. This isn’t common knowledge, but a SSNHL is s a medical emergency, and can potentially be restored with steroids and procedures if treated ASAP!