Isolation and depression can often be a result of hearing loss, but there are good treatments, including hearing aids and surgery. Learn about the actions you can take right now to protect yourself from hearing loss.
Is it harder for you to understand normal conversation, especially when there's background noise? Are sounds starting to seem a bit muffled? Or do you find yourself asking people to repeat themselves? If so, you're not alone. Turn Up The Volume may have been an obscure video magazine from the 1990s but today it's becoming an anthem for millions of Americans, especially as baby boomers hit the Big 6-0.
Hearing Loss Statistics
While hearing loss affects about one in ten Americans in all age groups, the condition increases significantly with age. We're born with a set of sensory cells, and at about age 18 we slowly start to lose them. Age-related hearing loss progresses slowly, so most people don't notice the change until well after age 50. By 55 years of age, 25% of us have developed obvious hearing loss. By the time we reach the age of 75, the number doubles to over 50%.
Unfortunately, the statistics may be changing for younger generations. Hearing loss is increasingly being reported as early as age 40, even among physically healthy people. Noise associated with our modern lives appears to be a major culprit. We don't know exactly how many hearing loss cases are noise-induced, but we're routinely being exposed to higher levels of noise than ever before. Simply listening to music through headphones with your player turned more than halfway up can create dangerous volume levels and result in permanent hearing loss over time.
The Impact of Hearing Loss
Of course, age and noise aren't the only hearing loss perpetrators. The auditory system is one of the human body's most complex and delicate sensory systems, and a variety of factors can cause damage or malfunction. Some forms of hearing loss are hereditary, while others can stem from infections, medications or chemicals, disease or injury.
Whatever the cause, hearing loss can significantly impact our day-to-day lives – physically, emotionally and mentally. Helen Keller said, "Loss of vision means losing contact with things, but loss of hearing means losing contact with people." Hearing loss may make us seem rude, inattentive or less intelligent. It can lead to fatigue, irritability, depression, anxiety, low self-esteem, and contribute to impaired memory and paranoia in the elderly. We may withdraw from social situations to avoid the stress of not hearing. It can decrease our job effectiveness, damage our important relationships and even put us in personal danger. We can be around our family and friends, yet feel alone.
If you have difficulty hearing, talk to your doctor so you can be tested. There are many options for treatment that can help you turn down the volume and tune back in to life.
- Hearing loss is the most common sensory disorder in the United States.
- Approximately 10% of the U.S. population or 31 million Americans have a significant hearing loss.
- Approximately 3 million children in the U.S. have a hearing loss; 1.3 million of them are under the age of three.
- By 55 years of age, 25% of people have developed hearing loss. By the time a person reaches the age of 75, over 50% will have some degree of hearing loss.
- By the year 2030, it is estimated that 78 million Americans will have some degree of hearing loss.
- Undetected, hearing loss is likely to interfere with a child's speech, language and communication with others. A mild hearing loss can cause a child to miss as much as 50% of classroom discussion.
- Unidentified hearing loss in children can often be mistaken as Attention-Deficit Disorder, mental retardation, behavioral problems, rudeness, or inattentiveness.
- Individuals with hearing loss have a higher incidence of unemployment, depression, anxiety disorders and stress-related illnesses.
- Hearing loss in the elderly can lead to social and family isolation, depression, low self-esteem and difficulty functioning.
- Hearing loss often develops very slowly over time and as a result many people don't recognize that they have a hearing loss until it has a significant impact on their day-to-day life.
- Age-related and noise-induced hearing loss generally affects one's ability to hear higher frequencies. The higher speech frequencies are responsible for helping us to understand consonants clearly, impairing speech perception.
- Noise is one of the leading causes of hearing loss.
- Exposure to a noisy subway for just 15 minutes a day can cause permanent damage to hearing over time.
- Listening to music through headphones with the player turned more than halfway up can create dangerous volume levels that can result in permanent hearing loss over time.
- Only 16% of physicians routinely screen for hearing loss.
- People with hearing loss wait an average of 7 years before seeking help.
- Hearing aids or cochlear implants can offer dramatic improvement for most people with hearing loss.
- Of those people who could significantly benefit from hearing aids, less than 25% actually have them, and fewer wear them on a regular basis.
Ask Your Doctor
This list of questions is a good starting point for discussion with your doctor; however, it is not a comprehensive list.
- What should I do if I think I'm losing my hearing?
- How do I know when hearing loss becomes a problem?
- Is my hearing loss on one side or both?
- What is my percent of hearing loss?
- What type of hearing loss do I have?
- Is my hearing loss permanent?
- Can anything be done to prevent further hearing loss?
- Could any of the medications I'm taking cause my hearing loss?
- What treatments or devices would you recommend? Do they really help? How much?
- How much should I expect to pay for a hearing device?
- Are there surgical options I should consider?
- What other measures can I take to cope with hearing loss at home and work?
- Are there clinical trials available for my type of hearing loss?
Key Point 1
Normal hearing requires all components of the physical hearing chain to be functioning properly. Any breakdown or impairment in that chain, from the ear to the brain, may result in a loss of hearing acuity.
Our ability to hear depends on a complex series of events. Sound is first picked up by the ears and then "read" by the brain.
When something makes a noise, it sends vibrations, or sound waves, through the air. The ear is made up of three parts: the outer ear (pinna or auricle), the middle ear, which includes the eardrum (tympanic membrane), and the inner ear (cochlea), which is shaped like a snail shell and lined with tiny hair cells. Sound waves are collected by the outer ear and strike the eardrum, causing it to vibrate. The eardrum's vibrations are amplified through the chamber of the middle ear along three tiny interconnected bones which pass on the vibrations of sound waves to the cochlea. Inside the cochlea there are thousands of sensory cells and nerve endings that detect the vibrations and produce electrical signals. The hearing centers of the brain are sent these messages through the auditory nerve where they're interpreted as sounds. The brain sorts different sources of sound based on their uniquepitch, or frequencies, and their timing. That allows you to concentrate on some sounds and suppress less important ones. The brain also uses the source and direction of the sound and loudness as clues to decipher messages. The entire process occurs within a split-second timeframe.
Hearing loss is the loss of hearing ability characterized by decreased sensitivity to sound in comparison to normal hearing. It's different for different people.
There are generally three considerations in evaluating hearing loss:
- Configuration or "shape" of the hearing loss as shown on an audiogram
Type of hearing loss is generally categorized according to what part of the auditory system is affected. The types of hearing loss are conductive, sensorineural, mixed, and central auditory dysfunction.
• Conductive hearing loss occurs when the passage of sound through the outer and/or middle ear is blocked and usually reduces our ability to hear faint sounds. This type of hearing loss can often be medically or surgically corrected. Examples of conditions that may cause a conductive hearing loss include fluid in the middle ear from a cold or allergies, ear infection, perforated eardrum, tumors, otosclerosis (calcium buildup on the bones), impacted earwax, presence of a foreign body or malformation of the outer ear, ear canal or middle ear.
• Sensorineural hearing loss occurs when there's damage to the inner ear or to the nerve pathways from the inner ear to the brain. It not only involves a reduction in the ability to hear faint sounds, but also affects speech understanding. It can be caused by disease, birth injury, drugs or chemicals that are toxic to the auditory system, genetic syndromes, noise exposure, viruses, head trauma, aging, and tumors. Sensorineural hearing loss cannot be medically or surgically corrected. It's a permanent loss. Hearing aids or cochlear implants can help.
• Mixed hearing loss exists when conductive hearing loss occurs in combination with a sensorineural hearing loss.
• Central auditory dysfunction results from damage or dysfunction at the level of auditory brain stem or cerebral cortex.
Degree of hearing loss represents the severity of loss. The numbers are representative of a patient's thresholds, or the softest intensity at which sound is perceived, and ranges from slight to profound. Hearing is measured indecibels (dB) and the severity of hearing loss is graded as:
• Normal hearing: -10 to 15 dB
• Slight loss: 16 to 25 dB
• Mild loss: 26 to 40 dB
• Moderate loss: 41 to 55 dB
• Moderately severe loss: 56 to 70 dB
• Severe loss: 71 to 90 dB
• Profound loss: 91 to 120 dB
Configuration of hearing loss is the extent of hearing loss at each frequency and the overall picture of hearing that's created. A hearing loss that only affects the high frequencies means you have good hearing in the low frequencies and poor hearing in the high frequencies. If only the low frequencies are affected, the configuration would show inferior hearing for low tones and better hearing for high tones. Some hearing loss configurations are flat, showing the same amount of hearing loss for low and high tones. Higher speech frequencies are responsible for helping us to understand consonants clearly, whereas lower pitches are for vowels.
Key Point 2
Some types of hearing loss are preventable. Avoidable hearing loss can be due to noise, toxins and injury.
The auditory system is one of the human body's most complex and delicate sensory systems, and a variety of factors can cause damage or malfunction.
Hearing loss can be caused by:
• Ear abnormalities such as an underdeveloped outer ear, a narrowing of the ear canal or complete absence of the ear canal, and abnormalities in the hair cells of the organ of Corti in the cochlea.
• Excessive noise exposure
• Ototoxic drugs or chemicals, such as chemotherapy agents, cardiac medications and antibiotics.
• Changes in the blood supply to the ear because of heart disease, high blood pressure, blood vessel conditions caused by diabetes, or other circulatory problems
• Hormonal imbalances and declines
• Specific illnesses, such as measles and mumps
• Skull (temporal bone) fractures
• Traumatic brain injury
Hearing loss can be inherited from one or both parents who may or may not have a loss of hearing themselves. Of all the children born deaf each year, more than half have a hereditary disorder. However, not all hereditary hearing loss is present at birth. You may inherit the tendency to acquire hearing loss later in life. In fact, there's a strong genetic component in age-related hearing loss. This type of loss generally affects both ears equally, and tends to make it difficult to hear the higher frequencies, which can affect our ability to understand speech clearly or to hear common sounds such as doorbells, the telephone and emergency sirens. Unfortunately, genetics "are what they are" and hereditary hearing loss can't be prevented.
Preventable Hearing Loss
Noise-induced hearing loss (NIHL) is the largest category of hearing impairment that's entirely avoidable. Both repeated episodes of excessive noise and severe one-time events can cause harm. The bad news is that once exposed to very loud noises, the damage is done. The good news is that it's not that difficult to prevent noise-induced hearing loss in the first place. What's too loud? Any sounds in excess of 85 dB (decibels). In practical terms, if you have to raise your voice to be heard from three feet away, the noise level is too loud. The dB levels of some common sounds are:
• Normal breathing 10 dB
• Whisper 20 dB
• Normal conversation 40 to 65 dB
• Vacuum cleaner / hair dryer 70 dB
• City traffic 80 dB
• Lawn mower / New York City Subway 90 dB
• Chain saw 110 dB
• Rock concert 110 dB
• Snowmobile 120 dB
• Firecrackers 140 dB
To prevent noise-induced hearing loss:
• Be aware of the sound levels to which you're exposing your ears.
• Whenever possible, reduce noise at its source. Keep the volume low when using earphones or car stereos (noise is accentuated in enclosed spaces, such as a car).
• Wear safety approved hearing protection such as ear muffs and/or ear plugs in noisy environments. This includes movie theaters, concerts and sporting events. Disposable and custom-fitted earplugs can provide 20 to 40 decibels of protection when used correctly.
• If you're caught without ear plugs or muffs, cover your ears with your hands.
• Educate your children about the danger of loud music and other noises.
• Get regular screening, particularly if you're in a high-risk job or participate in a high-risk hobby.
For other potential hearing loss factors:
• If you have a sudden severe hearing loss, see your doctor right away. If you have some hearing loss, and your hearing doesn't return to normal within two days, see your doctor for a rapid treatment that can prevent permanent damage.
• Lead a healthy lifestyle. Follow a diet that protects your circulatory system and includes antioxidants, and abstain from caffeine and nicotine.
• Don't blow your nose too hard. It's better to gently blow one nostril at a time.
• Don't put cotton-tipped swabs, fingers or anything else into the ear canal.
• Make sure children never cuff each other on the ears.
• Get proper immunizations for measles and other diseases.
• Act on ear infections. If you or your child has an earache, see your doctor.
• During high speed water sports like water skiing, wear a swim cap or approved swimmer's earplugs.
• Avoid flying if you have a heavy cold.
• Follow your doctor's advice for medical conditions that can cause hearing loss, such as high blood pressure and Ménière's disease.
• If possible, avoid prolonged use of medications that can cause hearing loss, for example, some antibiotics.
• Get regular hearing tests, especially from age 60 on. If you have a hearing loss, continue to be monitored annually; if you don't have a hearing loss, every five years is generally adequate.
Key Point 3
There are personal and societal implications to hearing loss. However, there are good treatments available, including hearing aids, cochlear implants and surgery. Technology is constantly improving.
What's the economic cost to society for America's millions with hearing loss? It's a whopping $56 billion a year – a number that's 50 percent higher than the cost of blindness. It's measured in the price tags for treatment, specialized education and social services and in reduced work productivity. But, until you or someone you're close to experiences it, it's hard to imagine the profound impact it can have on the day-to-day lives of a single individual and his or her family.
In children, hearing loss can lead to delayed social development and learning. It can interfere with a child's language. It can be mistaken as Attention-Deficit Disorder, mental retardation, behavioral problems, rudeness, or inattentiveness. Even a mild hearing loss can cause a child to miss as much as 50% of classroom discussion.
Those who lose their hearing later in life face their own challenges. Many have difficulty in accepting their loss. They may refuse to use hearing aids for fear of looking old. They can feel lonely and isolated and those around them can feel the same. Relationships suffer when family members feel as if their partner who has hearing loss doesn't care about them enough to make changes to make it easier to communicate. Hearing problems make it difficult to hear doorbells, car horns, and alarms. It can make it hard to understand and follow a doctor's advice or respond to warnings, and can cause depression. Its effect on speech communication can reduce a person's professional and social well-being.
There are countless ways to compensate for hearing loss, but the first step is to acknowledge it – to psychologically and emotionally adjust. With many people this includes working through the grieving process for their hearing loss. The next step is to get an accurate diagnosis. Hearing loss is said to be like fingerprints – with no two people having exactly the same circumstance. To effectively help you, your doctor must understand the cause, type and severity of your loss.
At first, your primary care doctor will conduct a general screening test to get an overall idea of how well you can hear. If warranted, he or she may send you to an audiologist for further testing. Tests in the audiologist's arsenal include (but are not limited to):
• Pure-tone audiometry (air and bone conduction) to determine the lowest intensity at which an individual "hears" a pure tone as a function of frequency (or pitch). Speech reception thresholds (SRTs) and speech discrimination are assessed
• Hearing in Noise Test (HINT) to measure an ability to understand speech in quiet and noisy environments
• Air conduction audiometry to test the condition of the external ear canal, middle ear, and inner ear.
• Bone conduction audiometry to evaluate the condition of the inner ear.
• Various physiologic tests to determine the functional status of the entire auditory system.
With test results in hand, doctors can recommend strategies and treatments tailored to the individual.
In some cases of conductive hearing loss, treatment can be simple. Loss caused by wax buildup can be fixed with irrigation and suction. Infection can be successfully treated with oral antibiotics or eardrops, fluid in the middle ear can be drained. More complicated procedures may be needed to treat other conductive problems including:
• Blocked Eustachian tubes (small tube connecting the back of the throat to the middle ear which neutralizes air pressure on both sides of the eardrum). Sometimes tubes need to be inserted through the eardrum.
• Infected mastoid bone. This infection of a bone behind the ear is usually treated with antibiotics, but occasionally needs to be treated surgically (mastoidectomy).
• Ruptured eardrums. These may heal on their own but sometimes surgery is necessary.
• Otosclerosis. This is often treated by an operation (stapedectomy) which replaces the damaged bones of the middle ear with tiny metal substitutes.
Other conductive hearing loss and sensorineural hearing loss (which involves permanent damage to the cochlea, the hair cells or the nerve) is permanent. Loss can be mitigated with a combination of the following:
• Simple coping skills
• Assistive listening and alerting devices, such as TV-listening systems or telephone-amplifying devices, telecommunications devices for the deaf (TDD), flashing lights to signal events such as a ringing telephone, a doorbell, or a fire alarm
• Learning to lip read / speech read
• Hearing aids
• Cochlear implants
• Learning sign language
• Face the person with whom you're having a conversation
• Get as close to the speaker as possible
• Choose quiet settings / turn down background noise like TV
• Tell the person you're talking to what they need to do so you can effectively communicate with them
• Use assistive devices
Lip Reading / Speech Reading
This is a technique used in understanding speech by watching the movements of the lips and mouth. It's sometimes referred to as speech reading, which technically also includes the reading of facial expressions and body language. Only about 25 percent of the speech sounds we produce are visible on our lips.
While hearing aids can't help everyone with hearing loss, they're the mainstay of treatment for most people today. Unfortunately, they can't restore hearing to normal – even the most advanced hearing aids don't correct hearing the way eyeglasses correct vision.
The choice of hearing aid depends on the person's particular type of hearing loss. For example, people whose hearing loss affects mainly higher frequencies don't benefit from simple amplification. That merely makes the garbled speech they hear sound louder. Think of it in the context of listening to your radio. If your volume is turned low, simply increasing it solves the problem. However, if you have a reception problem, the sounds being transmitted won't be clear no matter how much you increase the volume. Hearing aids that selectively amplify the high frequencies markedly improve speech recognition.
Hearing aids suffer from the bad reputation earned by models our grandparents used – those that produced annoying feedback and over-amplified background noise. There's been tremendous improvement in today's models with many using digital sound processing with multiple frequency channels so the amplification can most precisely match the person's hearing loss. When considering a hearing aid, expect to:
• Try more than one device before finding the one that works best for you. Most states have laws requiring a trial period before you buy a hearing aid, making it easier for you to decide if the hearing aid helps.
• Use it consistently for weeks or months to give your brain a chance to adjust to the new sound information it now receives.
• Accept that there isn't a hearing aid made today that can cut out all background noise. Background noise is made up of a lot of the same energy that speech is made up of – if you had a hearing aid that cut out all the background noise, you'd also cut holes in the speech.
An out-patient operation can provide a cochlear implant that can help restore partial hearing to some people with profound sensorineural deafness who do not benefit from even the highest-powered hearing aids. Unlike a hearing aid that amplifies sound and directs it into your ear canal, a cochlear implant compensates for damaged or nonworking parts of your inner ear. It consists of a small battery-operated speech processor and microphone worn outside the ear that converts sounds into electrical signals. The signals are transmitted to electrodes that are surgically implanted in the cochlea. The electrodes stimulate the nerve in the ear directly so that the sound can get to the brain. The implants don't restore normal hearing. However, most people who have had the surgery can hear sounds. They also report that the implants help them read lips better, and in some cases, even use the telephone.
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