Hearing Loss

Hearing loss affects roughly 20 percent of the American population and can strike people of all ages. The most common causes of hearing loss are noise exposure and aging.

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How Is Hearing Loss Diagnosed?

In order to diagnose hearing loss, your doctor will review your medical history, discuss your symptoms, and give you a physical examination followed by a hearing evaluation consisting of a series of audiological tests.

What Are the Symptoms of Hearing Loss?

Hearing loss is a progressive condition that worsens over time. Symptoms appear so gradually, you may be completely unaware of your affliction for some time. Even when hearing loss is suspected, it takes an average of seven years for a person to seek medical treatment.

Knowing the signs are helpful in spurring you to take action sooner. Any of the following might indicate hearing loss:

  • Frequently asking people to repeat what they have said.
  • Feeling like others mumble when they speak.
  • Having difficulty following conversations in which background noise is present.
  • Turning up the volume on the television or radio.
  • Avoiding social gatherings in noisy places.

Often, a family member or friend will be the first to notice a hearing problem. Since treatment is most effective when began early, if you think you might be suffering from diminished hearing, do not hesitate to schedule an appointment with a hearing specialist. The sooner, the better!

What Are the Types of Hearing Loss?

Treatment will depend on your type and degree of hearing loss. Conductive hearing loss occurs when there are problems in the outer ear, ear canal, eardrum or middle ear. It can be caused by any of the following:

  • Ear infection.
  • Fluid in the ears.
  • Malformation or abnormalities of the outer or middle ear.
  • Impacted earwax.
  • Foreign object in the ear.
  • Allergies.
  • Perforated eardrum.
  • Otosclerosis.
  • Benign tumors.

Conductive hearing loss is often correctable with surgery or medications (typically antibiotics). Alternatively, it may be treated with hearing aids.

Sensorineural hearing loss involves a problem with the inner ear, and is frequently referred to as “nerve deafness.” It may be caused by any of these:

  • Noise exposure.
  • Head trauma.
  • Aging (presbycusis).
  • Viral disease.
  • Autoimmune ear disease.
  • Meniere’s disease.
  • Malformation or abnormality of the inner ear.
  • Otosclerosis.
  • Tumors.

Sensorineural hearing loss can sometimes be treated with medications (corticosteroids) or surgery. More likely, hearing aids will be required.

Mixed hearing loss is a combination of both types. Treatment might involve a combination of medication, surgery and/or hearing aids.

Hearing Loss & Dementia

Research by Johns Hopkins University and others has confirmed what many audiologists and physicians have long feared: there is an irrefutable link between hearing loss and cognitive decline. Initial problems such as memory loss and an inability to concentrate can worsen over time. Left untreated, this may eventually lead to dementia and other forms of severe cognitive impairment.

In the most recent study, published in 2013, 2,000 older adults (average age: 77) were tracked for a period of six years. Those who began the study with the worst hearing loss – impairment bad enough to interfere with daily conversational ability – were 24 percent more likely to see a decline in cognitive ability compared to individuals with normal hearing. A similar study published in 2011 concluded that persons with moderate hearing loss were three times as likely to develop dementia. These figures are striking and hard to refute. Though the reason for the correlation isn’t completely understood, several theories exist. It may be that the increased cognitive load the brain experiences when trying to hear properly taxes the resources that would otherwise be available for memory and concentration. Alternatively, a decrease in the brain’s “gray matter” may lead to a shrinkage in brain cells and a resulting inability to process sound. Another factor may be the social isolation many individuals with hearing loss experience; this lack of socialization has been shown to accelerate cognitive decline and dementia.

Whatever the reason, one thing is clear: hearing aids can help. Studies show that patients who treat their hearing loss with hearing devices reduce their odds of cognitive decline and, at the very least, delay the onset of dementia. Early detection is key! If you are experiencing hearing loss, it’s best to seek treatment as soon as possible in order to avoid mental deterioration. Even if you are unaware of a problem, schedule a hearing evaluation in order to make sure. Because symptoms develop slowly, many patients adjust to gradual changes in hearing without realizing there is anything wrong.

Communication Strategies

Communicating with a person who has a hearing loss can be stressful for both parties. Even when hearing devices are used, proper communication strategies are essential for maximizing the experience. Try the following tips when communicating with a hearing impaired individual.

  • Maintain eye contact with the hearing impaired individual, facing them directly. Do not attempt to hold a conversation from another room; visual cues are an important component of successful communication.
  • Make sure you have the person’s attention before beginning a conversation. It helps to state their name so they are aware you are addressing them, and can focus on your words.
  • Speak slowly and concisely. Resist the temptation to shout, which can lead to distorted speech and make your words more difficult to understand. Pause between sentences to ensure what you are saying is understood.
  • Do not cover your face with your hands or other objects. Individuals with hearing loss rely on visual cues to help follow the conversation, and sometimes find lip reading helpful. Avoid eating and drinking while conversing, as well.
  • Try to find a quiet area free of background noise. This can be distracting and cause the hearing impaired individual to miss out on much of what you are saying.
  • Repeat yourself if necessary. Try using a different word or rephrasing your sentence if it is too confusing. Refrain from complex words and phrases.
  • Supplement your conversation by writing down important information. This might include jotting down the topic you will be discussing beforehand.
  • Pay attention to the listener. If they look confused, offer to clarify what you have just said.
  • Remember, communication is a two-way street. Give the other person a chance to speak, and do not interrupt.

Noise-Induced Hearing Loss

Background sound is a constant in our busy lives. Normally, background noises are at safe levels that won’t impact our hearing, but repeated exposure to noise above 85 decibels (dL) can cause hearing loss. Noise induced hearing loss, as a matter of fact, is the second most common form of hearing loss (ranking behind presbycusis, hearing loss related to normal aging), and is the most preventable type.

Facts About NIHL

Hearing loss is often perceived as “a disease of the elderly,” but noise induced hearing loss shatters that stereotype because it can affect people of all ages, including children, teenagers, and adults young and old. It is estimated that 15 percent of Americans between the ages of 20 and 69 are experiencing hearing loss that is the result of exposure to excessive noise either at work or through recreational activities. High-risk pursuits include hunting, riding motorcycles and snowmobiles, attending rock concerts, listening to music at high volume through ear buds or headphones, and even mowing the lawn or using a leaf blower.

Signs & Prevention

Hearing loss often develops gradually, and may not be immediately noticeable. If conversations and other noises sound distorted or muffled, you may be experiencing early symptoms. Other signs include frequently asking people to repeat themselves when speaking, and watching TV or listening to the radio with the volume set at a level uncomfortable to others.

Many times exposure to loud noise causes a temporary hearing loss that disappears within 48 hours, but over time this may lead to long-term hearing damage. The good news? Noise induced hearing loss is 100 percent preventable. An awareness of activities that can cause hearing damage is key. When exposed to loud noise, be sure to wear earplugs or other protective devices. Many audiologists carry custom earplugs designed for specific activities such as hunting and listening to live music. Keep the volume at a reasonable level on your MP3 player. Regular hearing tests can help identify problems early, reducing your risk of developing long-term damage.

Single-Sided Deafness

Single sided deafness (SSD), sometimes referred to as unilateral hearing loss, is a condition in which an individual experiences hearing loss in only one ear but can hear normally out of the other ear. While the majority of patients with a hearing impairment suffer from bilateral (two-sided) hearing loss, SSD is diagnosed in approximately 60,000 people in the United States each year. There is no cure, and treatment can be a challenge because traditional amplification devices prove less effective. However, alternative options are available for managing single sided deafness.

What Causes Single Sided Deafness?

SSD can be caused by a variety of factors. One of the most common causes is acoustic neuroma, a benign, slow growing tumor that can push against the auditory nerve and affect the ability to hear properly in one ear. Sudden deafness – a rapid onset of hearing loss that occurs with little or no warning, often following a viral infection – is another condition commonly associated with SSD. Patients may fall victim to sudden deafness as a result of an inflammation in the cochlea that causes permanent damage to the hair cells responsible for hearing.

Additional causes of SSD include trauma to the head, genetic disorders, Meniere’s disease, labyrinthitis, microtia, mastoiditis and even common childhood diseases such as measles and bumps.

Patients with SSD find understanding speech in the presence of background noise especially problematic and have great difficulty localizing sound (recognizing the location or origin of a sound source). Sound localization depends on subtle hearing cues from two ears; removing one from the equation confuses the brain. Other symptoms might include anxiety, stress, social isolation, dizziness, difficulty paying attention and speaking loudly.

Treatments for SSD

While there is no cure for single sided deafness, options exist for helping patients cope with unilateral hearing. Traditional hearing aids don’t offer much help to those suffering from SSD, but Contralateral Routing of Signal (CROS) hearing aids can improve hearing and localization. They utilize a microphone that is placed in the vicinity of the impaired ear and an amplifier near the normal ear. The microphone picks up sounds and transmits them to the patient’s “good” ear. A similar device known as BICROS is suitable for individuals with some degree of hearing loss in one ear and total deafness in the other.

Another option is a Bone Anchored Hearing Device, a surgically implanted device that uses direct bone conduction to transmit sounds from the affected ear to the normal one. Vibrations in the bones of the ear canal and middle ear stimulate the hair cells of the cochlea, boosting the ability to hear.

Sudden Deafness

For most people who experience hearing loss, the condition comes on gradually over a period of years. In rare cases, an abrupt loss of hearing occurs with little or no warning. This condition, known as sudden sensorineural hearing loss (SSHL), is defined as a hearing reduction of 30 dB or greater over three contiguous frequencies, occurring over a period of 72 hours or less. Ninety percent of cases result in unilateral (single-sided) hearing loss, which may be accompanied by dizziness or tinnitus.

The severity of the hearing loss varies. Some patients recover completely and without medical intervention in just a few days. Others find their symptoms improve gradually over a couple of weeks. Fifteen percent of those who experience sudden deafness will have hearing loss that worsens over time.

Causes of Sudden Deafness

There are over 100 possible causes for SSHL. These include infectious diseases, head trauma, abnormal tissue growth, circulatory problems, neurologic disorders, toxic causes, immunologic diseases, inner ear problems such as Meniere’s disease and ototoxic medications. Certain groups of antibiotics, in particular, have been shown to destroy the hair cells of the cochlea, causing sudden deafness that is often permanent in nature. These must be used with extreme caution and should be avoided unless they are the only viable course of treatment for a life-threatening illness. Be sure to question your physician or clinic thoroughly when antibiotics are prescribed.

Risk factors for SSHL include a prior diagnosis of meningitis, a recent head injury, ear infection, exposure to loud noise, a sudden change in pressure and starting a new medication.

Symptoms of Sudden Deafness

Symptoms that often precede or accompany sudden deafness include:

  • Tinnitus (ringing in the ears).
  • Vertigo or dizziness.
  • Fullness in the ear.
  • A sudden loud “pop” in the ear, similar to what you’d experience with a change in pressure.
  • Muffled hearing upon wakening or when trying to use the telephone.

Treatments For Sudden Deafness

If you experience any of these symptoms, see a physician or audiologist immediately. Doctors believe that prompt medical attention offers the best chances for a full recovery. Do not delay – your hearing depends upon it.

Treatment varies and will depend upon the cause (if known). Steroids, which reduce inflammation and swelling and aid the body in fighting illness, are the most common treatment method for sudden deafness.

Hearing Loss FAQs

What are the signs of hearing loss?

Symptoms of hearing loss include difficulty understanding what others are saying, asking people to repeat themselves, struggling to hear in crowded places with distracting background noise, the perception that others are mumbling or not speaking clearly, listening to the television or radio at a higher volume than others, experiencing a ringing or buzzing in the ears. You may find yourself withdrawing from social situations in order to avoid conversation and might experience depression.

Are there different types of hearing loss?

Yes. There are three types of hearing loss: Sensorineural, conductive and mixed. Sensorineural is the result of damage to the inner ear nerves. Conductive is the result of obstructions in the outer or middle ear. Mixed hearing loss is a combination of the other two types; this means that in one ear you have an issue with the outer or middle ear and the inner ear.

What causes hearing loss?

A number of factors can cause hearing loss. The most common include aging, noise exposure, ear infections, excessive earwax, ear or head trauma, genetics, birth defects, benign growths or tumors, otosclerosis, Meniere’s disease and reactions to drugs.

Can hearing loss be prevented?

Some types of hearing loss are preventable. Noise-induced hearing loss can be avoided by wearing proper hearing protection when exposed to occupational or recreational noise and turning down the volume on your TV, radio or personal music device. To prevent other types of hearing loss, avoid sticking cotton swabs or other objects in your ears, blow your nose gently through both nostrils and swallow or yawn frequently when traveling by airplane.

Will wearing a hearing aid make me appear old or frail?

Today’s hearing aids are small and discreet, and some models are completely invisible to others. Besides, asking people to repeat themselves, responding inappropriately when others are talking and social withdrawal are more obvious indicators of hearing loss than wearing hearing aids.

What is a cochlear implant?

A cochlear implant is an electronic device that converts sound to digital signals that are sent to the brain, bypassing damaged nerve cells, where they are translated as sound. Whereas hearing aids amplify sounds, cochlear implants enable the user to understand speech and speak more clearly. They help patients with severe or profound hearing loss who can’t benefit from hearing aids.

What are assistive listening devices?

Assistive listening devices (ALDs) are portable amplifiers that may be used either in conjunction with hearing aids and cochlear implants or on their own. They separate speech from background noises, making it easier to follow conversations in certain environments where distance, competing distractions or poor acoustics are factors.

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