CONDITIONS

Hearing Loss

What Is Hearing Loss

Hearing loss, also known as hearing impairment or deafness, is the inability to detect or a decreased sensitivity to sounds. Unfortunately, hearing loss is extremely common and becomes even more prevalent as we age. Presbycusis is a term that specifically refers to the loss of hearing as we age. It is estimated that 1 in 3 of adults in the US ages 65 to 75 have some degree of hearing loss. For those above the age of 75, almost 1 in 2 people have hearing impairment.

 

When describing hearing loss, it is useful to consider the type of hearing loss, degree of hearing loss, and configuration of hearing loss (2). In children, it is important to diagnose hearing loss as soon as possible as it may have drastic consequences on learning and development. However, hearing loss also can have negative ramifications for adults considering it can impact employment, education, and general wellbeing.

 

Types of hearing loss include the following:

  • Conductive hearing loss occurs when sound is not transmitted through the outer ear canal to the eardrum, and to the small bones of the middle ear termed ossicles. Symptoms usually include an inability to hear faint sounds or a reduction in overall sound. This can usually be medically or surgically corrected.
  • Sensorineural hearing loss occurs when there is damage to the inner ear, known as the cochlea or the auditory nerve itself. This is the most common type of permanent hearing loss and is usually refractory to medical or surgical intervention. Symptoms usually include an inability to hear faint or even all sounds.
  • Mixed hearing loss occurs when there is a combination of conductive and sensorineural hearing loss.

What Causes Hearing Loss

To fully understand how hearing loss occurs, it is helpful to understand how the human body detects sounds, or hears. First, sound is collected by the outer most part of the ear, known as the pinna. Sound is then funneled through the ear canal and eventually to the eardrum, or the tympanic membrane. The tympanic membrane is in contact with three small bones in the middle ear, which allow transmission of sound (and can amplify it as well) through the middle ear eventually to the inner ear. The inner ear has a fluid-filled snail-like structure known as the cochlea. Within the cochlea lie small nerve cells with “hairy” projections, which turn sound into electrical signals that propagate to your brain and allow you to perceive sound.

According to the Mayo Clinic, doctors believe hearing loss stems from both hereditary and environmental factors. And, the causes of hearing loss are often times specific to the type.

Causes of conductive hearing loss include:

  • Fluid in the middle ear from infections or colds (otitis media)
  • Allergies (serous otitis media)
  • Poor Eustachian tube function
  • Perforated ear drum
  • Tumors
  • Impacted ear wax (cerumen)
  • Infection in the ear canal (otitis externa or swimmers ear)
  • Presence of a foreign body
  • Absence or malformation of the external ear, ear canal, or middle ear

Causes of sensorineural hearing loss include:

  • Illness
  • Medications that are toxic to the ear (ototoxicity), such as gentamicin, loop diuretics (furosemide), cisplatin, and many non-steroidal anti-inflammatory drugs (NSAIDs),
  • Genetic causes of hearing loss
  • Aging
  • Head trauma
  • Malformation of the inner ear
  • Exposure to chronic noise

Causes of mixed hearing loss include:

  • All of the following above for both conductive and sensorineural hearing loss.

Risk Factors For Hearing Loss

According to the Mayo Clinic, the following are risk factors for hearing loss:

 

  • Age—exposure to sound over many year eventually damages the cells within the inner ear
  • Genetics—your specific genetic make-up may make your more or less prone to hearing impairment either due to sound exposure or aging
  • Occupational noises—those who work in environments with constant loud noises are at risk for hearing loss. This is common in farming, construction, and factory jobs.
  • Recreational noises—exposure to loud noises from jet-engines, loud music, motorcycles, snowmobiles, and many other sources can exacerbate or induce hearing impairment
  • Medications—drugs such as gentamicin, loop diuretics (furosemide), cisplatin, and NSAIDs increase your risk of hearing impairment
  • Illnesses—those who suffer from conditions with high fevers, such as meningitis, may also have associated damage to the cochlea and resulting hearing impairment
  • Trauma—secondary to temporal bone (head) fractures

Diagnosing Hearing Loss

Although hearing loss is very common, it is often under-diagnosed. In addition to a thorough medical history and physical examination (which will likely include a visual examination of the outer ear canal and ear drum with the use of an otoscope), your physician may do the following to diagnose your condition:

 

  1. Air conduction, conventional, or standard audiometry: commonly used to test hearing of adults and older children. A range of tones, from low to high frequencies, is administered via headphones, and patients are asked to indicate a perceived (or heard) sound with a verbal response or hand raise. This test allows one to determine the softest sound you can perceive and at which frequencies hearing is impaired. Frequencies associated with speech are particularly important for communication and others are vital for particular environmental sounds, like traffic signals.
  2. Bone conduction: if the above test indicates hearing loss, another headset used for bone vibration is used to test for bone conduction in order to diagnose the type of hearing loss. This type of test sends sound directly to the inner ear and bypasses the outer and middle ear. If sounds are heard better via bone conduction, hearing loss is likely an issue in the outer or middle ear. If the sounds are heard equally well via bone conduction and earphones, the hearing loss is sensorineural in nature.
  3. Word recognition: this test evaluates the ability to discriminate different speech sounds and words. During this test, you will listen to and repeat words.
  4. Acoustic immitance: these tests are used to evaluate the function of the middle ear and related structures. One type of acoustic immitance test is called tympanometry, which assesses the integrity of the tympanic membrane, or eardrum. Limited movement of the eardrum could indicate an issue with the eardrum itself, or the middle ear.
  5. Otoacoustic emissions (OAE): these tests assess the function of the inner ear, or cochlea. OAEs are present with normal hearing and usually absent with a malfunctioning cochlea.
  6. Auditory brainstem response (ABR): these tests measure hearing sensitivity and determine if the neural pathways within the brainstem are intact and functioning. This test can rule out auditory-neurological pathways. During this procedure, electrodes are placed on the scalp and brain activity is recorded in response to a series of sounds/clicks.

Symptoms of Hearing Loss

Symptoms of hearing loss include the following:

 

  • Muffling of speech and other sounds
  • Difficulty understanding words, especially with other noise in the environment
  • Trouble hearing consonants
  • Needing to turn up the volume of the TV or radio
  • Withdrawal from conversations
  • Avoidance of social settings
  • Ringing in the ears, also known as tinnitus

Prognosis

The prognosis for each type hearing loss varies. In general, those with minimal hearing loss and early treatment will have the best prognosis.

Living With Hearing Loss

According to the Hearing Loss Association of America, when someone has hearing loss, the first step in coping with it is simply acknowledging it’s a reality. Although this can be difficult, it is vital because on it is acknowledged, treatment options can be sought. As stated above, hearing aids and cochlear implants are often very effective treatment strategies.

 

In addition to or before treatment, it is often helpful for the person communicating with a patient with hearing loss to do the following:

  • Face the person directly
  • Have adequate light on your face
  • Avoid noisy backgrounds
  • Ensure you have the person’s attention
  • Ask how you can facilitate communication
  • Emphasize visual cues and references
  • Don’t shout – speak clearly and at a moderate pace
  • Don’t hide your mouth, chew gum or food, or smoke while talking
  • Be patient
  • Be positive and relaxed

 

The person with hearing impairment can do the following to improve communication:

  • Tell others how best to talk to you
  • Pick the best spot (light, close to speaker, quiet)
  • Pay attention
  • Look for visual cues

Don’t interrupt

Screening

Screening for hearing loss is easy and quick. All babies should be screened for hearing impairment within 1 month of life. If the screening results suggest hearing impairment, the baby should undergo a full hearing test.

 

According to the United States Preventive Services Task Force, or USPSTF, concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for hearing loss in asymptomatic adults aged 50 years or older.

Complementary and Alternative Treatment

As the definitive treatment for hearing impairment remains medications, procedures, and surgery, alternative treatments for this condition should only be considered after definitive traditional medicine and discussion with your physician.

 

Complementary medicine, which refers to interventions performed in addition to traditional or standard treatment, are numerous and may provide additional symptom relief and improved quality of life for many patients. According to the National Center for Complementary and Integrative Health, these include:

  • Massage therapy — may help to alleviate symptoms experienced by many types of patients, such as pain, nausea, anxiety, and depression.
  • Mindfulness-based Stress Reduction —as a type of meditation, mindfulness-based stress reduction can help patients by relieving anxiety, stress, fatigue, and general mood and sleep disturbances. As a result, this can lead to an overall improvement in quality of life.
  • Yoga—preliminary studies suggest that yoga may improve anxiety, depression, and stress in patients. However, additional studies need to be completed for better evidence and conclusions.
  • Hypnosis, relaxation therapies, and biofeedback—various studies are currently assessing the benefits of these activities patients.

When To Contact A Doctor

If you are beginning to experience difficulty with hearing or pain in the ear, it is wise to seek medical attention. In general, you can visit your primary care physician with these concerns first and then he or she can refer you to a specialist, such as an ENT or otolaryngologist, to ensure optimal care.

 

Find a Doctor

Your medical team may consist of several healthcare professionals, including your primary care physician, an ENT (Ears, Nose and Throat doctor or otolaryngologist), and an audiologist. You can find healthcare providers near you here:  http://thirdage.com/care-provider

 

Resources

Other useful resources to help you learn about hearing loss can be found at:

Hearing Loss Association of America: http://www.hearingloss.org/

American Speech Language Hearing Association: http://www.asha.org/public/hearing/Hearing-Loss/

 

References

  1. The Mayo Clinic. Hearing loss – definition. http://www.mayoclinic.org/diseases-conditions/hearing-loss/basics/definition/con-20027684
  2. The American Speech, Language, Hearing Association. What is hearing loss? http://www.asha.org/public/hearing/What-is-Hearing-Loss/
  3. The Mayo Clinic. Hearing loss – risk factors. http://www.mayoclinic.org/diseases-conditions/hearing-loss/basics/risk-factors/con-20027684
  4. The Mayo Clinic. Hearing loss – tests and diagnosis. http://www.mayoclinic.org/diseases-conditions/hearing-loss/basics/tests-diagnosis/con-20027684
  5. The Mayo Clinic. Hearing loss – symptoms. http://www.mayoclinic.org/diseases-conditions/hearing-loss/basics/symptoms/con-20027684
  6. Disability guidelines. Hearing loss – prognosis. http://www.mdguidelines.com/hearing-loss/prognosis
  7. Hearing Loss Association of America. Living with hearing loss. http://www.hearingloss.org/content/living-hearing-loss
  8. United States Preventive Task Force. Hearing loss in older adults – screening. http://www.uspreventiveservicestaskforce.org/Page/Topic/recommendation-summary/hearing-loss-in-older-adults-screening
  9. Better Hearing Institute. Hearing loss prevention. http://www.betterhearing.org/hearingpedia/hearing-loss-prevention
  10. The Mayo Clinic. Hearing loss – treatment and drugs. http://www.mayoclinic.org/diseases-conditions/hearing-loss/basics/treatment/con-20027684

Questions For A Doctor

When you go to see your doctor, it’s good to have a list of the questions you’d like to have answered. Take a moment to write down some of the things you want to know. Your questions for your doctor might include some of these:

 

  • How far advanced is my hearing loss?
  • What is my diagnosis?
  • What is the prognosis?
  • What are my treatment options?
  • Why do you believe this occurred?
  • What types of resources are available to me for community support?
  • What if I elect for no treatment?