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Hearing Loss

Do You Think You Have a Hearing Loss?
Are You Afraid to Know for Sure?
Do You Know Someone Who May Not Admit He or She Has a Hearing Loss?

If you think you or someone you know might have a hearing loss, you are not alone. If you have suspected for a while but just haven’t got around to doing anything about it, that is not unusual.

How can I tell if I have a hearing loss?

If you answer yes to some of the following questions, you may have a hearing loss

  • Often ask people to repeat what they say?
  • Have trouble hearing in groups?
  • Think others mumble?
  • Fail to hear someone talking from behind you?
  • Turn up the volume on the TV or car radio?
  • Have difficulty on the phone?
  • Have trouble hearing your alarm clock?
  • Have difficulty hearing at the movies
  • Dread going to noisy parties and restaurants?
Think about these situations
  • Are you embarrassed to talk openly about not being able to hear?
  • Are you cutting out activities that you used to love but have become painful because you cannot join in fully anymore?
  • At work are you afraid to reveal your hearing loss in case it jeopardizes your job and your supervisor and coworkers may see you as less competent?
  • Are you bluffing when out with friends in noisy restaurants?
  • Are you feeling cut off from your young children because you cannot hear their high-pitched voices?
  • Are family holidays a strain because so many people are talking at once?

These are common reactions and can lead to withdrawal from social interaction, anxiety, loss of self-esteem and even depression.

“I can hear but can’t understand.”
Other Things to Consider if You Think You or Someone You Know Has a Hearing Loss

For most adults, the onset and progression of a hearing loss extends over some time.

Often, people will blame their hearing problems on the nature of the other person’s speech. For example, someone might say: “If people wouldn’t mumble, I could hear! “Or, “People talked a lot clearer when I was younger.”

One’s family and friends are likely to be the first to notice some difficulty hearing, long before the person does.

Typically at this stage, the individual will deny a problem. This is understandable, since there is usually great variability in how the person functions in various situations and with different people. In some situations and with some people, he or she may do pretty well.

People will not be aware of what they don’t hear (like the sounds of birds, the beep of the microwave, and soft everyday sounds). They will be aware that they do not understand speech, as when they say, “I can hear but can’t understand,” especially the high-pitched voices of children.

Family members frequently complain that the TV volume is set too high, leading to some family squabbles.

The person with hearing loss will notice difficulty in understanding when someone talks from another room.

Probably, the major complaint of people with hearing loss is the difficulty they experience in comprehending speech in any kind of noisy place (restaurants, receptions, large family dinners, in the car, or on a plane).

Group conversations are particularly difficult, especially when there is great deal of cross-talk.

These increasing difficulties in hearing may produce conflict between the person with hearing loss and family members, with the family insisting on getting help and the person with hearing loss reluctant to recognize the reality.

For children who are hard of hearing, the situation is different. Parents should be on the lookout for delayed or aberrant speech and language development, apparent inattention, and poor school work.

Hearing loss can be caused by many different causes, some of which can be successfully treated with medicine or surgery, depending on the disease process.

Three Types of Hearing Loss
  • Conductive hearing loss
  • when hearing loss is due to problems with the ear canal, ear drum, or middle ear and its little bones (the malleus, incus, and stapes).

  • Sensorineural hearing loss (SNHL)
  • when hearing loss is due to problems of the inner ear, also known as nerve-related hearing loss.

  • Mixed hearing loss
  • refers to a combination of conductive and sensorineural hearing loss. This means that there may be damage in the outer or middle ear and in the inner ear (cochlea) or auditory nerve.

Conductive Hearing Loss
Causes:
  • Malformation of outer ear, ear canal, or middle ear structures
  • Fluid in the middle ear from colds
  • Ear infection (otitis media - an infection of the middle ear in which an accumulation of fluid may interfere with the movement of the eardrum and ossicles)
  • Allergies
  • Poor Eustachian tube function
  • Perforated eardrum
  • Benign tumors
  • Impacted earwax
  • Infection in the ear canal
  • Foreign body in the ear
  • Otosclerosis
Treatments of Conductive Hearing Loss:

Types of conductive hearing loss include congenital absence of ear canal or failure of the ear canal to be open at birth, congenital absence, malformation, or dysfunction of the middle ear structures, all of which may possibly be surgically corrected. If these are not amenable to successful surgical correction, then the hearing alternatively may be improved with amplification with a bone conduction hearing aid, or a surgically implanted, osseointegrated device, or a conventional hearing aid, depending on the status of the hearing nerve.

Other causes of conductive hearing loss are: infection; tumors; middle ear fluid from infection or Eustachian tube dysfunction; foreign body; and trauma (as in a skull fracture). Acute infections are usually treated with antibiotic or antifungal medications. Chronic ear infections, chronic middle fluid, and tumors usually require surgery. If there is no response to initial medical therapy, infectious middle ear fluid is usually treated with antibiotics -- while chronic non-infectious middle ear fluid is treated with surgery (or pressure equalizing tubes).

Conductive hearing loss from head trauma is frequently amenable to surgical repair of the damaged middle ear structures, performed after the patient’s general medical status is stabilized following acute traumatic injuries.

A genetic form of conductive hearing loss is otosclerosis, in which there is bony fixation of the stapes (the third little bone of hearing in the middle ear), where sound can’t get to the middle ear. Otosclerosis usually presents with hearing loss in early adulthood. Otosclerosis can successfully be managed with surgery to replace the immobile stapes with a mobile stapes prosthesis or with a hearing aid. Research suggests that the measles virus may contribute to stapes fixation in those with a genetic predisposition to otosclerosis. The incidence of otosclerosis may be decreasing in some communities due to measles vaccination. Otosclerosis (a hereditary disorder in which a bony growth forms around a small bone in the middle ear, preventing it from vibrating when stimulated by sound) usually causes a conductive hearing loss, a hearing loss caused by a problem in the outer or middle ear. Less frequently, otosclerosis may cause a sensorineural hearing loss (damaged sensory cells and/or nerve fibers of the inner ear), as well as a conductive hearing loss.

Sensorineural Hearing Loss
Causes:
  • Exposure to loud noise
  • Head trauma
  • Virus or disease
  • Autoimmune inner ear disease
  • Hearing loss that runs in the family
  • Aging (presbycusis)
  • Malformation of the inner ear
  • Meniere’s Disease
  • Otosclerosis - a hereditary disorder in which a bony growth forms around a small bone in the middle ear, preventing it from vibrating when stimulated by sound.
  • Tumors
Treatments of Sensorineural Hearing Loss:
  • Sensorineural hearing loss can result from acoustic trauma (or exposure to excessively loud noise), which may respond to medical therapy with corticosteroids to reduce cochlea hair cell swelling and inflammation to improve healing of these injured inner ear structures.
  • Sensorineural hearing loss can occur from head trauma or abrupt changes in air pressure such as in airplane descent, which can cause inner ear fluid compartment rupture or leakage, which can be toxic to the inner ear. There has been variable success with emergency surgery when this happens.
  • Sudden sensorineural hearing loss, presumed to be of viral origin, is an otologic emergency that is medically treated with corticosteroids.
  • Bilateral progressive hearing loss over several months, also diagnosed as autoimmune inner ear disease, is managed medically with long-term corticosteroids and sometimes with drug therapy. Autoimmune inner ear disease is when the body’s immune system misdirects its defenses against the inner ear structures to cause damage in this part of the body.
  • Fluctuating sensorineural hearing loss may be from unknown cause or associated with Meniere’s Disease. Symptoms of Meniere’s disease are hearing loss, tinnitus (or ringing in the ears), and vertigo. Meniere’s disease may be treated medically with a low-sodium diet, diuretics, and corticosteroids. If the vertigo is not medically controlled, then various surgical procedures are used to eliminate the vertigo.
  • Sensorineural hearing loss from tumors of the balance nerve adjacent to the hearing nerve, generally are not reversed with surgical removal or irradiation of these benign tumors. If the hearing loss is mild and the tumors are very small, hearing may be saved in 50 percent of those undergoing hearing preservation surgery for tumor removal.
  • Sensorineural hearing loss from disease in the central nervous system may respond to medical management for the specific disease affecting the nervous system. For example, hearing loss secondary to multiple sclerosis may be reversed with treatment for multiple sclerosis.
  • Irreversible sensorineural hearing loss, the most common form of hearing loss, may be managed with hearing aids. When hearing aids are not enough, this type of hearing loss can be surgically treated with cochlear implants.
Mixed Hearing Loss
Treatments of Mixed Hearing Loss:

Audiologist recommends taking care of the conductive component first. There have been times when the addition of the conductive component made the person a better hearing aid candidate, by flattening out the audiogram for example, while the underlying sensorineural component presented a high-frequency loss. However, still the emphasis would be on treating medically what can be treated. They says that, generally, you would expect positive results.

Causes of Hearing Loss

There are many causes of hearing loss that are beyond our control, such as those caused by heredity. We can’t pick our parents and our genetic make-up - though with continuing advances in gene research, clinical applications, this may be changing. But for now, we have to deal with the hand that heredity has dealt us.

In Some Cases, Hearing Loss Can be Prevented
Ototoxic Drugs

These are medications that are toxic to the ears and can cause hearing loss, sometimes accompanied by tinnitus. We may have some options; however, about the medications we take. It is always a good idea to ask a physician if a hearing loss is one of the possible side-effects. If it is, and there is a substitute medication that would work just as well, then that would be the one to take.

Examples of Otoxic Drugs
  • some over-the-counter drugs such as aspirin in high doses
  • some antibiotics
  • some chemotherapy drugs
  • loop diuretics
  • some anti-inflammatory drugs
Signs of Ototoxicity (in order of frequency)
  • Development of tinnitus in one or both ears
  • Intensification of existing tinnitus or the appearance of a new sound
  • Fullness or pressure in the ears other than being caused by infection
  • Hearing loss in an unaffected ear or the progression o an existing loss.
  • Development of vertigo or a spinning sensation usually aggravated by motion which may or may not be accompanied by nausea
Noise-Induced Hearing Loss – Completely Preventable
  • A major cause of hearing loss in our society is noise exposure. Tiny hair cells in the ear are damaged when assaulted by loud noise. Once those hair cells are destroyed they cannot be replaced.
  • A noise-induced hearing loss is the most common cause for its occurrence in our society and it’s completely preventable.
  • Repeated and lengthy exposure to loud sound – whether is it music or a jackhammer - will eventually produce a sensorineural hearing loss.
Damage Risk Criterion

As the sound level increases, the time span one can be exposed to it is reduced. Each day we create more hearing losses in our society with our tolerance of the ear-shattering cacophony that surrounds us.

Musicians

Musicians are particularly at risk. It is their job to listen to the sounds that they and their group are producing, and these may be as high as 135 dB. They have no choice to do this as often as daily; this is their career and their livelihood.

Musicians earplugs are available that can help. The newest and best version reduce the sound equally all across the spectrum, from low to high frequencies. Everything sounds just as good as it did before, only softer.

A less expensive, though still effective earplug, can be obtained for the students in a school music program.

How to Reduce the Damage to Hearing from Noise

Your ears can be your warning system for potentially dangerous noises. The noise is too loud when:

  • You have to raise your voice to be understood by someone standing nearby
  • The noise hurts your ears
  • You develop a buzzing or ringing sound in your ears, even temporarily (indicates some hair cells have died)
  • You don't hear as well as you normally do until several hours after you get away from the noise.
How to Protect Yourself When Around Loud Noise
  • Block the noise (wear earplugs or earmuffs)
  • Avoid the noise (put hands over ears if you can’t walk away)
  • Turn down the volume
Decibel Loudness Comparison Chart
Painful
  • 150 dB = fireworks at 3 feet
  • 140 dB = firearms, jet engine
  • 130 dB = jackhammer
  • 120 dB = jet plane takeoff, siren
Extremely Loud
  • 110 dB = maximum output of some MP3 players, model airplane, chain saw
  • 106 dB = gas lawn mower, snow blower
  • 100 dB = hand drill, pneumatic drill
  • 90 dB = subway, passing motorcycle
Very Loud
  • 80–90 dB = blow-dryer, kitchen blender, food processor
  • 70 dB = busy traffic, vacuum cleaner, alarm clock
Moderate
  • 60 dB = typical conversation, dishwasher, clothes dryer
  • 50 dB = moderate rainfall
  • 40 dB = quiet room
Faint
  • 30 dB = whisper, quiet library