According to the Hearing Loss Association of America, about 20 percent of adults in the United States – or about 48 million – report some degree of hearing loss. But on average, it takes people seven years from the time they think they might have hearing loss to actually seek treatment. What many people don't know is that time is of the essence, and seeking professional help as soon as you notice hearing changes in yourself or a loved one can help delay or even prevent certain types of hearing loss. By recognizing the signs and acting early, you may benefit from the variety of new treatments and devices available today.
How Does It Happen?
Age and noise are two of the most common causes of hearing loss in adults. In our 50s and 60s, we often experience a gradual decrease in hearing, but there can be a genetic predisposition as well. "Age-related hearing loss is not preventable or reversible, but it can be easily treated with hearing aids," explains Dr. Kelly Shea-Miller, Director of Audiology for Kaiser Permanente of Georgia. "Noise-induced hearing loss occurs when we are exposed to loud sounds and damage is done to our hearing. This can result from recreational noise (loud music, leaf blowers, motorcycles) or occupational noise (factory work, firefighters, military). As with age-related hearing loss, noise-induced hearing loss is not reversible, but it is preventable."
In children, however, the most common cause of hearing loss is conductive hearing loss, which is often due to fluid in the ears from an ear infection. "Research has also identified over 100 genes that may influence the development of hearing loss in children," says Dr. Brian Herrmann, pediatric otolaryngologist at Children's Healthcare of Atlanta at Scottish Rite. "There are many genetic syndromes associated with hearing loss. Some examples include Down syndrome, Usher syndrome, Treacher Collins syndrome, Crouzon syndrome and Alport syndrome."
Hearing loss can result from a problem with any of the three main parts to the ear: the outer ear, middle ear or inner ear. Many problems with the outer ear and middle ear, such as earwax and infections, can be treated, but inner ear problems are typically permanent. "Both age-related hearing loss and noise-induced hearing loss are a result of a problem in the inner ear," Dr. Shea-Miller says. "Inside the cochlea, there are inner ear hair cells called cilia, which convert sound to neural impulses. These cilia can be damaged and die off, resulting in a hearing loss for the sounds those inner hair cells were responsible for converting. It's similar to a piano with damaged keys. If only the keys on the right-hand side of the piano are damaged, then you will be able to hear some – but not all – sounds."
Recognizing the Signs
The most common signs of hearing loss include sounds or speech seeming muffled, difficulty understanding words (especially in background noise or in a group of people), frequently asking others to repeat things or to speak more clearly, and setting the television or radio louder than friends or family would prefer. With inner ear disorders like Meniere's disease, however, the symptoms can be more immediate. "You'll have fluctuating hearing, a blocked-up sensation or ringing in the ears," says Dr. Vivek Gupta, WellStar Bi-County ENT. "With sudden hearing loss, a person could wake up and be deaf in one ear. There are debates about the root cause of this. Sometimes it can be a tumor growing on the inner ear, but it could be any number of things."
This is why it is so important to have a hearing evaluation as soon as possible. Many health fairs and physician's offices offer hearing screenings, but if you do not pass this test or want a more detailed evaluation, be sure to see an audiologist who is licensed by the state and has either a master's or doctoral degree. If you are not sure where to find one, the following sites have lists of licensed audiologists:
Recognizing the signs of hearing loss in babies and young children, on the other hand, can be trickier than a simple test. According to Dr. Herrmann, a telltale sign is when babies fail to awaken or startle with loud noises. "The two most common methods of assessing the hearing levels of a newborn include otoacoustic emissions (OAE testing) and automated brainstem response testing (ABR testing)," he says. "Current guidelines recommend that if a baby fails a newborn screen, to repeat the assessment by one month of age, have diagnostic assessment by three months of age and intervention completed by six months of age."
Can Hearing Loss Be Prevented?
Reducing our exposure to recreational noise is one of the most important things we can do to protect our hearing later in life. "There are over-the-counter foam earplugs and earmuffs that can keep your lawn mower, leaf blower and favorite music venue from contributing to the damage in your inner ear," Dr. Shea-Miller says. "For people with more consistent noise exposure, custom hearing protection is also available."
And in the case of hearing loss with a sudden onset, she says it may be reversible. "If you have a sudden change in hearing in one or both of your ears, you should see your health care provider, otolaryngologist or an audiologist as soon as possible." Expert evaluation for sudden hearing loss is best because home treatments such as ear candling are not considered effective remedies and should be avoided. "The American Academy of Audiology is against ear candling," Dr. Gupta says. "I tell my patients that nothing smaller than your elbow should go in your ear, so no Q-tips."
Certain medications can also aggravate hearing loss, sometimes accompanied by tinnitus. This is why it's a good idea to ask your physician if hearing loss is one of the possible side effects. If it is, be sure to ask if there is a substitute medication that would work just as well. Examples of ototoxic drugs include some over-the-counter drugs such as aspirin in high doses, some antibiotics, some chemotherapy drugs, loop diuretics and some anti-inflammatory drugs.
Treatment and Breakthroughs
Even for people with aggressive ear disorders, a variety of treatments can help reduce their symptoms. "With otosclerosis, one of the bones behind the ear drum can harden up and stiffen to the point that it prevents hearing," Dr. Gupta says. "This can be treated with hearing aids or a surgical procedure." This procedure, called a stapedotomy, involves drilling a small hole in the stapes footplate with a micro-drill or a laser and inserting a piston-like prosthesis. "If someone is deaf on one side, we can use a device called the Baha implant," he says. "It's a metal screw implanted on the deaf side, which sends signals and transfers sound to the normal hearing side." This ultimately results in a sensation of hearing from a deaf ear.
In the majority of cases of hearing loss in adults, the most effective treatment is a hearing aid. But the hearing aids of today are vastly different from what you might be familiar with. The Hearing Loss Association of America recently announced a breakthrough at The Ohio State University, where computer engineers and hearing scientists are working to solve what many experts call "the cocktail party problem," or difficulty hearing one person's voice in the midst of background noise. This technology, which uses a computer algorithm to analyze speech and remove most background noise, could pave the way for the next generation of digital hearing aids. These hearing aids could be a feature inside of a smartphone, which would do the computer processing and broadcast the enhanced signal to the earpieces wirelessly.
Those advancements are already being made by companies like Beltone, which recently introduced the Beltone First hearing aid. The First hearing aid connects to your iPhone, making it simple and discreet to adjust the hearing aid's volume or other settings right from the palm of your hand. Atlanta Beltone's COO, Alexandra Sims, says the device is even more sophisticated than meets the eye. "The First is the only hearing aid to memorize locations and settings, so that every time a user goes to a particular location, it can automatically switch to the desired settings." This means that as you travel from the office to your favorite restaurant, for example, the hearing aid will learn your personal settings and transition seamlessly to the new noise level. It can even be reprogrammed to meet the user's needs over time. The price range for these new hearing aids, Sims says, is between $2,750 and $3,875, but she adds, "There are hearing aids for every budget, every lifestyle and every hearing loss."
Living with Hearing Loss
If you or a loved one is coping with hearing loss, organizations such as The Hearing Loss Association of America are full of resources, educational programs and support. Also, programs like the Georgia Telecommunications Equipment Distribution Program (GATEDP) can provide resources and equipment to make to make elements of day-to-day life, like making a simple phone call, much easier. With the use of amplifiers, captioning and speech assistance, this free program helps Georgia residents with any degree of hearing loss speak and understand more easily on the phone. Kevin Steffy, a GATEDP coordinator, says users appreciate the independence they achieve through this equipment. And in addition to independence, users also enjoy the real benefits: connection. "Some of them had tears when they made their first calls to their children or grandchildren and were able to hear them speak, after a long time of not being able to," Steffy says.
Regardless of the profundity of hearing loss, options exist to make life easier, and plenty of organizations are out there to support you and your loved ones. "Living with hearing loss is hard work and requires lots of coping skills," Bonnell says. "Our clear, straightforward message has changed the lives of thousands of people: 'Hearing loss is a daily challenge you can overcome. You do not have to hide your hearing loss. You do not have to face hearing loss alone.'"
Jeff Bonnell, The Hearing Loss Association of America – www.hearingloss.org
Vivek Gupta, MD, WellStar Bi-County ENT – www.wellstar.org
Brian Herrmann, MD, Children's Healthcare of Atlanta – www.choa.org
Kelly Shea-Miller, Ph.D., Kaiser Permanente of Georgia – www.kp.org
Alexandra Sims, Atlanta Beltone – www.beltone.com
Kevin Steffy, GACHI – www.gachi.org/gatedp
Mayo Clinic – www.mayoclinic.org
WellStar – www.wellstar.org