Hearing Loss

The anatomy of the hearing system can be divided into four components for our convenience in remembering the parts and associating these parts with their function. These divisions are the:

1. Outer Ear
2. Middle Ear
3. Inner Ear
4. Central Auditory Pathways

The Outer Ear (1)
The outer ear is made up of the pinna or auricle and the external auditory canal. The pinna collects and funnels sound down the ear canal. The ear canal is curved, “S” shaped, and about 1 inch long in adults. It has hairs and glands that produce wax called cerumen. Cerumen helps to lubricate the skin and keep it moist

The Middle Ear (2)
The eardrum (tympanic membrane) is a membrane at the inner end of the ear canal. On that inner side of the tympanic membrane is an air-filled space called the middle ear cavity. The vibrations of the tympanic membrane are transmitted through the malleus (hammer) incus (anvil) and stapes (stirrup), also called the ossicles. The stapes footplate transmits the vibrations into the inner ear.

The Inner Ear (3)
The inner ear has two divisions: one for hearing, the other for balance. The hearing division consists of the cochlea and the nerve of hearing. The cochlea is snail-shaped, bony structure that contains the sensory organ for hearing called the organ of Corti. The organ of Corti releases chemical messengers when the vibrations from the stapes activate its tiny hair cells. These then excite the nerves of hearing which carry sound to the brain.

Central Auditory Pathways (4)
The central auditory system is a complex network of neural pathways in the brain that is responsible for sound localization, speech understanding in noisy listening situations and other complex sounds, including music perception.

THE PROCESS OF “HEARING”
Sound is transformed into mechanical energy by the tympanic membrane. It is then transmitted through the ossicles to the inner ear where it is changed again into hydraulic energy for transmission through the fluid-filled cochlea. The cochlea’s hair cells are stimulated by the fluid waves and a neurochemical event takes place that excites the nerves of hearing. The physical characteristics of the original sound are preserved at every energy change along the way until this code becomes one the brain can recognize and process.

Hearing loss misleads our brain with a loss of audibility and introduces distortion into the message that reaches the brain. Changes in the effectiveness of the brain to process stimuli, from head trauma, disease, or from aging, can result in symptoms that mimic hearing loss. The ears and the brain combine in a remarkable way to process neural events into the sense of hearing. Perhaps it’s fair to say that we “hear” with our brain, not with our ears

Many people are aware that their hearing has deteriorated but are reluctant to seek help. Perhaps they don’t want to acknowledge the problem, are embarrassed by what they see as a weakness, or believe that they can “get by” without using a hearing aid. And, unfortunately, too many wait years, even decades, before getting treatment.

But time and again, research demonstrates the considerable negative social, psychological, cognitive and health effects of untreated hearing loss… with far-reaching implications that go well beyond hearing alone. In fact, those who have difficulty hearing can experience such distorted and incomplete communication that it seriously impacts their professional and personal lives, at times leading to isolation and withdrawal.

Studies have linked untreated hearing loss to:

• irritability, negativism and anger
• fatigue, tension, stress and depression
• avoidance or withdrawal from social situations
• social rejection and loneliness
• reduced alertness and increased risk to personal safety
• impaired memory and ability to learn new tasks
• reduced job performance and earning power
• diminished psychological and overall health

Hearing loss is not just an ailment of old age. It can strike at any time and any age, even childhood. For the young, even a mild or moderate case of hearing loss could bring difficulty learning, developing speech and building the important interpersonal skills necessary to foster self-esteem and succeed in school and life.

At the Hearing Associates, our mission is to help educate the public about hearing loss and promote the importance of prevention and treatment. On this website, you will find basic information about hearing loss, including advances in diagnosis and treatment, a review of different hearing aids, and resources for medical care and financial assistance.

If you think you or a loved one suffers from hearing loss, don’t delay another day. Visit a hearing healthcare professional and take the first step toward a world of better hearing

In general terms, there are two types of hearing loss, conductive and sensorineural. A combination of both is also seen as a mixed hearing loss.

Conductive Hearing Loss
Conductive hearing loss is caused by any condition or disease that blocks or impedes the conveyance of sound through the middle ear. The result is a reduction in the sound intensity (loudness) that reaches the cochlea. Generally, the cause of conductive hearing loss can be treated with a complete or partial improvement in hearing.

Sensorineural Hearing Loss
Sensorineural hearing loss results from inner ear or auditory nerve dysfunction. Often, the cause cannot be determined. It is typically irreversible and permanent. It, too, reduces the intensity of sound, but it might also result in a lack of clarity even when sounds, particularly speech, are loud enough. The treatment for sensorineural hearing loss is amplification through hearing aids.

Mixed Hearing Loss
A mixed hearing loss is a combination of a conductive and a sensorineural hearing loss. Hearing aids can be beneficial for persons with a mixed hearing loss, but caution should be made, a physician should provide medical clearance prior to the dispensing of a hearing aid.

The signs of hearing loss can be subtle and emerge slowly, or they can be significant and come on suddenly. either way, there are common indications. you should suspect hearing loss if you experience any of the signs below.

You might have hearing loss if you…

Socially:

• require frequent repetition.
• have difficulty following conversations involving more than 2 people.
• think that other people sound muffled or like they’re mumbling.
• have difficulty hearing in noisy situations, like conferences, restaurants, malls, or crowded meeting rooms.
• have trouble hearing children and women.
• have your TV or radio turned up to a high volume.
• answer or respond inappropriately in conversations.
• have ringing in your ears.
• read lips or more intently watch people’s faces when they speak with you.

Emotionally:

• feel stressed out from straining to hear what others are saying.
• feel annoyed at other people because you can’t hear or understand them.
• feel embarrassed to meet new people or from misunderstanding what others are saying.
• feel nervous about trying to hear and understand.
• withdraw from social situations that you once enjoyed because of difficulty hearing.

Medically:

• have a family history of hearing loss.
• take medications that can harm the hearing system (ototoxic drugs).
• have diabetes, heart, circulation or thyroid problems.
• have been exposed to very loud sounds over a long period or single exposure to explosive noise.

Hearing loss

I’ll just have some minor surgery like my friend did, and then my hearing will be okay.
Many people know someone whose hearing improved after medical or surgical treatment. It’s true that some types of hearing loss can be successfully treated. With adults, unfortunately, this only applies to 5-10% of cases.

I have one ear that’s down a little, but the other one’s okay.
Everything is relative. Nearly all patients who believe that they have one “good” ear actually have two “bad” ears. When one ear is slightly better than the other, we learn to favor that ear for the telephone, group conversations, and so forth. It can give the illusion that “the better ear” is normal when it isn’t. Most types of hearing loss affect both ears fairly equally, and about 90% of patients are in need of hearing aids for both ears.

Hearing loss affects only “old people” and is merely a sign of aging.
Only 35% of people with hearing loss are older than age 64. There are close to six million people in the U.S. between the ages of 18 and 44 with hearing loss, and more than one million are school age. Hearing loss affects all age groups.

If I had a hearing loss, my family doctor would have told me.
Not true! Only 14% of physicians routinely screen for hearing loss during a physical. Since most people with hearing impairments hear well in a quiet environment like a doctor’s office, it can be virtually impossible for your physician to recognize the extent of your problem. Without special training, and an understanding of the nature of hearing loss, it may be difficult for your doctor to even realize that you have a hearing problem.

My hearing loss is normal for my age.
Isn’t this a strange way to look at things? But, do you realize that well-meaning doctors tell this to their patients every day? It happens to be “normal” for overweight people to have high blood pressure. That doesn’t mean they should not receive treatment for the problem. Your hearing loss cannot be helped.

In the past, many people with hearing loss in one ear, with a high frequency hearing loss, or with nerve damage have all been told they cannot be helped, often by their family practice physician. This might have been true many years ago, but with modern advances in technology, nearly 95% of people with a sensorineural hearing loss can be helped with hearing aids.

Hearing Solutions

The consequences of hiding hearing loss are better than wearing hearing aids.

What price are you paying for vanity?
Untreated hearing loss is far more noticeable than hearing aids. If you miss a punch line to a joke, or respond inappropriately in conversation, people may have concerns about your mental acuity, your attention span or your ability to communicate effectively. The personal consequences of vanity can be life altering. At a simplistic level, untreated hearing loss means giving up some of the pleasant sounds you used to enjoy. At a deeper level, vanity could severely reduce the quality of your life.

Only people with serious hearing loss need hearing aids.
The need for hearing amplification is dependent on your lifestyle, your need for refined hearing, and the degree of your hearing loss. If you are a lawyer, teacher or a group psychotherapist, where very refined hearing is necessary to discern the nuances of human communication, then even a mild hearing loss can be intolerable. If you live in a rural area by yourself and seldom socialize, then perhaps you are someone who is tolerant of even moderate hearing losses.

Hearing aids will make me look “older” and “handicapped.”
Looking older is clearly more affected by almost all other factors besides hearing aids. It is not the hearing aids that make one look older, it is what one may believe they imply. If hearing aids help you function like a normal hearing person, for all intents and purposes, the stigma is removed. Hearing aid manufacturers are well aware that cosmetics is an issue to many people, and that’s why today we have hearing aids that fit totally in the ear canal. This CIC style of hearing aid has enough power and special features to satisfy most individuals with hearing impairment. But more importantly, keep in mind that “an untreated hearing loss is more obvious than a hearing aid.” Smiling and nodding your head when you don’t understand what’s being said, makes your condition more apparent than the largest hearing aid.

Hearing aids will make everything sound too loud.
Hearing aids are amplifiers. At one time, the way that hearing aids were designed, it was necessary to turn up the power in order to hear soft speech (or other soft sounds). Then, normal conversation indeed would have been too loud. With today’s hearing aids, however, the circuit works automatically, only providing the amount of amplification needed based on the input level. In fact, many hearing aids today don’t have a volume control.

I am concerned about the integrity of hearing health professionals and the value of hearing aids.
Rest assured in our research at the Hearing Associates with thousands of people like you we found that hearing healthcare professionals receive customer satisfaction ratings of 92%. And 9 out of 10 people indicate that the quality of their life has improved with hearing aids. Overall satisfaction with 1 year old hearing aids is now 78% which is close to satisfaction ratings for most consumer electronics.

“The most basic of all human needs is the need to understand and be understood. The best way to understand people… “

Noise is one of the most common causes of hearing loss, and one of the most common occupational illnesses in the United States. A single shot from a shotgun, experienced at close range, may permanently damage your hearing in an instant. Repeated exposures to loud machinery may, over an extended period of time, present serious risks to human hearing.

• 10 million Americans have already suffered irreversible hearing damage from noise;
• 30 million are exposed to dangerous noise levels each day.
• The effects of noise on hearing are often underestimated because the damage takes place so gradually.

Excessive noise damages the delicate hair cells in the inner ear. This damage results in sensorineural hearing loss and often tinnitus (ringing of the ears). Dangerous levels of noise can come from working in noisy occupations or in engaging in dangerous recreational activities:

• Beware of dangerous recreational activities: video arcades, fire crackers, discos, music concerts, shooting
  a gun, movie theatres, sporting events, motor boards, motorcycles, snowmobiles, “boom cars”.
• Occupations particularly under risk for hearing loss due to exposure to noise are as follows: firefighters, police officers, factory workers, farmers, construction workers, military personnel, heavy industry workers, musicians, entertainment industry professionals.

If you have to raise your voice to shout over the noise to be heard by someone within an arm’s length away, the noise is probably in the dangerous range. Some of the warning signs of the presence of or exposure to hazardous noise are as follows:

• You can’t hear someone three feet away
• You have pain in your ears after leaving a noisy area
• You hear ringing or buzzing (tinnitus) in your ears immediately after exposure to noise
• You suddenly have difficulty understanding speech after exposure to noise; you can hear people talking but you cannot understand them.

What You Can Do to Protect Your Hearing

• If you work in an at-risk occupation, check with your employer to make sure you have adequately protected your hearing according to OSHA regulations.
• Limit exposure time to noisy activities.
• Wear hearing protection, such as foam or silicone plugs or muffs. Foam plugs are available at your pharmacy while muffs and specialized ear protection can be purchased at sporting good stores or safety equipment stores.
• At home, turn down the volume on the television, radio, stereos and walkmans.
• Wear ear plugs or muffs when using loud equipment (i.e. lawn mowers, power saw, leaf blower).
• Buy quieter products (compare dB ratings – the smaller the better).
• Reduce the number of noisy appliances running at the same time in your personal environment.
• Avoid medications that can be dangerous to your hearing. Be sure to ask your physician about possible effects on your hearing.

An Ounce of Prevention
Be alert to hazardous noise. Since prevention is so critical, make sure that your family (especially children), friends, and colleagues are aware of the hazards of noise. Remember: One-third of hearing loss is preventable with proper hearing protection.

Tinnitus is the perception of a sound that has no external source. Some of the more common sounds reported are ringing, humming, buzzing, and cricket-like. It can be constant or intermittent and is heard in one ear, both ears or in the head. Tinnitus can originate in the middle ear (behind the eardrum) or in the sensorineural auditory system.

THE MOST COMMON CAUSES ARE:

• Noise exposure (e.g. from shooting or machines at work)
• A natural part of the aging process
• Head injury (e.g. from a car accident or fall)
• As a side effect of medications (e.g. aspirin — see ototoxic drugs)

Many causes are unknown.
Tinnitus is usually accompanied by hearing loss, and sometimes accompanied by loudness hyperacusis (when moderately loud sounds are perceived as very loud). Some 50 million adults suffer from tinnitus (it can also affect children). For 12 million, the problem is severe enough that it impacts their everyday life. Because tinnitus can be a symptom of a more serious disorder, it is important to have an appropriate health evaluation, from an audiologist or physician.

The Impact of Tinnitus

Tinnitus affects people differently. The most common areas in which tinnitus has a direct influence are:

• Thoughts and emotions. Some are annoyed, bothered, depressed, anxious or angry about their tinnitus. They think and focus on their tinnitus often.
• In some, the sound of the tinnitus competes with or masks speech or environmental sound perception.
• Many tinnitus sufferers report that their tinnitus interferes with them getting to sleep. It can also make it more difficult to get back to sleep when they wake up in the middle of the night.
• Some tinnitus sufferers report that they have difficulty focusing on a task because of their tinnitus. This might include reading a book or the newspaper.

The Treatment of Tinnitus
For most tinnitus sufferers, there is no cure. There is no pill or surgery that has been shown to eliminate tinnitus in scientific studies that have been replicated and accepted by the healthcare community.

There are some important exceptions to this. Some forms of tinnitus, particularly middle-ear tinnitus, can be treated. Sometimes a medication can cause tinnitus, and stopping or changing medications can eliminate the tinnitus (check with whoever prescribed the medication).

There are two broad categories of treatments that help people adjust to their tinnitus.

• Counseling can be beneficial with thoughts and emotions, hearing, sleep and concentration. One example of this approach is Tinnitus Activities Treatment, which includes individualized collaborative counseling in each of these areas.
• Sound Therapy. Many tinnitus sufferers report that the presence of background sound reduces the prominence or the loudness of their tinnitus. The background sound can be present in the environment (e.g. fan noise). There are non-wearable devices that produce pleasant background sound (e.g. raindrops). Additionally, wearable maskers or sound generators are available that produce a ‘shhh’ noise (these can also be combined with hearing aids). The use of hearing aids improves communication, reduces the stress associated with intensive listening, and also can partially mask the tinnitus. Music can also be very effective in non-wearable and wearable devices.
• Self-help Books. There are also some excellent self-help books available.

Conclusion
If you or someone you know suffers from tinnitus, I urge you to contact a physician who specializes in the ear (an otologist or otolaryngologist) or an audiologist as soon as possible to get tinnitus help.