Comprehensive Guide to Hearing Loss

How Hearing Loss Occurs

Hearing loss is a broad term to cover any form of disabling hearing issue that affects how well you can hear things. This can mean that there is a structural issue within your ear that causes your hearing to be affected, or maybe there are issues deep inside your ear connected to the nerves that create these issues. Millions of people are born with hearing problems, but many more also develop hearing loss as they age.

Hearing loss can occur at many levels, from very mild to severe to not being able to hear anymore, which is known as deafness.

No matter the form of hearing loss you’re living with, there are some important parts of the ear you need to know. We’ll work from the outer ear inward. These parts of the ear include:

• Auditory canal: Known as your ear canal, it moves sound from the outside through to your eardrum.
• Eardrum: This vibrates when you hear sound, sending the waves to the ossicles.
• Ossicles: These are three little bones—known informally as the hammer, the anvil, and stirrup—that transfer sound to the cochlea. They’re the smallest bones in the human body, but damaging them can cause severe hearing loss.
• Cochlea: A fluid-filled, spiral-like membrane that transforms sound waves to signals that get passed on to the brain.
• Vestibulocochlear nerve: The nerve that sends sound waves to the brain, it has two parts: the vestibular nerve (relates to balance and your equilibrium) and the cochlear nerve (relates to hearing).

Now that we know those, let’s dig into what happens when they are affected. There are two main forms of hearing loss:

Conductive Hearing Loss

This occurs when you have issues with the outer ear and middle ear, which include the ear canal, eardrum, and ossicles. It’s the less common form of hearing loss, and even though it can develop into a permanent issue, it is more easily treatable than the other.

Sensorineural Hearing Loss

This is the most common type of hearing loss. Sensorineural hearing loss means that something is wrong with the nerve-related parts of your ear, like the cochlea and vestibulocochlear nerve, which send sound waves to the brain.

There is also a form of hearing loss called mixed hearing loss. This occurs when there are components of conductive hearing loss and sensorineural hearing loss causing the hearing issues. While treatment for conductive and sensorineural are different, audiologists recommend that you get the conductive hearing loss treated first before dealing with the sensorineural, if you have issues with both.

The National Institute on Aging points out that there is another form known as rapid hearing loss, and that seniors need to be on the lookout for. When this occurs, seniors can lose hearing all at once or over the course of a couple days. It needs to be treated immediately.

Hearing loss can onset in a multitude of ways, and how it onsets can determine what form of hearing loss you have and how it is treated. One of the primary ways you can develop hearing loss is simply by aging. It is known formally as presbycusis, but from now on we’ll refer to it as age-related hearing loss.

This condition usually affects both ears equally, gradually decreasing the usage of your ears so slowly that you may not realize it has onset until it’s progressed to a detrimental point. The National Institute on Deafness and Other Communication Disorders (NIDCD) says that age-related hearing loss occurs simply because all the parts of our ear change as we age, making them less effective. (This is kind of similar to how the eyes and other organs may gradually not work as efficiently as they once did.)

What Causes Hearing Loss

This isn’t the only way seniors suffer from hearing loss, though. There are many reasons why hearing issues may develop in an older age, including:

Exposure To Noise

Overexposure to noise can cause hearing loss. Typically, consistent noise above 85 dB is what really does the damage. The noise damages the hair-like cells that exist in the ear and causes a gradual loss of hearing.

Genetic

Hearing issues may just run in your family.

Trauma

Suffering trauma to the head, especially the skull, can disturb the way your vestibulocochlear nerve transmits information to the brain. It can also damage your ossicles or eardrums, which are part of the sound-transmitting process.

Build-Up Of Fluid

The build-up can occur on the outer portion (wax, blood) or inner part (via disease) of your ear that can affect how sound moves through the ear.

Pressure

Pressure to various parts of your ear, typically from dropping to lower attitudes (like divers consistently existing in high-pressure environments underwater), can permanently damage your ear.

Antibiotics

Consuming large amounts of Vicodin, aspirin, chemotherapy drugs, and other medications can damage the hair-like cells in your inner ear.

Disease

Autoimmune issues, diabetes, and leukemia can damage your ear from within. There’s also an ear disease called Meniere’s disease that affects one ear at a time that causes vertigo, ringing, and pressure.

Infections

When infections occur in the ear (like ones that occur from a buildup of fluid) or throughout the body (like herpes, mumps, measles, the flu, and more), your hearing can be permanently damaged.

Signs And Symptoms Of Hearing Loss

Hearing loss reveals itself in many forms. In fact, they can creep up so slowly that you may not even notice you have hearing loss until it starts to take a significant toll on you.

Some signs of hearing loss include:

• Difficulty hearing conversation, both in person and over the phone
• Needing to turn the volume up on the television to extremely loud levels
• Difficulty hearing softer-speaking people
• Needing people to speak louder and slower to help you process the information
• Trouble hearing consonants (according to the Mayo Clinic)
• Tendency to think people are mumbling
• Exiting conversations because it’s hard to keep up

The symptoms of hearing loss manifest themselves in more physical, potentially painful, ways. These symptoms can often coincide with illnesses like the common cold and other infections, and they include:

• A constant ringing sound in one or both ears
• Nausea
• Dizziness
• Vomiting
• A pain in and around the ear
• A buildup of fluid, sort of feeling like there’s water in your ear

These symptoms may point to different forms of hearing loss. For instance, leaking fluid may indicate conductive hearing loss as there could be a buildup of fluid within the canal. On the other hand, a constant pain or ringing can mean that there’s an infection deep inside the ear.

How Hearing Loss Can Affect Your Daily Life

Hearing loss can begin to really affect your daily life when it develops into disabling hearing loss. This occurs in adults when they incur a loss of hearing 40 decibels (dB), a unit of sound, in their best ear.

For instance, a normal conversation occurs at about 60 dB, according to the NIDCD. Someone with disabling hearing loss needs more than 100 dB—about the loudness of max volume on a music player—to hear this conversation without any aid. The different levels of hearing loss are categorized as follows:

• Mild hearing loss: Loss of 21 to 40 dBs, difficulty hearing sounds like a human breathing
• Disabling hearing loss: Loss of 40 to 55 dBs, difficulty hearing in-person conversations
• Moderately severe hearing loss: Loss of 56 to 70 dBs, difficulty hearing televisions at moderate volume
• Severe hearing loss: Loss of 71 to 90 dBs, difficulty hearing loud traffic
• Profound hearing loss: Loss of more the 90 dBs, it’s difficult to hear loud engines and orchestras (in a pit) at this point

Not being able to hear or having difficulty hearing normal sounds like the door opening, a simple conversation, or the television on a normal volume can really start to affect how elderly people experience their daily lives.

Social Aspects

Having difficulty hearing can cause issues in your social life. To put it simply, it’s hard to interact with people on a fluid basis when you can’t understand what they’re saying. This can force seniors into reducing how much they interact with their friends and family.

Isolation can cause a slew of health issues for elderly people, including an increased rate or mortality, the advancement of cognitive diseases like Alzheimer’s, and depression, which has its own list of health problems, too. Once they’re isolated inside, it becomes difficult to hear a lot of practical goings-on in your living space, too.

Practical Aspects

Hearing loss can make it difficult to hear simple, practical things like someone knocking on the door, the door opening, the phone ringing, the television at a moderate volume, and a busy street. Most importantly, hearing loss can prevent you from hearing other people.

In all of these instances, someone’s life can be put in danger. Let’s say there’s an intruder that enters your home, and you need to notify authorities. Hearing loss could make it difficult for you to know that they’re even there until you see them.

Also, when you’re out and about on the town, hearing loss could put you in danger when you’re crossing the street, as you may not know a car is coming around the corner until the driver blares the horn. It may also increase the rate at which you fall because you’re not quite as aware of the sonics of your surroundings.

Economic Aspects

Hearing loss can make working incredibly difficult. Let’s say you have a job as a receptionist or telemarketer in your older years as a way to keep a steady income. Not being able to hear and understand the conversations you have on the phone can put you out of work.

The World Health Organization predicts that hearing loss’s economic impact is higher than $750 billion, between the amount of money that gets poured into treating it and the money lost by people with hearing loss not being able to work to their full potential.

Hearing Loss Treatment And Aids

The first part of the hearing loss treatment process is getting diagnosed with the right form of hearing loss. There’s not much treatment plans will do if doctors don’t exactly know what they’re treating. The earlier you’re able to detect you’re suffering from hearing loss, the better.

Unfortunately, many elderly people will wait an average of seven years between the time they first realize their hearing might be impaired and the time they get treatment. The moment you realize it’s more difficult to hear than it has been, you should be looking into doctors or audiologists for help.

Testing for hearing loss is done in a series of ways, including:

Questionnaire

Some doctors will ask you a routine series of questions like “do you struggle to hear the television at its normal volume?” or “do you ask people to speak up or repeat themselves in normal conversation?” Answering yes to questions like this helps doctors understand what they’re dealing with.

Physical Test

Doctors will primarily inspect your ear to see if there’s anything they can see from the outside that’s causing hearing loss, like a buildup of fluid.

Tuning Fork Tests

Doctors will hold pronged forks near your ear and strike them, causing them to make sound at varying frequencies. Depending which ones you can hear or not can let them know how well you can hear. According to the Mayo Clinic, these tests can also reveal what part of the ear you may be having issues with due to the vibrations given off by the tuning forks.

Audiometry Tests

Audiologists may conduct a thorough test called a “pure-tone audiometry” with an audiometer, which helps specifically detect how hard of hearing you may be. The test is conducted with headphones, and doctors control what type of sounds are played at what frequencies. These tests are more than 90 percent accurate and help pinpoint exactly what may be wrong.

Once these tests are conducted, doctors will develop a treatment plan for your hearing loss. As we mentioned before, the conductive hearing loss issues (fluid buildup, other outer and middle ear issues) will be dealt with first in order make the sensorineural issues a bit easier to handle.

In any case, all of these treatments are done to help elderly people live independently longer while not suffering the dangerous side effects of hearing loss like isolation and decreased awareness of your surroundings.

Because it typically gets treated first, let’s discuss treatments for conductive hearing loss:

• Remove the fluid: Whatever is blocking your ear—wax, blood, or some other leaking fluid—doctors will try and clear the inner canal to help sound travel to the back of the ear better.
• Medications: Various prescriptions and ear flushes can help clear out the outer parts of the ear, largely focusing on thinning out whatever is blocking the sound and draining it out.
• Surgery: If simpler procedures and medication don’t work in cleaning up your inner ear, surgery may be required. This is especially true if you have a tumor that’s causing the issue.

Once those issues are dealt with, treatments for sensorineural issues include (this is where the in-depth technology and treatment come in):

Hearing Aid

This is one of the most popular, effective, and useful treatments for issues deep inside the ear. Sometimes, these are recommended for people with conductive hearing loss, too. Aids don’t eventually “fix” whatever is wrong with your ear, because they simply bring the sound from the outside to the inner parts of your ear that are still working and can send these signals to the brain.

Hearing aids come in many different shapes and styles depending on how hard of hearing you are. Some rest behind your ear to capture sound, some rest deep in your ear, and others receive the sound within the ear canal. There are even apps on your phone that allow you to control the sounds and volume associated with hearing aids. Talk to an audiologist to see which fit may be best for your situation.

Cochlear Implants

Cochlear implants don’t quite work how hearing aids do. They’re a bit more of an intricate process, so they’re typically reserved for patients who have severe hearing loss in one or both ears. Whereas hearing aids amplify sound, cochlear implants aims straight for the vestibulocochlear nerve for stimulation with the goal of bypassing everything else that’s wrong with the ear. The implants are more like prosthetics that help the ear work how they should again.

PSAPs

Personal sound amplification products (or PSAPs) are similar to hearing aids, but are around 50 to 75 percent less expensive. That being said, they don’t work as well or address all the problems of hearing loss, but they’re still certainly helpful. They have hit a snag with the Food and Drug Administration, where they can’t be advertised as products that improve hearing—because they don’t. They amplify sound while not canceling out a lot of distortion and other noise hearing aids do. But there are groups lobbying the FDA to allow these products to be advertised as such.

Amplification Systems/Speakers/Headphones

No, we’re not talking about something associated with a live concert. However, an elderly person who is hard of hearing can be helped by a system with a speaker or amplifier on it that helps bring out dialogue without completely distorting everything else coming out of the television.

Wireless headphones and headsets can work with this, too. They make it so that a fuller sound enters your ears rather than something that is uncomfortably loud for everyone. These systems don’t always help every part of life that’s affected by hearing loss, but they’re certainly helpful in social settings within the home.

Hearing Loss Prevention

Hearing loss, in most cases, is a condition that develops over a lifetime, which means prevention lasts a lifetime. However, if you’ve begun to feel the effects of hearing loss in an older age, that doesn’t mean there aren’t steps you can take to give your ears the best conditions possible.

Let’s take a look at some of the preventative lifestyle choices:

Wear Hearing Protection

This is the most obvious preventative step that doesn’t always get taken seriously. Prolonged exposure to sound over 85 dBs, such as loud stereos, concert halls, and loud traffic, is not healthy for your ears.

No, this doesn’t mean you need to walk around the city all day every day with ear plugs, but this is especially important for people who work around loud noises and places like airports, sports venues, gun ranges, and concert venues. Popular ear protection include ear plugs, larger headphones, and noise-cancelling headphones, which help give your ears a much-needed break.

Turn Down The Volume

You don’t need to be listening to music and the television at its loudest volume all of the time. Sure, there’s a time and place to turn the knob up, especially when a lot of people are in the room with chatter ablaze, but loud televisions and stereos can damage your ears. Try and keep the volume around half its highest point unless it’s really needed. This is especially true for when you’re wearing headphones.

Buy Suitable Products

Simply put, purchase products that don’t aim to blow the speakers out when you turn it up a little. Various products have maximum decibel volumes, and all it takes is a little research to find out which products have manageable and healthier volumes.

If you have any questions regarding hearing loss, such as the different forms and the treatment process, contact an audiologist or your primary care physician.