What can cause hearing loss?
Damage to the outer, middle or inner ear. This can be from trauma, noise exposure, medication, autoimmune or metabolic disease conditions, tumors that are benign or malignant, or age-related changes. Just as with other organs and organ systems, there's degeneration of cells and nerves as we age.
What factors increase risk for developing age-related hearing loss?
In addition to the degeneration related to age, there's also noise exposure through the years and diseases of the ear that affect the middle ear like otosclerosis, which is the fixation of the ear bone, or Ménière's Disease. If you've had had a long-standing history of a chronic draining ear, which is called chronic otitis media, that will affect your chances of developing loss.
And of course, genetic background and general health will also affect the degree of hearing loss.
There are certain medical conditions that may affect your hearing loss such as diabetes and high blood pressure. Now, all the studies demonstrating this effect aren't excellent, controlled studies, but there is some thought, with diabetes for example, that the narrowing of blood vessels that occurs can compromise the blood flow in the ear, as it does in other organs, such as the kidneys and the eyes. With high blood pressure, it's not as clear-cut, but the thought is that anytime there's decreased blood flow to the inner ear, you can have some damage to your hearing.
What medications are associated with hearing loss?
The most common medications associated with hearing loss are a certain class of antibiotics called the aminoglycosides; gentamicin is the one that's most commonly cited for hearing loss. The other drug commonly associated with hearing loss is the chemotherapy agent cisplatin.
Often, patients who are on these medications will be informed that hearing loss can be a problem, and they are referred for baseline hearing test and have their hearing followed.
What are the early signs of hearing loss?
People come in with a variety of complaints. They usually have their spouses complaining that they're turning up the TV. They're not hearing the telephone ring. They're driving and have to turn the radio or music up in their cars. Every now and then they won't hear people honking or they won't be aware of the traffic because they're not able to hear it. Older people will have the most trouble with high frequencies such as high-pitched crying, female voices and children's voices. An example of a low frequency would be a deep male voice.
Occasionally you can also have ringing of the ear, also known as tinnitus, associated with hearing loss. Ringing is frequently due to loud noise exposure or noise exposure that accumulated throughout the years, and/or some neural damage. Occasionally, people will come in complaining of the ringing, and we check their hearing and notice that they have a hearing loss in addition to the ringing.
Why do you think so many people deny their hearing loss at first?
There's definitely a stigma associated with hearing aids. Many people don't want to wear a hearing aid, so often they deny or discount that they have a problem.
How do you confirm the diagnosis?
Usually we do a physical examination. That way we identify that there's no foreign body or a tumor in the ear canal or in the middle ear space that's causing this problem, although that's rare. Occasionally you can have a benign tumor called a cholesteatoma that can cause hearing loss. We ensure that the eardrum and canal is normal, and that there's no infection. Then we do an audiogram, which is performed in a sound booth by an audiologist, and that is where the actual decibel level or loudness that the patient can detect is determined. Afterwards, we do a speech discrimination score to determine, of the words that the patient is hearing, how many they are understanding.
So it's not enough to just hear it, but you also have to understand it, and that's where nerve loss comes into play. For example, people with nerve loss can hear, but words are jumbled and garbled and they can't make sense of them.
How do you measure hearing loss?
To determine if someone has hearing loss, we use a scale to measure the lowest decibel, or loudness level, that you can hear. People with normal hearing can hear tones that are between 25 and 0 decibels.
A whisper is probably about 20 decibels. If you are in an airport, and you're outside where you can hear the airplane revving up (say you're one of the workers on the ground crew), that's about 100 decibels. The average conversation is about 50 to 60 decibels.
There's mild, moderate, severe and profound hearing loss. If someone requires 70 decibels to hear a tone, then they're in the severe and profound range. If they require 25 decibels, then they're at the lower edge of normal.
Can a wax build-up cause hearing loss?
Yes, that can happen. It's actually a good thing when it is the cause of hearing loss because it's very treatable. As we age the cells in the ear canal don't produce as much moist wax, so you get drier wax that may be more likely to cause impaction. But usually the hearing loss in older people is due to a combination of the wax and nerve damage.
What can be done for wax buildup?
If you have a problem with wax build-up, you experience a clogged sensation, and you should go to your physician to have it removed. Usually we take the wax out under a microscope with suction devices. Or we use instruments that are called curettes.
But to avoid wax buildup we often tell patients to use one or two drops of mineral oil, maybe once every two weeks or three weeks or so, just to keep the canal moist. We discourage cotton swab use because cleaning the ears is not necessary. Usually the wax liquefies, so often people will feel moisture, especially at night. But it just self-expels, either in the shower or during the day, so there's really no need to use cotton swabs. Also cotton swabs can push the wax that does exist right up to the eardrum and lead to eardrum injuries.
And finally, if you take out all the protective wax, it leaves an acidic environment in the ear canal. Then you may develop an external canal infection, or otitis externa, which is very painful and requires treatment with antibiotic eardrops.
What devices are available for hearing loss?
For age-related hearing loss, the best thing we have is hearing aid or amplification. The hearing aids that are available now are really wonderful in that certain segments of the frequencies can be amplified. Most common hearing loss is called sensory presbycusis, where the hearing only drops in the high frequencies. Now there are aids available that can just make the high frequencies louder and preserve the lower frequencies, whereas before the hearing aid would be like a microphone amplifying everything. People were really uncomfortable because the lower frequencies were so loud.
The cosmetics of hearing aids have also improved, so now there are really small aids that go in the ear that decrease some of that stigma of wearing a hearing aid. But if you have a really severe hearing loss, then the bulky ones are the ones that are more visible or more powerful, and those are the ones you might need.
What advice would you give someone needing a hearing aid?
It's important to consult with an audiologist who's very well versed in hearing aid technology, rather than going directly to just any hearing aid distributor. You need to figure out what type of loss you have and what particular type of hearing aid would be best. We often see elderly people who have spent thousands on a hearing aid, and it's not the proper aid for them. And if they have the wax buildup, then their hearing aid will either be plugged up or they won't be able to hear anyway, and they'll have a lot of feedback noise. And then people get frustrated, and the majority of the hearing aids in this country are in someone's bedroom drawer rather than in the ear where they belong.
The most credible establishments will have a policy where you can borrow the aid for 30 days with a money-back guarantee if they're not working out for you.
Is there anything that people can do to minimize hearing loss as they age?
The best thing is to protect yourself from loud noise exposure. So if you happen to work in the music industry, for example, then you really want to wear the highest quality earplugs that you can to protect your ears from the loud noises.
When should adults have their hearing checked?
It's not a bad idea to have your hearing checked every year if you're concerned about it, or if you have ringing. You definitely want to get your hearing checked if you have any vertigo or spinning. |
