Break the Silence: Exploring hearing loss causes and treatments

Hearing loss affects people of all ages, newborns included, but is most common in older adults.

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One in six adults has trouble hearing and the number increases dramatically with age, with hearing loss afflicting nearly half of people 75 and older. Yet the majority of Americans with hearing loss (about 75 percent) never go to a doctor for diagnosis and treatment. As otolaryngologists—doctors who specialize in conditions affecting the ear, nose and throat—we find this to be an alarming number of people who could potentially benefit from hearing loss treatment.

With hearing loss, a lot of important information in your environment can be missed. It can be challenging to function at work or enjoy your relationships. It can lead to depression and social withdrawal. Untreated hearing loss can sometimes mask more serious medical conditions, such as tumors, and has even been associated with cognitive decline.

The important thing to know is that there are treatment options available. Age-related hearing loss is usually not reversible, but a number of devices can greatly improve your hearing, from cochlear implants and bone-anchored hearing aids (BAHAs) to new digitally programmable hearing aids. These “smart” hearing aids are not only more comfortable to wear; they are easier to use and can be programmed to offer customization to your specific hearing loss.

Common Causes of Hearing Loss

While aging is the most common culprit, hearing loss has many possible causes. Noise is a big one, whether it’s from exposure over time (such as at work) or from sudden very loud noises produced by firearms, loud machinery, motors and jet engines.

To help protect against noise-induced hearing loss, we recommend using hearing protection in noisy environments. (Employers are required to offer hearing protection that complies with guidelines set by the Occupational Safety and Health Administration.)

In addition, certain medications can cause hearing loss and/or tinnitus (ear ringing). These include some antibiotics (aminoglycosides like gentamicin, streptomycin and neomycin, for example), some chemotherapy drugs and high doses of aspirin or nonsteroidal anti-inflammatory drugs (NSAIDS). Other common causes of hearing loss include, but are not limited to:

1. Excessive ear wax, which can block the ear canal
2. Infection or fluid in the middle ear
3. Ménière’s Disease, a disorder of the inner ear that can cause episodes of tinnitus and vertigo
4. Viral or bacterial infections, heart conditions and stroke, all of which can damage the delicate inner ear
5. Structural issues within the ear

You should see your doctor if you suffer sudden hearing loss or if you begin having hearing difficulty. You might first notice you’re having trouble in situations where there is cross-talk or background noise, like at a dinner party, in a classroom or in a meeting. You might also find yourself turning up the TV and asking people around you to speak up or repeat themselves.

Your primary care doctor will likely do an initial assessment, perhaps including whispering or rubbing his or her fingers near your ear. If your doctor finds evidence of hearing impairment, you will be referred to an otolaryngologist and an audiologist, who typically work together to do a more complete assessment. The audiologist has equipment that can distinguish between the two major types of hearing loss:

Conductivewhich involves the outer ear and middle ear and their ability to conduct sound to the inner ear. Conductive hearing loss is most commonly seen in young children in the form of middle ear fluid, but also includes everything from malformations that can sometimes be treated surgically to earwax that can be removed in the office.

Sensorineural, which involves the delicate inner ear, where the cochlea transmits sound to the brain through the cochlear nerve. This is the kind of hearing loss associated with aging and/or nerve damage. Though not usually reversible, it can be improved with hearing aids and other devices such as cochlear implants.

The otolaryngologist will then do a further examination and come up with a treatment plan.

Hearing Aids: Reducing the Stigma

Historically, there has been resistance to hearing aids because of their association with aging, but this is changing as they become more sophisticated and easier to use. Today, ear devices of all sorts—cochlear implants, bone-anchored hearing aids, bluetooth, wireless earbuds, etc.—are being worn on the ear, and hearing aids have become more socially acceptable. Some patients are even showing off their hearing aids, opting for attractive designs and bright colors.

Just as people who need vision aids like glasses or contact lenses go through an adjustment period, people who need hearing aids must get used to wearing them. Hearing amplification is not appropriate for all hearing loss patients, but those who would benefit often have improved quality of life. The main obstacles are the learning curve and the cost (about $2,500 to $5,000 for an average pair of hearing aids, which is not typically covered by insurance or Medicare). As technology continues to improve, these devices will likely become even more effective and user friendly.

For more information about hearing loss and various treatment technologies, visit the American Academy of Otolaryngology-Head and Neck Surgery‘s and the National Institute on Deafness and Other Communication Disorders‘ websites.

Photos courtesy of Kendall X. Watson, Kaiser Permanente

Thuy-Anh Melvin, MD, and Shankar Sridhara, MD, are board-certified otolaryngologists and head and neck surgeons with the Mid-Atlantic Permanente Medical Group. Both doctors see patients at the Kaiser Permanente Tysons Corner Medical Center.