48 million Americans have significant hearing loss. 1 out of 3 people over age 65 have some degree of hearing loss. 2 out of 3 people over 75 have a hearing loss. 14% of those ages 45-64 have some type of hearing loss.
1) Age Related Hearing Loss:
The most common cause of hearing loss is presbycusis, or age-related hearing loss. The cochlea, an organ in our inner ear, is responsible for converting mechanical vibrations to nerve signals that the brain can interpret as meaningful sounds. The cochlea is composed of fragile cells that are susceptible to injury due to microscopic chemical and mechanical exposures that occur in day-to-day life. The aging process results in deterioration of these cells. These changes in the cochlea cause hearing loss that can be subtle and gradual. Often, hearing loss is quite advanced before a person notices the change. In fact, in many cases, friends and family will complain about their loved ones’ hearing impairment first. Typically, presbycusis initially affects high frequency, or high pitched, sounds. Often, people notice difficulty hearing women and children. Bird watchers and musicians are particularly sensitive to the loss of high pitched hearing. Hearing is usually preserved in the low frequency range, therefore men’s voices are frequently more easily heard and understood. Assistive hearing devices such as hearing aids can be very effective in treating presbycusis.
2) Noise Induced Hearing Loss:
While presbycusis is the most common cause of hearing loss, the second most common cause is injury from loud noise. Individuals who are exposed to excessive sound on a regular basis are at risk of losing their hearing. The mechanical vibrations of these sounds overtax the sensitive nerve cells in the cochlea and cause progressive and potentially irreversible injury. Sound over 85 decibels is considered “excessive.” Rock concerts, construction noise, factory noise, lawn and garden equipment, and hair blow dryers can all contribute to high-frequency hearing loss. One-time exposure to explosively loud noises, such as a shotgun or cannon blast can result in similar damage. There is also an increase in hearing loss in young people as the use of earbuds and headphones increase day to day sound exposure. While hearing aids can be helpful once this type of hearing loss has occurred, prevention is the best option. Avoid loud noise exposure when possible and consider the use of ear plugs or safety headphones.
3) Head Trauma:
Mechanical trauma to the head can cause hearing loss. As a concussion to the head can cause foggy thinking, light sensitivity, and headaches, a concussion to the cochlea can damage the hearing cells and result in hearing loss. Additionally, the mechanical forces of trauma can also disrupt the bones within the ear resulting in significant hearing loss. This kind of hearing loss will often require imaging studies (such as a CT scan) for diagnosis and occasionally require surgical intervention. In cases of irreversible hearing loss due to head trauma, hearing aids can be helpful.
Tumors can be a cause of hearing loss. While some malignant tumors can affect hearing, the most common tumor resulting in hearing loss is an acoustic neuroma. Acoustic neuromas (or vestibular schwannomas) are benign, non-malignant, tumors affecting the hearing and balance nerve. Generally, these tumors grow very slowly and cause a gradual hearing loss only in one ear. These tumors are typically first detected with a formal hearing test. The diagnosis can be confirmed definitively with a brain MRI. Treatment may involve surgery or a specialized type of radiation.
5) Ear Infections:
There are generally two mechanisms of hearing loss due to infections. Most commonly, the hearing loss is due to a disturbance of the air pressure and mechanics within the ear. Generally, these hearing losses are temporary, and the hearing is usually restored once the ear infection is resolved. Even frequently occurring ear infections can be successfully addressed and the hearing loss restored. In other cases, and infection can result in inflammation and injury to the hearing cells or hearing nerves. These need to be diagnosed and treated on a more urgent basis. Occasionally, these ear infections can be associated with a permanent hearing loss. Because early treatment is important, sudden hearing loss should be evaluated in a timely manner.
6) Ear Wax:
Cerumen, or ear wax, is naturally produced by glands in the outer ear canal and serves to protect the ear from infection and airborne debris. An excessive amount of wax in the ear can block the passage of sound through the ear canal resulting in hearing loss. Removal of the wax results in restoration of hearing.
7) Meniere’s Disease:
Meniere’s disease is a chemical and fluid imbalance within the cochlea. This disorder results in repeated episodes of fullness and ringing in the ears, dizziness, and hearing loss. If you are diagnosed with Meniere’s disease, your doctor will discuss management options including dietary and behavioral modifications, medications, and possibly surgery. Hearing loss due to Meniere’s disease can resolve or can be progressive and permanent. Hearing aids are often an important part of the management of Meniere’s disease.
Certain medications can cause hearing loss. Examples are chemotherapy agents, antibiotics, diuretics, and antidepressants. If you are experiencing hearing loss associated with a new medication, your hearing should be evaluated. Sometimes the medications can be discontinued or replaced with one that is not toxic to the ear.
How do you know if you might have hearing loss?
- If you are experiencing some of the following, it could be suggestive of hearing loss:Are others pestering you about your hearing loss? Close family members and close friends will not be shy to let us know that we are not hearing well.
- Do you have the sense that others are mumbling? We hear commonly from patients that others do not speak clearly. Yes, some people do mumble, but I suspect the incidence of mumbling is no greater now than it was 40 years ago. The perception of mumbling may be a sign of hearing loss
- Do others complain that you have the TV turned up too loud?
- Do you have difficulty understanding conversation over the telephone?
- Are you having difficulty hearing in noisy environments, like restaurants?
- Do you find yourself asking others to repeat themselves?
- Do you have tinnitus, or ringing in the ears?
Answering yes to some of these questions can be suggestive of hearing loss. We suggest obtaining a hearing test with one of our doctors of audiology to assess if you might have a hearing loss.