Symptoms, Causes, Treatment, and More
10 July 2019
If you have trouble understanding conversations in restaurants or in other noisy settings, or if you need to turn up the TV louder than those around you, you're not alone. Around one out of every seven adults in the United States reports some difficulty hearing.
Table of Contents
- What are the symptoms of hearing loss?
- What are the causes of hearing loss?
- What are the types of hearing loss?
- What are the consequences of untreated hearing loss?
- How is hearing loss treated?
- What is the prevalence of hearing loss?
- How can hearing loss be prevented?
- Does hearing loss cause dementia?
- Who are some celebrities with hearing loss?
- How do I know if I have hearing loss?
- How can I cope with my hearing loss?
- How do I read a hearing test?
What are the symptoms of hearing loss?
Symptoms of hearing loss can be difficult to identify, particularly if the onset is gradual. Many times a loved one notices a problem before the person with the hearing loss does. Symptoms of hearing loss may include difficulty hearing in background noise. Examples of noisy environments may include social settings with several people speaking at once, such as restaurants, grocery stores, churches, movie theaters, sporting events, etc. Hearing in the car can be especially difficult due to two factors. One, is the road noise can seem as if it is drowning out the conversation, and the second factor is the inability to face the person you are speaking with. Without visual cues, you may find it difficult to hear conversational speech in the car. All of us, even those of us with normal hearing, benefit from good communication strategies such facing the person you are speaking with. Those of us with hearing loss have an especially difficult time hearing what someone is saying when that person is not facing you. You may find that you are unable to follow conversation without face-to-face visual cues and particularly struggle when someone speaks to you from another room. Additionally, you may find that you need more volume than others to listen to the television or radio.
Another symptom of hearing loss is feeling as if people seem to mumble. You may frequently find yourself thinking “if so-and-so could just enunciate or slow down, I’d have no problem hearing.” Frequently asking for repetition is common. It’s possible you may not even hear that someone is speaking to you in the first place, or you may find that you frequently ask people repeat themselves because you weren’t able to understand what they said to you. A general difficulty following conversation can cause to listening fatigue is another symptom of hearing loss. Many people tell me they are so exhausted from filling in the blanks of what they cannot hear, that they prefer to just not even try to participate in conversation. Hearing loss can be exhausting to both the speaker and the listener. Isolation and withdrawal from social activities are quite common when a hearing impaired person finds engaging in conversation to be too difficult to keep up with.
Tinnitus, which can be described as a ringing or buzzing sound in the ears, is another symptom of hearing loss. Research indicates that hearing loss is the most common cause of tinnitus. However, it is important to note that there are a variety of other factors that cause tinnitus. If you are experiencing some or all of the above symptoms, speak with your doctor to schedule a hearing evaluation. This is the only way to know for sure if the symptoms you may be noticing are possibly related to hearing loss.
What are the causes of hearing loss?
Hearing loss refers to a decrease in sensitivity to sounds that are audible to those with normal hearing. Hearing loss can also be described as a breakdown in the ear which affects the brain's ability to identify sounds. There are several types of hearing loss, and numerous possible causes. Hearing loss is often described by the location of where the loss occurs, the degree of hearing loss, and the configuration or what sounds are affected.
Conductive Hearing Loss
A conductive hearing loss is due to the sound signal is not being directed properly to the inner ear. This can occur in the outer or middle ear. This type of hearing loss is not typically a complete deafness, but a reduction in the loudness of sounds. Conductive hearing loss can be present at birth (or congenital) or can be acquired during a person’s lifetime. Causes include:
- Ear wax blockage
- Foreign body in the ear canal
- Fluid in the middle ear space
- Disruption in the bones of the middle ear
- Outer ear infection (such as “swimmers ear”)
- Middle ear infection
- Cholesteotoma, (an abnormal, non-cancerous growth of skin cells)
- Benign tumor (such as a vestibular schwannoma)
- Otosclerosis (an abnormal growth of bony tissue in the middle ear)
- Perforated ear drum
- Eustachian tube dysfunction
- Congenital conductive malformation such as an absence of the external auditory canal
This type of hearing loss is most likely to be treated by means of medication or surgery, and will often require a referral to an ENT physician. Treatments may include antibiotics, OTC decongestants, surgical intervention such as myringotomy and placement of PE tubes, use of osseointegrated hearing devices, or traditional hearing devices.
Sensorineural Hearing Loss
A sensorineural hearing loss occurs in the inner ear, or along the auditory pathway as sound signals travel to the brain. Without extensive testing, it is difficult to pinpoint whether the loss is in the cochlea (the inner ear) or in the auditory nerves between the ear and brain pathway. Causes of sensorineural hearing loss include:
- Excessive exposure to loud noise (greater than 85 dB)
- Ototoxic drugs (these include some antibiotics, ED drugs, and combinations of certain drugs with loop diuretics)
- Head trauma
- Autoimmune inner ear disease
- Meniere’s disease
- Benign tumor (acoustic neuroma)
- Viral or bacterial diseases (measles, mumps, meningitis, rubella, herpes)
- Genetic syndromes (Ushers Syndrome, Down Syndrome, Waardenburg Syndrome)
- Uncontrolled blood sugar
- High blood pressure
- Heart or vascular problems
- Kidney disease
- Large vestibular aqueduct
- Superior canal dehiscence syndrome
Sensorineural hearing loss can be treated medically, where there is an underlying cause such as disease or tumor. Most noise-induced or inherited losses are treated through traditional hearing amplification and auditory rehabilitation.
Auditory Processing Disorders
Some hearing loss occurs not in the middle or inner ear, but in the pathway to the brain or in the processing areas of the brain responsible for hearing and language. The causes of these types of hearing disorders are more elusive, but can occur due to
- Developmental disorders
- Head trauma
Treatment for auditory processing disorders may include listening therapy, use of assistive listening devices, and/or various forms of hearing amplification.
What are the types of hearing loss?
The human ear is a fascinating and complex piece of engineering. In a normal functioning ear, sound arrives at the outer ear, or pinna, and travels down the ear canal, where it meets the tympanic membrane, also known as the eardrum. The sound waves vibrate the eardrum, which in turn vibrates three tiny bones in the middle ear in a chain reaction. These three tiny bones, the tiniest in the human body, are called the malleus, incus, and stapes. The vibration of these three bones culminates in a pumping motion that causes movement in the cochlea in the inner ear, a small, snail-shaped organ that is filled with fluid. Hair cells inside the cochlea are stimulated by the movement of the fluid in the cochlea, sending a signal to the auditory nerve, which in turn, carries the signal to the brain, where it is interpreted and recognized as sound. The entire process takes a split second to complete.¹
Obviously, in a system this complex, sometimes things can go wrong. There are three types of hearing loss, conductive, sensorineural, and mixed hearing loss (a combination of conductive and sensorineural). A comprehensive audiologic evaluation is necessary to identify which type and severity of hearing loss an individual has, as well as treatment steps.
Conductive hearing loss occurs when there is a disturbance to one or more of the structures in the outer or middle ear. Causes of conductive hearing loss can include fluid in the middle ear space from congestion due to allergies or colds, perforations (holes) in the eardrum, benign tumors, impacted cerumen (earwax), presence of a foreign body in the ear canal, infection in the outer ear canal (often called Swimmer’s Ear), poor Eustachian tube function, or absence or malformation of the outer ear, ear canal, or middle ear. Another common cause is otosclerosis, or a stiffening of the chain of bones in the middle ear. Conductive hearing loss results in a reduction of the intensity of the sound that reaches the inner ear, but where the inner ear itself is intact. This means that an individual with conductive hearing loss would usually find that as long as a sound is loud enough, they are able to hear it clearly and without distortion. The cause of conductive hearing loss can be often identified and treated medically or surgically, and partial or total improvement to the hearing loss is often possible.²
Sensorineural hearing loss occurs when there has been damage or dysfunction of the inner ear, or the auditory nerve. The most common form of sensorineural hearing loss is age-related hearing loss, also known as presbycusis. Other common causes of sensorineural hearing loss can include noise trauma, genetic hearing loss, medications that are toxic to hearing, head trauma, malformation of the inner ear, illnesses and/or high fever, and even tumors on the auditory nerve. This type of hearing loss can be sudden or gradual. Sensorineural hearing loss includes a reduction in the loudness of the sound like conductive hearing loss, but unlike those with conductive hearing loss, a reduction in speech understanding ability is often present. It is usually irreversible and permanent.
Mixed hearing loss is a combination of both conductive and sensorineural hearing losses, and is often reflective of two or more different conditions affecting the ear in both the inner ear, and the outer or middle ear. It may require a combination of treatments.³
What are the consequences of untreated hearing loss?
Recent data suggests that while at least 10% of the population self-reports some degree of hearing loss, only about 3% actually wear hearing aids.¹ Taking the initial steps towards management of a hearing loss is often one the most challenging aspects of the process. Reports suggests it takes an average of seven years after hearing loss is suspected for an individual to do something about it despite many well-documented consequences of untreated hearing loss and its significant impact on communication, interactions with others, and overall quality of life.²
In general, those with hearing loss who do not wear hearing aids are more likely to report feelings of depression, loneliness, isolation, worry, and dissatisfaction with family life. Difficulty communicating often leads to loss of interest in participating in social activities. Often times the person with hearing loss may not realize they are not participating in the conversation around them and eventually choose not to even attend the birthday celebration or dinner with friends due to struggles with hearing and communication. Sergei Kockin demonstrated that while hearing aid wearers and non-wearers participate in similar numbers of solitary activities, the hearing aid wearers were far more likely to participate in organized social activities compared to the non-hearing aid user group.³ This withdrawal from social activities also limits loved ones socially; having either to go alone or serve as the interpreter for their partner. Untreated hearing loss has also been documented to lead to added marital stress and ultimately feelings of frustration and depression for both parties.
Safety is also a concern for those with hearing loss. When one cannot hear alarms, doorbells, someone entering their home, or cannot successfully converse over the phone, this creates barriers to maintain independence and a safe environment in the home. Feelings of paranoia, worry, and anxiety are often reported by those with hearing loss due to less access to important alerting sounds in their environment.³
Finally, walking around with an untreated hearing loss can have consequences on physical and cognitive health. Strong associations have been found linking hearing loss to reduced cognitive function including potentially exacerbating the symptoms of dementia; researchers do not suggest that hearing aids can prevent dementia but suggest use of amplification may reduce or delay consequences such as reduced function because of the disease. Individuals with hearing loss who do not wear hearing aids report more fatigue and exhaustion at the end of the day due to the extra effort put forth in trying to listen and understand all day. Kochkin and Ciorba also reported that hearing aid wearers reported overall better health than their non-hearing aid wearing counterparts.³
Unaddressed hearing loss leads to reduced awareness of the environment, reduced ability to understand speech, and reduced communication which is often the pillar of relationships and many aspects of life. These consequences not only affect the individual who has hearing loss but those around them; too frequently, these consequences are gradual and go unnoticed. The good news is those who wear hearing aids, and their family members, report a reduction in feelings of anger, frustration, and depression with the use of hearing aids. Hearing aid wearers, and their family members, also self-report significant improvements in areas such as relationships at home, feelings about themselves, and quality of life overall compared to those who do not wear hearing aids.³
How is hearing loss treated?
The manner in which hearing loss is treated depends greatly on the type and degree of hearing loss an individual has been diagnosed with. Hearing loss is broken into three categories: conductive, sensorineural, and mixed.
Conductive hearing loss occurs when there is some sort of obstacle in the outer ear or middle ear preventing sound from being conducted to the cochlea (inner ear). Common causes of conductive hearing loss include cerumen (wax) occluding the outer ear (ear canal), a perforation in the tympanic membrane (eardrum), an ear infection, or a disruption of the ossicles (the bones in the middle ear that conduct sound from the eardrum to the inner ear).
Treatment for conductive hearing loss typically involves removing or repairing whatever it is that is preventing the conduction of sound. In the case of impacted cerumen, an audiologist or physician may remove it. In the cases of infections, perforations in the tympanic membrane, or disruptions to the ossicles, physicians perform surgical procedures or prescribe medications. In some instances, where these treatments are ineffectual, an audiologist will provide hearing aids. Hearing aids, if medical and/or surgical options are exhausted, are usually quite beneficial with conductive hearing losses.
Due to decades of medical advancements that have allowed for very effective treatments of infection, the most common type of hearing loss is sensorineural; according to the National Institute on Deafness and Other Communication Disorders (NIDCD), 90% of all cases of hearing loss are sensorineural in nature. Sensorineural hearing loss occurs when there is a decline in the performance of sensory cells in the cochlea, the cochlea’s connection to the auditory nerve, or to the auditory nerve itself. Causes of sensorineural hearing loss include age, side effects of medications, symptoms of other health conditions such as heart disease, diabetes, thyroid conditions, kidney conditions and others.
In very rare cases, benign tumors may be present on the auditory nerve, and these cases, once discovered, require monitoring by audiologists and physicians. Sometimes, after monitoring, surgical removal eventually becomes a necessity due to the proximity of these tumors to the brainstem.
At this point in time, with the exception of a few very rare circumstances, there are no pharmaceutical or surgical interventions that can reverse sensorineural hearing loss, and hearing aids are the most common treatment. Individuals with severe to profound amounts of sensorineural hearing loss who receive little to no benefit from hearing aids are often candidates for cochlear implants. The technology of both hearing aids and cochlear implants have advanced significantly in the digital age and in recent years, devices that are a hybrid of cochlear implants and hearing aids have been introduced to the market.
Hearing aids, in most states, are provided with a trial period during which an individual can ensure that the devices are meeting their listening needs. The devices are programmed and dispensed by hearing instrument specialists or audiologists. Cochlear implants are surgically implanted by otologic surgeons and after post-operative healing, programmed by audiologists.
What is the prevalence of hearing loss?
People who have a hearing loss are often embarrassed by it, thinking that they are alone in their communication difficulties, but statistics show that hearing loss is far from an uncommon problem. In fact, hearing loss is the third most common physical health problem in the United States, behind such common ailments as heart disease and arthritis. According to the National Institute for Deafness and other Communication Disorders (NICDC), approximately 15% of adults (or 37.5 million people) over the age of 18 in the United States report some difficulty in hearing.¹ About two or three out of every 1,000 children are born with a detectable level of hearing loss as well. Overall, the greatest predictor of hearing loss of adults aged 20-69 is age, with adults aged 60-69 demonstrating the greatest degree of hearing loss, although hearing loss affects all age groups. Men in this 20-69 age group were found to be almost twice as likely as women to have hearing loss. Among that same age group, as far as race is concerned, non-Hispanic, white adults are more likely than any other ethnic or racial group to have hearing loss, and non-Hispanic, black or African American adults were found to have the lowest prevalence of hearing loss. Almost 25% of adults aged 65-74 were found to have “disabling hearing loss,” defined by the NICDC as hearing loss where hearing was 35 decibels or poorer, generally the level at which a person can benefit from hearing aids. Estimates show that rate rises to nearly 50% of adults aged 75 and older who were identified with disabling hearing loss.
The World Health Organization (WHO) estimates that over 5% of the world’s population, or 360 million people (183 million males and 145 million females), have disabling hearing loss, and 32 million of them are children. Roughly one-third of the world’s population over the age of 65 is affected by disabling hearing loss. The greatest majority of people with disabling hearing loss are found in low- and middle-income countries; in fact, the prevalence of disabling hearing loss in both children and adults over the age of 65 is greatest in the areas of South Asia, Asia Pacific, and Sub-Saharan Africa.²
While the cause of many types of hearing loss may be unavoidable, the World Health Organization finds that in children under 15 years of age, 60% of childhood hearing loss could be prevented.³ This figure is higher in low- to middle-income countries at 75% than in high-income countries at 49%, and factor in infections such as mumps, measles, rubella, cytomegalovirus and chronic ear infections, complications during childbirth, use of medications that can be damaging to the auditory system by expecting mothers and infants, and other factors as reasons for this. WHO has also found that 1.1 billion young people from ages 12 to 35 years old are at risk of hearing loss due to noise exposure, most often from recreational activities.
How can hearing loss be prevented?
A common cause of hearing loss is loud noise. Noise at damaging levels can cause both permanent and temporary hearing loss, particularly for sounds above 85 decibels.¹ It is probably no surprise to you that the best way to prevent hearing loss is to avoid sounds at or exceeding damaging levels, both at work and home. The Occupational Safety and Health Administration (OSHA) advises that 85dB is the loudest sound that worker should be exposed to over an 8 hour period. OSHA also outlines that as the damaging sound gets louder, a worker must spend less time exposed to the sound to avoid hearing damage.² It is also a good idea to also consider sounds that you may be exposed to outside of your workplace. Be aware of common sounds such as appliances, traffic, flights, machinery and equipment, firearms, and listening to music or attending concerts. Consider loud sounds in your environment that you are both frequently and infrequently exposed to. Some may assume that frequent exposure to loud sounds is required to cause noise induced hearing loss. However, exposure to a loud enough sound, even one time, could potentially cause hearing damage.
Unless you have a sound level meter or a smartphone application to measure sound level, it may be difficult to identify if you are in a situation that is loud enough to potentially cause hearing damage. The question that comes to mind is, how does one identify a sound that may cause hearing damage? One option is to measure the sound. If you have concerns, you could consider downloading a smartphone application such as The NIOSH Sound Level Meter (NIOSH SLM) application for iOS devices. This is a free option that was created by the Centers for Disease Control and Prevention.³ If you do not have a way to measure sound, there are other guidelines available that may help you decide if you are in an environment with potentially damaging sound levels. The American Speech-Language-Hearing Association identifies possible signs that your environment is too loud as: “you must raise your voice to be heard, you can't hear someone 3 feet away from you, speech around you sounds muffled or dull after you leave the noisy area, and you have pain or ringing in your ears (this is called 'tinnitus') after exposure to noise¹.” If you notice any of these concerns in your environment, consider reducing the sound level when possible or simply leaving the noisy situation.
The best way to prevent hearing loss is to reduce your exposure to loud sounds. Consider wearing properly fitting hearing protection, lowering the level of the sound, avoiding loud sound exposure when possible, reading labels to find out what the reported sound levels are for products, and advocating for yourself and others if you have concerns that a local restaurant, bar, health club, etc, may be exposing patrons and employees to dangerous sound levels.
Does hearing loss cause dementia?
This is a commonly asked and important question. Unfortunately, what we are seeing in often reported in the news can be a stretch. The important term to distinguish here is the term “cause”. There is currently no evidence to show that hearing loss causes dementia. What there is evidence to support is that individuals with worse hearing tend to demonstrate poorer cognitive function. Research also indicates a higher rate of comorbidity of hearing loss and dementia; meaning they often occur in the same individuals.¹ Dr. Frank Lin’s is a leading researcher in this topic area and has demonstrated accelerated cognitive decline by 30-40% in those who have hearing loss compared to those who have normal hearing. He has also shown increased risk of dementia in older adults with hearing loss and that the greater the degree of hearing loss, the greater the likelihood of dementia.²
Why we see this between hearing loss and reduced cognitive abilities is a topic still being heavily researched, however there are some proposed theories. For one, we know that individuals with hearing loss tend to require more effort listening compared to those who do not have hearing loss. This extra cognitive effort may lead to fewer cognitive resources available for other tasks, presenting as decreased memory or cognitive function. Another possibility is an indirect association between hearing loss and cognition; it is well established that untreated hearing loss can lead to social isolation, depression, and reduced self-efficacy. These characteristics are also known to be linked to having an increased risk of dementia1. Anecdotally, as a clinician, I have seen many patients brought in for their initial appointment by a family member who also expresses concern for memory loss. The individual is found to have a hearing loss, we pursue the appropriate form of management, and both the family and myself are shocked by the change in the individual with hearing loss’s personality, involvement in the conversation, demeanor, and overall functional ability simply because they have greater access to communication and their environment.
Another commonly proposed theory linking hearing loss and cognitive decline is auditory deprivation. We know that when individuals live with untreated hearing loss for extended periods of time, their auditory system is deprived of critical input. Eventually the auditory system loses its ability to process this input, even when it is loud enough to hear. Think of this like exercise and the importance for your muscles and body to keep moving and exercising. The longer you go without movement, the more your muscles atrophy and the harder it is to comeback and rebuild strength. It has been suggested that this auditory deprivation, from lack of hearing, may have an impact on cognitive abilities. Finally, the ‘common cause’ hypothesis suggests that age-related changes and degeneration lead to both hearing loss and cognitive decline.³
Ultimately, someone who has age-related hearing loss does not necessarily need to fear that they will suddenly or certainly develop dementia. Rather than saying “hearing loss causes” dementia, it is more appropriate to say is that there is an association, or possible link, between cognitive function and hearing loss. Based on the current research, it is recommended that an individual showing signs of memory loss or cognitive decline consider having a hearing evaluation and address hearing loss and communication as one step of the process.
Who are some celebrities with hearing loss?
Many celebrities suffer from hearing loss and have been open about their experiences with it. AARP lists the following celebrities that have hearing loss:
- Whoopi Goldberg: The Academy Award winner has spoken out encouraging others to protect their hearing, citing excessive noise exposure during concerts as the possible cause for her hearing loss.
- Luis Miguel: The singer suffers from tinnitus, and even had to cancel some of his performances due to the impact tinnitus was having on him.
- Lou Ferrigno: TV’s Incredible Hulk actor and former bodybuilder has suffered from hearing loss since a young age. He attributes his loss of hearing to an ear infection that had had lasting effects. As an adult, Ferrigno opted for an implantable Esteem Device, which he says has made his hearing better than he could have hoped for.
- Rob Lowe: The actor reportedly lost hearing in one ear as an infant, and has been open about the difficulty he experiences hearing in background noise.
- María Antonieta de las Nieves: The actress, comedian and singer wears hearing aids, but still finds that she struggles to hear in certain environments. She announced that she will no longer give telephone interviews due to her hearing loss.
- Bill Clinton: The former President noticed his hearing worsening slowly overtime, and it became worse with age. He noted that his his was especially troublesome when communicating in background noise, causing him to have a difficult time distinguishing sounds. The former President now uses two hearing aids to make communication easier.
- Halle Berry: The actor has spoken out about an abusive relationship she had 20 years ago that resulted in the loss of hearing in her left ear. By sharing her experience, Berry hopes to raise awareness about domestic violence.
- Stephen Colbert: The political satirist has hearing loss in one ear that he has had since childhood. The loss of hearing is reportedly due to a growth in his ear that required surgery that resulted in the loss of his eardrum.
- Rush Limbaugh: The talk show host suffers from severe loss of hearing in both ears. The cause is up for debate, and includes autoimmune disorder of the inner ear as well as opioid abuse.
- Pete Townshend: The songwriter and guitarist suffers from both hearing loss and tinnitus that he attributes to years of exposure to loud music.
- Jane Lynch: The actor has hearing loss in one ear that she first noticed when she was seven years old could not hear her radio equally from each ear.
- Robert Redford: The actor suffered an ear infection after continual water submersion for a role he was playing in a film. Unfortunately, the ear infection caused permanent hearing loss in one ear.
- Holly Hunter: The Academy Award winner has hearing loss in one ear due to suffering from mumps as a child. She reportedly finds that she must pay closer attention to compensate for her hearing loss, and that she is then more aware of details in conversation.
- Jodie Foster: The actor has been spotted wearing a hearing aid and has admitted that she could be better about seeking hearing healthcare. She also has suffered from vertigo.
How do I know if I have hearing loss?
There is no way to know for sure without a completing a hearing test by an audiologist, however, there are some warning signs that may indicate if you have a hearing loss. Ask yourself the following questions and if the answer is to any of the questions, you likely have a hearing loss and should have your hearing evaluated by an audiologist:
- Do I hear a ringing in my ears or head that is not present in the environment? If the answer is yes, you are experiencing tinnitus, which is highly correlated with hearing loss. (Typically, tinnitus is associated only with hearing loss, but it can be a sign of other health issues or a side effect of medications, so be sure to contact a health professional.)
- Does it seem as if other people are mumbling? This is a classic sign of hearing loss. Often, when someone has a hearing loss, some sounds of speech are more audible than other sounds, which is perceived as mumbling.
- Do I hear better out of one ear than another? Normal hearing individuals have the same degree of acuity in each ear. If one ear appears to hear better than the other, that means that at least one ear likely has hearing loss. (Similar to tinnitus, hearing loss in one ear can also be a sign of other health issues and you should consult with a health professional.)
- Has there been a rapid decline or fluctuation in my hearing? In normal hearing individuals, hearing does not fluctuate very much, if at all, and so this is likely a sign that your hearing is declining. And, if your hearing is fluctuating frequently, you should visit an audiologist or physician relatively soon so as to possibly avoid permanent hearing loss.
- Have I been exposed to high intensity noise? Frequent exposure to moderately high levels of noise, or, a single instance of very high levels of noise can cause temporary or permanent hearing loss.
- Is there a history of hearing loss in my family? Some forms of hearing loss are genetic in nature, and if certain family members have or have had hearing loss, you may be at risk yourself.
- Am I in good health? Heart disease, diabetes, thyroid conditions and side effects of many medications can cause temporary or permanent hearing loss.
- Am I over 50 years of age? This question should be pretty easy to answer. If the answer is yes, then the chances that you have at least a small degree of hearing loss rises significantly. Most individuals over the age of 70 have at least a mild hearing loss.
Again, the surest way to know if you have a hearing loss, of course, is to have a comprehensive hearing evaluation by a licensed audiologist. Most audiologists participate with insurance carriers and most carriers cover the cost of a hearing test. However, even if you do not have insurance coverage, the cost of a basic hearing test is typically less than $150 and often less than $100.
How can I cope with my hearing loss?
The question of ‘how do I cope with hearing loss?’ is an interesting one. The Oxford dictionary defines the word ‘cope’ as to deal effectively with something difficult.¹ Learning to live well and continue to do the things you want to do with hearing loss is a challenge that takes work and is an ongoing process.
My first recommendation to learning to cope with a hearing loss is consult an audiologist if you have not already. There likely are many options for mediating hearing loss and that is the place to start. Ensure you have a hearing device that is appropriately fit for your hearing loss and are aware of any additional pieces of technology that may be beneficial in your day-to-day life. There are numerous options for listening to music, improving speech understanding in a noisy environment, hearing well over the phone, being safe in your home, and addressing any specific work or recreational needs. These options are constantly changing and improving which is why it is best to consult with an expert in this area to discuss what would be best for you.
Part two of this discussion is addressing the emotional aspects of living with a hearing loss. Most individuals who have a newly acquired hearing loss have to go through a grieving process just like any other type of loss, disease, or disorder. The Kubler-Ross five stages of grief model are denial and isolation, anger, bargaining, depression, and acceptance.² When someone is in the initial phases of grief, they often deny the hearing loss exists or blame communication difficulties on others. This may sound like “She speaks to quietly”, “She never moves his lips when he’s talking”, “Everybody mumbles these days”. In these stages of mourning, a person may become withdrawn, express anger, or may even show signs of depression.1 This is a normal part of the grieving process but the hope and goal is that these stages are brief and allow the individual to move towards acceptance of their hearing loss and seeking out information and options.
Outside of seeking out guidance from a hearing professional, a significant part of living well with a hearing loss is becoming a good self-advocate and creating a good support system. A critical aspect of this process is being open with family members, friends, co-workers, anyone you come in contact with about your hearing loss and what they can do to help with communication. Many people don’t know how to best communicate with someone who has a hearing loss (for example slow down, face me when you’re speaking, get my attention first, don’t yell) but are willing to modify their actions and communication after being informed and have heard frequent reminds. Understand that most family members and communication partners may not know or understand the physical, psychological, and emotional impact of having a hearing loss. It may require patience and multiple honest conversations and education to get there.³ Regular, open conversations with those around you is critical for increased understanding about your hearing loss and how to work together to make communication a positive and successful experience for both of you.
Another excellent option is to seek out a local support group to meet and talk with others who have gone through the same experience. This is often something a hearing professional can guide you to or the national organization Hearing Loss Association of America has many local chapters across the country and may be a good place to start.
How do I read a hearing test?
You’ve had your hearing tested, now comes time to make sense of the test results. What are those X’s and O’s, triangles and squares, brackets and S’s and U’s? What do those symbols mean – what do they quantify and how do they apply to the real world? It can seem daunting and confusing at first, but once you learn how to read the test it will all make sense.
Down to the Basics
In order to understand the hearing test, one must first understand the basic concepts of sound. Sound is the way we perceive particle vibrations. When something vibrates, it pushes and pulls against the particles around it. Those particles, in turn, push and pull on the particles surrounding them, allowing the sound wave to move through space.
Sound is quantified using three measures: (1) intensity; (2) frequency; and (3) phase. It isn’t important to understand phase for the purpose on interpreting a hearing test, so let’s concentrate on intensity and frequency.
Intensity is the technical term for what we perceive as volume. It’s essentially how much the particles are displaced by the sound wave. The harder the sound wave pushes and pulls on particles, the louder the sound we hear. Intensity is quantified as decibels (or dB) and, while there are different dB scales, the important one to know for your hearing test is dB Hearing Level (dB HL).
Frequency is the technical term for what we perceive as pitch. It’s what allows us to tell the difference between musical notes, or hear inflections in someone’s voice that indicate sarcasm or question, or even tell certain speech sounds apart. Physically, it’s the speed at which the sound particles oscillate, measured as cycles per second or Hertz (Hz).
How Hearing Is Measured
First, we need to establish what frequencies and intensities are important for people to hear. Since we are social animals who use our hearing to communicate with one another, let’s assume that the range of frequencies and intensities people want to hear is that of normal conversational speech. People can hear a frequency range from roughly 20 Hz to 20,000 Hz, but only a small portion of that range contains speech sounds (called phonemes).
We assess how well you hear by finding the softest sounds you hear, called pure tone thresholds, at a range of frequencies (usually 250 Hz to 8,000 Hz). Think of it in terms of sensitivity instead of loudness; the softer the sound you hear, the more sensitive you are to that sound. A normal-hearing person can hear these sounds when they’re as soft as -10 dB HL to 20 dB HL. We display these pure tone thresholds on a graph called an audiogram (see below).
Reading The Audiogram
The audiogram is a graph of pitch along the X-axis and volume along the Y-axis. The low pitches are on the left side of the graph and the high pitches on the right side, like a piano. The soft sounds are at the top and loud sounds at the bottom, so the higher you are on the scale the more sensitive you are to the sounds.
One part of the exam, called air conduction, is plotted on the audiogram using X’s to denote the left ear thresholds and O’s for the right ear thresholds. Air conduction thresholds are how well you hear through the headphones. They tell us how sensitive you are to regular sounds that are presented through the air (as are most of the sounds that you hear).
Occasionally when there is a big difference in thresholds between ears, you may see squares instead of X’s and triangles instead of O’s. These symbols are used when your audiologist has to apply a masking noise to the opposite ear to get your true thresholds. It’s not really necessary for you to understand how masking works, just know that the squares can be a substitute for the X’s (left ear) and the triangles for the O’s (right ear).
Another part of the exam, called bone conduction, is plotted using the symbols “<” for the right ear and “>” for the left ear. This is the part of the test where your audiologist put the headband on you with the little box behind your ear. Bone conduction thresholds are how well your inner ear (the cochlea) hears. When your audiologist uses masking for bone conduction thresholds, the symbols “[“ and “]” are used as substitutes for “<” and “>”.
You may also see symbols like “U” or “M”. These are other types of scores, used to indicate the volumes you found most comfortable or the loudest volumes you’re able to tolerate. These scores are mainly used for prescribing hearing aid settings.
Interpreting The Results
The cutoff for what’s considered normal hearing is 20 dB HL, so any of the scores you see on the graph that are at or above the 20 dB HL line are within normal limits. There is a 5 dB test-retest variability, so some audiologists consider 25 dB HL normal as well. Any of the scores you see below the 20 dB HL line are considered a hearing loss.
There are three types of hearing loss that can be seen on an audiogram. The first type of hearing loss, called sensorineural loss, is most commonly due to damage in the cochlea. There are little hair cells in the cochlea that pick up sound vibrations and convert them into a neurological signal that is sent to the brain. Those hair cells can be damaged by a variety of environmental factors like noise or medications, preventing them from picking up sound as they normally would. Sensorineural loss can also be caused by a blockage along the nerve in rare instances.
Sensorineural hearing loss is seen on the audiogram when the air conduction thresholds (the X’s and O’s) fall below the normal cutoff (20 dB HL) and are within 10 dB of the bone conduction thresholds (< and >). Since there is no significant difference in thresholds between your hearing through the air and hearing when a sound goes straight to the inner ear via bone conduction, the hearing loss is in the inner ear.
The second type of hearing loss, called conductive loss, is essentially a problem with sound getting in to the ear. The hair cells can’t pick up sound because the sound isn’t reaching them the way it should. This includes problems like earwax impaction, ear infection, perforated eardrums, or hardening of the bones in the middle ear. Conductive hearing loss can usually be treated by a physician without the need for hearing aids.
Conductive hearing loss is seen on the audiogram when the bone conduction thresholds are within normal limits, but the air conduction thresholds are not. In other words, you hear normally when sound goes straight to the inner ear via bone conduction, but not when hearing through the air, so something is blocking the sound before it gets to the cochlea.
The third type of hearing loss, called mixed loss, is a combination of sensorineural and conductive losses. The sound is blocked on the way into the ear, but the hair cells are also damaged. Mixed loss is seen on the audiogram when both the bone conduction and air conduction thresholds are below the 20 dB HL cutoff and are separated by 15 dB or more.
What It Means For You
Everyone experiences hearing loss differently, so it’s impossible to generalize in a way that relates to everyone. People who have hearing loss in the higher pitches tend to describe a feeling like they can hear but can’t understand, as though everything is muffled. People who have hearing loss in the lower pitches tend to describe a feeling like sound is too sharp and soft at the same time. Some people describe difficulty telling where sounds are coming from, or just difficulty hearing in noisy environments.
When it comes down to it, the only one who can accurately describe how the hearing problem affects you is you. Your audiologist can help break down the test results, explain why you are experiencing communication problems, and provide recommendations. But it’s up to you to follow along and voice your concerns. Now with your newfound knowledge of how to read the test results, hopefully you can join in on the conversation with ease!