Health Care and Hearing Loss

According to the Mayo Clinic, gradual hearing loss that occurs as you age (presbycusis) is common. According to the National Institutes of Health, an estimated one-third of Americans between the ages of 65 and 75 and close to one-half of those older than 75 have some degree of hearing loss. Doctors believe that heredity and chronic exposure to loud noises are the main factors that contribute to hearing loss over time. Other factors, such as earwax blockage, can prevent your ears from conducting sounds as well as they should. You can't reverse hearing loss. However, you don't have to live in a world of quieter, less distinct sounds. You and your doctor or hearing specialist can take steps to improve what you hear.

According to the American Speech-Language-Hearing Association (ASHA), when describing hearing loss professionals generally look at three attributes: type of hearing loss, degree of hearing loss, and the configuration of the hearing loss. Hearing loss can be categorized by where or what part of the auditory system is damaged. There are three basic types of hearing loss: conductive hearing loss, sensorineural hearing loss and mixed hearing loss.

1.) Conductive hearing loss occurs when sound is not conducted efficiently through the outer ear canal to the eardrum and the tiny bones, or ossicles, of the middle ear. Conductive hearing loss usually involves a reduction in sound level, or the ability to hear faint sounds. This type of hearing loss can often be medically or surgically corrected. Examples of conditions that may cause a conductive hearing loss include:
--Conditions associated with middle ear pathology such as fluid in the middle ear from colds, allergies (serous otitis media), poor eustachian tube function, ear infection (otitis media), perforated eardrum, benign tumors.
--Impacted earwax (cerumen).
--Infection in the ear canal (external otitis).
--Presence of a foreign body.
--Absence or malformation of the outer ear, ear canal, or middle ear.

2.) Sensorineural hearing loss occurs when there is damage to the inner ear (cochlea) or to the nerve pathways from the inner ear (retrocochlear) to the brain. Sensorineural hearing loss cannot be medically or surgically corrected. It is a permanent loss. Sensorineural hearing loss not only involves a reduction in sound level, or ability to hear faint sounds, but also affects speech understanding, or ability to hear clearly. Sensorineural hearing loss can be caused by diseases, birth injury, drugs that are toxic to the auditory system, and genetic syndromes. Sensorineural hearing loss may also occur as a result of noise exposure, viruses, head trauma, aging, and tumors. Sometimes a conductive hearing loss occurs in combination with a sensorineural hearing loss. In other words, there may be damage in the outer or middle ear and in the inner ear (cochlea) or auditory nerve. When this occurs, the hearing loss is referred to as a mixed hearing loss.

3.) Unilateral hearing loss (UHL) means that hearing is normal in one ear but there is hearing loss in the other ear. The hearing loss can range from mild to very severe. Approximately one out of 1000 children is born with UHL. Unilateral hearing loss can occur in both adults and children. Nearly 3% of school-aged children have UHL.Children with UHL are at higher risk for having academic, speech/language and social/emotional difficulties than their normal hearing peers. Some children with UHL experience these difficulties but others do not. Many times we do not know the cause of hearing loss. Below are some possible causes of UHL:
--Hearing loss that runs in the family (genetic or hereditary).
--An outer, middle or inner ear abnormality.
--Specific syndromes.
--Specific illnesses or infections.
--Skull (temporal bone) fractures.
--Excessive or extreme noise exposure.
--Traumatic brain injury.

Degree of hearing loss refers to the severity of the loss, according to ASHA. The numbers are representative of the patient's thresholds, or the softest intensity at which sound is perceived. The configuration or shape of the hearing loss refers to the extent of hearing loss at each frequency and the overall picture of hearing that is created. For example, a hearing loss that only affects the high frequencies would be described as a high-frequency loss. Its configuration would show good hearing in the low frequencies and poor hearing in the high frequencies. On the other hand, if only the low frequencies are affected, the configuration would show poorer hearing for low tones and better hearing for high tones. Some hearing loss configurations are flat, indicating the same amount of hearing loss for low and high tones. Other descriptors associated with hearing loss are:
--Bilateral versus unilateral. Bilateral hearing loss means both ears are affected. Unilateral hearing loss means only one ear is affected.
--Symmetrical versus asymmetrical. Symmetrical hearing loss means that the degree and configuration of hearing loss are the same in each ear. An asymmetrical hearing loss is one in which the degree and/or configuration of the loss is different for each ear.
--Progressive versus sudden hearing loss. Progressive hearing loss is a hearing loss that becomes increasingly worse over time. A sudden hearing loss is one that has an acute or rapid onset and therefore occurs quickly, requiring immediate medical attention to determine its cause and treatment.
--Fluctuating versus stable hearing loss. Some hearing losses change—sometimes getting better, sometimes getting worse. Fluctuating hearing loss is typically a symptom of conductive hearing loss caused by ear infection and middle ear fluid, but also presents in other conditions such as Meniere's disease.

ASHA suggests ways to consider if you have hearing loss. For adults:

--You frequently complain that people mumble, speech is not clear, or you hear only parts of conversations when people are talking.

--You often ask people to repeat what they said.
--Your friends or relatives tell you that you don't seem to hear very well.
--You do not laugh at jokes because you miss too much of the story.
--You need to ask others about the details of a meeting that you just attended.
--Others say that you play the TV or radio too loudly.
--You cannot hear the doorbell or the telephone.
--You find that looking at people when they talk to you makes it somewhat easier to understand, especially when you're in a noisy place or where there are competing conversations.

For children:

--Your child is inconsistently responding to sound
--Language and speech development is delayed
--Speech is unclear.
--Sound is turned up on electronic equipment (radio, TV, cd player, etc.)
--Your child does not follow directions
--Your child often says "Huh?"
--Your child does not respond when called.
If you have concerns, seek the services of an audiologist certified by the American Speech-Language-Hearing Association.

According to eMedicineHealth.com, the likelihood that hearing will return depends on the cause of the hearing loss. Hearing will usually return to normal with removal of foreign bodies in the canal, removal of wax in the canal, and treatment of ear canal infections (otitis externa).
Hearing will usually return to normal after treatment of middle ear infection (otitis media).
Antibiotics are usually given for 7-14 days. Rarely, a second course of different antibiotics may be necessary if the infection does not respond to the first type of antibiotic. It may, however, take a longer period of time for the fluid in the middle ear to resolve completely and the hearing to return to normal. Injuries to the tympanic membrane will usually heal on their own. Once healed, hearing usually returns to normal. If the perforation is large (bigger than 50% of the membrane), surgery may be required to fix the eardrum. A skin graft is sometimes used to replace or fix the tympanic membrane. Hearing loss due to drugs may or may not return with withdrawal of the drug. No proven treatment restores the hearing other than removal of the drug. Some doctors may try giving drugs known as steroids to restore hearing. Hearing loss due to infections such as meningitis may not return. The doctor may try using steroids during the illness to decrease the amount of hearing loss. Hearing loss due to Ménière disease, acoustic neuroma, and age is usually permanent.

If you cannot determine the cause of your hearing loss, see a doctor, according to eMedicineHealth.com. Other symptoms that require a trip to the doctor include the following:
--You have associated symptoms such as ringing in the ears or vertigo.
--You have a fever or pain.
--You are taking any medications that affect hearing.
--Your hearing loss is sudden and prolonged.
Do not delay getting medical attention if your hearing loss is associated with any of the following:
--Recent or present foreign body in the ear
--Fluid or blood coming from the ear
--Recent pressure changes (diving)
--Fever not controlled with acetaminophen (Tylenol)
--Severe trauma to the head

Hearing loss is a serious health care matter. The severity can be temporary or permanent based on the type of loss, injury, or illness. See your primary care physician if the hearing loss is not caused by a traumatic medical situation. Always seek emergency medical care if the hearing loss is sudden and severe. Otherwise, take precautions to prevent hearing loss that are a common sense approach. Your hearing is precious. Don't take it for granted.

Until next time. Let me know what you think.