What Should Be Done About Hearing Loss?
By THE NEW YORK TIMES
Judging purely by the responses to Ask an Expert, hearing problems are an enormous concern for baby boomers, rivaled only by worries about memory. More than 200 people wrote to this week’s expert on hearing, Neil J. DiSarno.
Dr. DiSarno is chief staff officer for audiology at the American Speech-Language-Hearing Association, and from 1998 to 2012 was chairman of the department of communication sciences and disorders at Missouri State University.
Because of the large response, not all questions can be answered individually. Dr. DiSarno is selecting representative questions on similar topics, and a second set of answers will appear on Booming next Wednesday. This feature is now closed to new questions.
Dr. DiSarno’s first set of answers follows.
As is quite evident from the number of comments readers sent in, hearing loss affects large numbers of baby boomers.
Although I would like to have the time to answer each question individually, that is not possible.
Those of you who have read the comments, however, see that they fall pretty neatly into seven or eight categories. I will address the questions by topic area.
First I would like to point out that although the effects of hearing loss differ as a result of type and degree of impairment, one important aspect to be mindful of is that the use of hearing aids is only part of a plan of treatment.
Although it is a prime component, amplification in the form of hearing aids only brings sounds closer to the individual.
How the individual’s auditory system processes that information differs considerably among those with impaired hearing.
This is one reason some individuals benefit greatly from the use of hearing aids and others somewhat less.
The treatment following the fitting of hearing aids includes extensive counseling that is tailored to the degree of impairment as well as the lifestyle of the individual user.
Hearing aid users must establish realistic expectations with regard to the benefit they can expect.
Although hearing aids have become more technologically advanced in recent years, it must be kept in mind that the auditory system is the most complex organ in the human body.
When it becomes altered, either through the process of normal aging, or other health-related factors, it can leave the individual with limitations ranging from an inability to hear soft speech which is easily addressed by hearing aids, to complete inability to understand any speech information, even when using very powerful hearing aids.
Another factor to consider is the change that occurs in how the brain processes speech.
Consider this example. A twenty-something and a sixty-something both have their hearing checked and learn that hearing is within normal limits.
Each individual receives a cellphone call while dining in a very noisy restaurant.
If you are me, you are amazed that the twenty-something appears to have no difficulty at all understanding the conversation.
The sixty-something on the other hand can barely understand who they are speaking with, much less what is being said. Remember, each had quite good hearing on a hearing test.
The brain’s ability to understand speech in background noise undergoes changes and this imposes limitations on how the aging auditory system processes speech under those circumstances.
Now, add a bit of hearing loss or a foreign accent to the cell phone situation and you can imagine, or probably already live with that frustration.
Help can be found for many of the limitations impaired hearing imposes on an individual; however, appropriate counseling and realistic expectations are key to successful rehabilitation.
Please understand that any advice in this section is provided without the benefit of seeing you as a patient.
It is only with the knowledge of a complete medical history and a thorough audiological evaluation that accurate information can be provided.
Please allow this to serve as a stepping-off point to allow you to research your condition further and to seek professional consultation
Q. After thorough testing, the Mayo Clinic told me that I had a slight hearing loss, but my difficulty separating sounds (as in a noisy restaurant) is caused by a brain function that can’t be alleviated by audiology modifications.
What is the name of this disability, and are people being sold hearing aids that can’t deal with it very successfully? — George B., Creve Coeur, Mo.
Q. I only have hearing problems in certain situations, e.g., at movies, crowded restaurants. If I got a hearing aid, would there be any problem wearing it in just those situations? — John Fisher, Winston-Salem, N.C.
A. Without seeing audiological test results from either George B. or John Fisher it is difficult to provide consultation as to whether hearing aids would help.
An important fact to keep in mind is that most hearing loss occurs in the high-frequency range.
This is the part of the hearing organ that typically produces awareness of sounds such as “s”, “f”, “th”, “p”, and “t”.
An inability to hear these consonant sounds can cause considerable confusion when listening to speech. When listening in the presence of background noise, the damaged high-frequency portion of your hearing organ cannot provide you with accurate high-frequency speech information.
You may easily confuse the word shoot with shoe, or hit with hip.
Your inability to hear these high-frequency consonant sounds can certainly send your brain an inaccurate message.
The fortunate part of this condition is that these high-frequency sounds are some of the most visible sounds on a person’s lips.
So, if you are able to see the speaker’s face, your brain can often fill in what your ears may have misunderstood.
Positioning yourself in restaurants, at family dinners, or group settings where you are able to see the speaker’s face can improve your ability to follow conversation.
Can hearing aids help as well? A properly fit hearing aid may boost up the damaged region of your hearing, in most cases this is the high-frequency portion.
Depending on the degree of the damage, the boosted high-frequency sounds can fill in where your damaged hearing organ is lacking.
The extent of the benefit you may receive is dependent upon several factors.
Certainly you must give your brain a chance to get used to utilizing this new amplified information.
A trial period of at least one month of consistent hearing aid use often times will provide you with the answer.
Q. I’ve had tinnitus on my left ear since August 2011 but it was not annoying at first. Hearing tests show mild to moderate hearing loss on my left ear; however, for some inexplicable reason my tinnitus got very loud in October 2012. I suspect it was emotional stress.
I have tried many things to lessen the sound and its effects on my mood and reaction including a hearing aid but nothing seems to help. I am only 25 and the hissing continues.
The sound is destroying my life day by day! It is not life anymore it is torture.
Can you please recommend something a college student like me can do to improve this unfortunate situation? And do you have any further knowledge on acoustic neuromodulation treatment offered in the U.K.? Thank you. — Henry, Sacramento
Q. Following surgery to repair a ruptured eardrum about five years ago, I experienced a catastrophic loss of high-frequency hearing in one ear.
I wear a hearing aid in that ear and can get by except in the presence of high background noise (cocktail party effect).
However, I’ve never completely adjusted to the tinnitus, which is not only intrusive and distracting but wakes me up at night.
What are the latest developments in overcoming tinnitus? And is there anything on the horizon as far as hair cell regeneration? — Liza, Connecticut
Tinnitus refers to “ringing in the ears” or “head noises” when no other sound is present.
Tinnitus can sound like hissing, roaring, pulsing, whooshing, chirping, whistling or clicking. Tinnitus can occur in one ear or both ears.
It is a symptom common to many problems.
While the exact cause of tinnitus is unknown, it may be a symptom of other problems like hearing loss, exposure to loud noise, ototoxic medications, allergies or even too much wax in the ear canal.
If you have tinnitus, chances are the cause will remain a mystery.
The American Speech-Language-Hearing Association has more about commonly asked questions about tinnitus.
Both Henry and Liza as well as many others who have written are experiencing the effects of tinnitus to the point where it is disruptive to their lives, and both asked about the latest treatments.
An advocacy group for tinnitus suffers is the American Tinnitus Association, and this link provides information about the latest research on tinnitus treatment, including neuromodulation treatment.
With regard to hair cell regeneration to replenish the damaged sensory hair cells, a critical component to the hearing process, the National Institutes of Health provides information regarding recent advances in this area. Successes dealing with hair cell regeneration have so far been limited to animal studies.
Some facts regarding tinnitus are:
¶One-third of all adults report experiencing tinnitus at some time in their lives. Ten to 15 percent of adults have prolonged tinnitus requiring medical/audiologic evaluation.
¶Up to 18 percent of the general population of industrialized countries is mildly affected by chronic tinnitus, and 0.5 percent report tinnitus having a severe effect on the ability to lead a normal life.
Tinnitus and hearing loss often go hand in hand. Contact an audiologist to find out if your tinnitus symptoms also include hearing loss. For a provider check here. If you have hearing loss as well as tinnitus, in some cases hearing aids can help.
Q. What is the latest research on tinnitus and treatments/cure? Congress is looking at this issue because so many of our returning military have tinnitus so hopefully that will mean more research dollars to benefit them as well as the rest of us who have tinnitus. — Anne Royal Oak, MI
A. New brain imaging techniques have led to insights about the connections between structures and function within the ear and in the cognitive process of the brain.
These new imaging techniques suggest the possibility of more effective treatments for tinnitus and hyperacusis (oversensitivity to normal sounds; see question below).
Imaging advances will also increase the knowledge about the plasticity of the brain and its ability to compensate for hearing dysfunction.
Q. Following surgery to repair a ruptured eardrum about five years ago, I experienced a catastrophic loss of high-frequency hearing in one ear (complicated story). I wear a hearing aid in that ear and can get by except in the presence of high background noise (cocktail party effect). However, I’ve never completely adjusted to the tinnitus, which is not only intrusive and distracting but wakes me up at night. What are the latest developments in overcoming tinnitus? And is there anything on the horizon as far as hair cell regeneration? – Liza, Connecticut
A. One area of exciting research involves inner ear hair cell regeneration with the use of stem cells. The discovery of both adult and embryonic stem cells in the inner ear and scientific evidence that they can be converted into hair cells raises hope for the development of stem-cell based treatments to regrow damaged hair cells.
Researchers are studying precisely how hearing may have been damaged from exposure to loud noise or ear-damaging medications, known as ototoxic medications.
This research is looking at the biology of the ear structures and chemistry to understand the role of free radicals, highly reactive molecules in the body.
Free radicals are a result of stress (oxidation) on the inner ear tissues and can lead to cell death. Several pharmaceutical interventions based on natural and synthetic antioxidants are being studied.
AGE-RELATED HEARING LOSS
Q. I am 63 years old. I blame my “hearing loss” on cell phones and poor audio quality of DVDs and inconsiderate people who talk from distant rooms, but my wife is not buying it. I can hear fine if someone speaks to me face to face, but . . . Is it me? — John, Memphis
Q. After thorough testing, Mayo Clinic told me I had slight hearing loss, but my difficulty separating sounds (as in a noisy restaurant) is caused by a brain function that can’t be alleviated by audiology modifications. What is the name of this disability, and are people being sold hearing “aids” that can’t deal with it very successfully? — George B., Creve Coeur, Missouri
A. Age-related hearing loss, or presbycusis, is increasing as the baby-boom generation grows older. Scientists are still trying to determine whether the age-related deficit is mostly due to loss of sensitivity in the inner ear. Increasingly, research suggests that other areas within the hearing system may be affected.
For example, it has been found that the brain processes sound less quickly with advancing age.
This suggests that a major contributor to poor speech understanding in older people is poor processing of sound in the brain.
Thus, simple hearing aid strategies that only address damage in the inner ear by amplifying sound may not solve the communication problems often expressed by older hearing aid users.
An emerging area of research is looking at a link between noise exposure and the degree and rate of development of presbycusis.
What we know now is that exposure to loud levels of noise over time will increase the ear’s vulnerability to the aging process.
PAINFULLY LOUD SOUNDS
Q. Would like to learn more about “recruitment.” Although I have a moderate to severe hearing loss, I notice that sounds that others can tolerate are painfully loud to me. This seem paradoxical; can you explain to me how and why this happens? — Jerry M., Little Rock, Ark.
Q. What is the latest information on helping people who have tinnitus and hyperacusis caused by having a bad case of the flu or a virus.
This happened to me in 1991 and actually the hyperacusis is harder to deal with than the tinnitus, which never stops hissing and screaming.
Have you seen any success with acupuncture treatment? — Chadds Ford, Pa.
A. Recruitment is a condition sometimes observed in people with known damage to the hair cells of the inner ear and/or the damaged auditory nerve cells to which they are connected.
Although it seems paradoxical, consider this situation. An individual without hearing loss has a tone presented to one ear just barely above the level he can hear (his hearing threshold) and he responds that yes, he hears a very soft tone.
An individual with impaired hearing is also presented with a tone that is just above his threshold of impaired hearing and he reports that yes, he hears a very soft tone.
The level of the tone is brought up the same amount (e.g., 20 dB additional) for the normal hearing individual and he reports that the tone is a little louder.
The same additional 20 dB of loudness is presented to the individual with impaired hearing and he reports that the new tone is much louder than the original tone and may be approaching a painfully loud level.
The impaired ear is experiencing an abnormal growth of loudness.
Recruitment is defined as an abnormal perception of loudness and is seen in some people with sensory and/or neural hearing loss.
Hyperacusis is a rare hearing disorder that causes sounds which would otherwise seem normal to most people to sound unbearably loud.
People who suffer from hyperacusis may even find normal environmental sounds to be too loud.
Hyperacusis is not discomfort around loud sounds. Individuals with hyperacusis may find a car engine, dishes clanking, rustling of paper or even loud conversation uncomfortable enough to avoid such situations.
Many people with hyperacusis have normal hearing.
The disorder can occur in one or both ears and is often accompanied by tinnitus (ringing or buzzing in the ear). It is reported that 1 in 50,000 people has hyperacusis and that 1 in 1,000 people who have tinnitus will also have hyperacusis.
There are some diseases or disorders that are linked to hyperacusis, like Bell’s palsy, chronic fatigue syndrome, Lyme disease, Ménière's disease, post-traumatic stress disorder, depression and autism.
Additionally, hyperacusis is seen in patients who have experienced a head trauma, such as an air bag deployment, surgery to the jaw or face, or a viral infection of the inner ear.
One major cause of hyperacusis is loud noise exposure. It may be triggered by a single intense noise such as a gunshot, or it may develop gradually from listening to loud noise without hearing protection.
People exposed to loud levels of noise through their occupation, whether as a machinist or a musician, should be protective of their hearing to avoid noise-induced hearing loss and other changes in their hearing such as tinnitus or hyperacusis.
Depending on the cause, hyperacusis may get better with time.
Specifically, in cases of trauma to the brain or hearing system, there is a chance that the sensitivity to sounds will become more tolerable.
In cases where the cause is not clear, however, relief may not come on its own.
I do not have any personal experience with acupuncture as a successful treatment for hyperacusis.
Many people who suffer from hyperacusis get by in their everyday life by wearing earplugs or earmuffs to reduce incoming sound levels that may be bothersome or by withdrawing from social situations that may have uncomfortable sounds present. This is a logical response.
But these strategies may not work — hyperacusis sufferers may be furthering their poor tolerance to relatively soft sounds.
Wearing earplugs or earmuffs may provide immediate relief from an environment that seems uncomfortably loud, but when the individual eventually removes the earplugs or earmuffs, that environment will seem even louder than it might have otherwise.
Additional resource: http://www.hyperacusis.org/
On March 6, Booming will post Dr. DiSarno’s answers about hearing aids, cochlear implants, genetic causes of hearing loss, ear wax and other hearing issues.
Booming: Living Through the Middle Ages offers news and commentary about baby boomers, anchored by Michael Winerip. You can follow Booming via RSS here or visit nytimes.com/booming. You can reach us by e-mail at firstname.lastname@example.org.
Fuente: The New York Times