Hearing Loss Overview

How do I know if I have Hearing Loss?

Hearing loss can occur at any age for a variety of reasons. Most often hearing loss occurs as a combination of causes, such as the aging, exposure to loud noise, family history of hearing loss, certain medications, infections, head or ear trauma, and several other causes. It is estimated that 34 million people in America have some degree of permanent hearing loss. Hearing loss is the single most common medical disorder at birth. Hearing loss in adults, particularly in seniors, is one of the most common health issues.

You may have hearing loss if…

  • You hear people speaking but you have to strain to understand their words.
  • You frequently ask people to repeat what they said.
  • You miss too much of the story or the punch line.
  • You commonly complain that people mumble.
  • You need to ask others about the details of a meeting you just attended.
  • You play the TV or radio louder than your friends, spouse and relatives.
  • You cannot hear the doorbell or the telephone.
  • You find that you understand people more clearly if you can see them.

Types of Hearing Loss

There are two main types of hearing loss, Sensorineural and Conductive. Additionally, central auditory processing can greatly affect hearing on top of sensorineural or conductive hearing loss.

Sensorineural

Sensorineural refers to the most common type of hearing loss.  The tiny hearing hair cell receptors in the inner ear are not as sensitive as they used to be.  This commonly occurs from:

  • A natural change from aging or family history of hearing loss
  • Damage caused by loud sound or noise exposure – even if that exposure occurred many years ago.  The hair cell receptors are damaged at the time of exposure but may not show as hearing loss until many years later.
  • Disease or infection in the inner ear may result in a sensorineural hearing loss in 5-10% of people.  There are usually other symptoms that lead us to this diagnosis.

85% of people with hearing loss have sensorineural hearing loss.  This type cannot be corrected with medication or surgery.  Appropriate hearing aids are the best way to improve your hearing and regain understanding.

Conductive

Conductive hearing loss is caused by a condition with your eardrum, middle ear, or middle ear bones.  These structures can become stiff and this stiffness prevents the sound from entering the inner ear at full strength.  Conductive hearing loss can be caused by:

  • Hardening of the eardrum from scar tissue
  • Hole in the eardrum
  • Middle ear infection or progressive tumor
  • Stiffening of the middle ear bones – often called Otosclerosis.

Conductive hearing loss can frequently be corrected with medication and/or surgery.  If you have this hearing loss we may be referring you to an Otologist, a physician specializing in treatment and surgery of the ear.

If you are not a candidate for treatment or surgery, hearing aids are very effective in improving conductive hearing loss.

 Central

Another condition that can affect your hearing is worth mentioning, although it is not a distinctive type of hearing loss.  Central hearing loss is caused by changes in the neural system within the brain. All meaning of sound is interpreted inside the brain and this may change so the brain is not able to accurately decipher sounds to make them understandable words.  Central deficits may result from:

  • Family history
  • Other central influences like stroke and vascular problems.
  • Progressive neurologic disease like multiple sclerosis,
  • Age-related diseases such as dementia and Alzheimers disease greatly effect brain process and attention.
  • Injury from trauma, motor vehicle accident, localized brain injury.

This problem looks like hearing loss – the person just doesn’t “hear” well. While there may be some hearing loss the bigger issue is actually a change in processing within the brain. Since the understanding centers in the brain are not reacting to sound as quickly or as accurately it looks like they “can’t hear”.  This problem almost always occurs with sensorineural hearing loss and is most frequent in the elderly, particularly those who have an untreated hearing loss for many years. Hearing aids can be helpful to reconnect you to people and things around your but expectations for improvement must be realistic.  Your hearing clarity will improve through a combination of hearing aids and improved listening habits.

Degrees of Hearing Loss

The amount of hearing loss is measured by its degree:  normal, mild, moderate, moderately severe, severe, and profound.  It is important to understand that most people with hearing loss of any degree report the same symptom – “I hear pretty well, I just don’t understand all the words as clear as I used to”.  This is the first and most common sign of hearing loss.

The graph above, an audiogram, shows the degree of hearing loss down the right side.

Mild hearing loss starts making it difficult to understand some speech in specific situations, such as with a soft speaker or when listening in background noise. In quiet rooms, a mild hearing loss causes little problem.

Moderate hearing loss creates more problems understanding conversations, particularly with women, children, and people who seem to talk fast.This is particularly noticeable in background noise such as restaurants or social gatherings.  The TV or radio may be somewhat louder for some programs in order to be heard clearly.  Others may notice your hearing problem before you do.  Hearing aids are very helpful when used at this level.

Moderately-severe hearing loss is obviously noticeable to others. Clarity of speech is affected whether in quiet or busy gatherings. You will misunderstand words more frequently, thinking the speaker said one word when they actually said another.  The punch lines to jokes are much harder to understand. Others complain that the TV is too loud and hearing people from a distance becomes more difficult. At this level, even the person with the hearing loss notices the hearing problem. In an elderly person, they often do not realize that they have lost half of their hearing and begin to withdraw without even noticing.  Hearing aids are incredibly helpful at this level.

Severe hearing loss requires people to speak directly to you with a louder voice. All communication must be direct and purposeful.  Often you will need to watch the speaker in order to understand. Usually, the hearing loss has been present for years and has finally reached this level where communication is no longer easier or enjoyable.  Hearing aids are vital at this stage to remain engaged with the communication around you. If the person has never used hearing aids they must be guided carefully to achieve the best possible hearing over a period of months.

Profound Hearing loss creates pervasive hearing problems for almost all daily sounds. At this level, people with profound hearing loss may have difficulty understanding even amplified speech.  Hearing aids or other amplification is vital to remain connected to the hearing world around you.

What if I delay treatment for my hearing improvement?

Often people resist any examination or treatment of hearing difficulty until it reaches the moderate range – about 50% hearing loss. At this point, it creates daily frustration in several listening environments.   Older people in particular often wait until the hearing problem extends into the severe category.  They finally resign themselves to seeking help when their hearing problem becomes pervasive. Often it is too late to regain optimal understanding because the decline has persisted for far too long and changes in neural pathways have occurred. Had they responded earlier to the hearing problem the improvement would have been more obvious, easier to adjust to, and would likely have prevented some of the further hearing difficulty.

It is vital that family members insist on early diagnosis and treatment when faced with a person who is often reluctant and unbelieving about their hearing problem.

A good rule of thumb is to seek treatment when any of the following occur:

  • Family members begin commenting about your hearing difficulty.  Even a joke can be a gentle prod for you to recognize the emerging problem.
  • When you find that a growing number of people seem to “mumble”.  It is easy to blame others for their poor speaking habits when it’s likely your hearing.  If other listeners around you seem to understand the speaker then it’s likely your hearing, not their speaking.
  • When you rely on watching people as they speak.  We use our eyes to augment what our ears have stopped doing.  If you understand noticeably better when watching someone, it’s time to have your hearing checked.
  • When background noise interferes with your ease of listening.  An obvious sign of hearing loss is when your hearing seems satisfactory in quiet situations but is obviously more frustrating when in crowded rooms like restaurants and other busy gatherings.  It is easy to dismiss this as simply a problem with the crowd, or the room, or the speaker – when it is likely related to your hearing.
  • When you start dropping out of conversations because it requires too much effort, or you avoid challenging listening situations altogether – it’s time for a hearing evaluation.  Isolation is a common effect of untreated hearing loss and usually starts as withdrawal from specific situations – “I’m not going to church anymore because I just can’t hear anyone”.