HEARING IMPAIRMENT
Hearing loss is defined as one of three types:
Conductive (involves outer or middle ear)
Sensorineural (involves inner ear)
Mixed (combination of the two)
Presbycusis - hearing loss that occurs gradually as one ages (between the ages of 65 and 75)
Aging and chronic exposure to loud noises both contribute to hearing loss. Other factors, such
as excessive earwax, can temporarily reduce how well the ears conduct sounds.
Hearing loss is irreversible. A hearing specialist can take steps to improve what a person hears.
Physiology of Hearing
The ear consists of three major areas: outer ear, middle ear and inner ear. Sound waves pass
through the outer ear and cause vibrations at the eardrum. The eardrum and three small bones
of the middle ear amplify the vibrations as they travel to the inner ear. There, the vibrations
pass through fluid in a snail-shaped structure in the inner ear (cochlea).
Attached to nerve cells in the cochlea are thousands of tiny hairs that help translate sound
vibrations into electrical signals that are transmitted to the brain. The brain turns these signals
into sound.
Comparing loudness of common sounds
The chart below lists common sounds and their decibel levels. The Environmental Protection
Agency's (EPA) safe noise level is 70 decibels. The louder the noise, the less time it takes to
cause permanent hearing damage.
Sound levels of common noises
Decibels Noise source
Safe range
30 Whisper
40 Refrigerator
60 Normal conversation
75 Dishwasher
Risk range
85 Heavy city traffic, school cafeteria
95 Motorcycle
100 Snowmobile
110 Chain saw, jackhammer, rock concert, symphony
Sound levels of common noises
Decibels Noise source
115 Sandblasting
120 Ambulance siren, thunder
140-165 Firecracker, firearms
Causes (How hearing loss can occur)
Damage to the inner ear. Aging and exposure to loud noise may cause wear and tear on
the hairs or nerve cells in the cochlea that send sound signals to the brain. When these
hairs or nerve cells are damaged or missing, electrical signals aren't transmitted as
efficiently, and hearing loss occurs.
Higher pitched tones may become muffled. It may become difficult for a person to pick
out words against background noise.
Gradual buildup of earwax. Earwax can block the ear canal and prevent conduction of
sound waves. Earwax removal can help restore one’s hearing.
Ear infection and abnormal bone growths or tumors. In the outer or middle ear, any of
these can cause hearing loss.
Ruptured eardrum (tympanic membrane perforation). Loud blasts of noise, sudden
changes in pressure, poking one’s eardrum with an object and infection can cause the
eardrum to rupture and affect one’s hearing.
Risk factors
Factors that may damage or lead to loss of the hairs and nerve cells in the inner ear include:
Aging. Degeneration of inner ear structures occurs over time.
Loud noise. Exposure to loud sounds can damage the cells of the inner ear. Damage can
occur with long-term exposure to loud noises, or from a short blast of noise, such as from
a gunshot.
Heredity. The genetic makeup may make one more susceptible to ear damage from sound
or deterioration from aging.
Occupational noises. Jobs where loud noise is a regular part of the working environment,
such as farming, construction or factory work, can lead to damage inside the ear.
Recreational noises. Exposure to explosive noises, such as from firearms and jet engines,
can cause immediate, permanent hearing loss. Other recreational activities with
dangerously high noise levels include snowmobiling, motorcycling, carpentry or listening
to loud music.
Some medications. Drugs such as the antibiotic gentamicin, sildenafil (Viagra) and certain
chemotherapy drugs, can damage the inner ear. Temporary effects on the hearing —
ringing in the ear (tinnitus) or hearing loss — can occur if a person takes very high doses of
aspirin, other pain relievers, antimalarial drugs or loop diuretics.
Some illnesses. Diseases or illnesses that result in high fever, such as meningitis, may
damage the cochlea.
Symptoms
Signs and symptoms of hearing loss may include:
Muffling of speech and other sounds
Difficulty understanding words, especially against background noise or in a crowd
Trouble hearing consonants
Frequently asking others to speak more slowly, clearly and loudly
Needing to turn up the volume of the television or radio
Withdrawal from conversations
Avoidance of some social settings
Diagnosis
Tests to diagnose hearing loss may include:
Physical exam. Your doctor will look in your ear for possible causes of your hearing loss,
such as earwax or inflammation from an infection. Your doctor will also look for any
structural causes of your hearing problems.
General screening tests. Your doctor may use the whisper test, asking you to cover one
ear at a time to see how well you hear words spoken at various volumes and how you
respond to other sounds. Its accuracy can be limited.
App-based hearing tests. Mobile apps are available that you can use by yourself on your
tablet to screen for moderate hearing loss.
Tuning fork tests. Tuning forks are two-pronged, metal instruments that produce sounds
when struck. Simple tests with tuning forks can help your doctor detect hearing loss. This
evaluation may also reveal where in your ear the damage has occurred.
Audiometer tests. During these more-thorough tests conducted by an audiologist, you
wear earphones and hear sounds and words directed to each ear. Each tone is repeated at
faint levels to find the quietest sound you can hear.
Treatment
If you have hearing problems, help is available. Treatment depends on the cause and severity of
your hearing loss.
Options include:
Removing wax blockage. Earwax blockage is a reversible cause of hearing loss. Your
doctor may remove earwax using suction or a small tool with a loop on the end.
Surgical procedures. Some types of hearing loss can be treated with surgery, including
abnormalities of the ear drum or bones of hearing (ossicles). If you've had repeated
infections with persistent fluid, your doctor may insert small tubes that help your ears
drain.
Hearing aids. If your hearing loss is due to damage to your inner ear, a hearing aid can be
helpful. An audiologist can discuss with you the potential benefits of a hearing aid and fit
you with a device. Open fit aids are currently the most popular, due to fit and features
offered.
Cochlear implants. If you have more severe hearing loss and gain limited benefit from
conventional hearing aids, then a cochlear implant may be an option. Unlike a hearing aid that
amplifies sound and directs it into your ear canal, a cochlear implant bypasses damaged or
nonworking parts of your inner ear and directly stimulates the hearing nerve. An audiologist,
along with a medical doctor who specializes in disorders of the ears, nose and throat (ENT), can
discuss the risks and benefits.
Complications
Hearing loss can have a significant effect on your quality of life. Older adults with hearing loss
may report feelings of depression. Because hearing loss can make conversation difficult, some
people experience feelings of isolation. Hearing loss is also associated with cognitive
impairment and decline.
The mechanism of interaction between hearing loss, cognitive impairment, depression and
isolation is being actively studied. Initial research suggests that treating hearing loss can have a
positive effect on cognitive performance, especially memory.
Prevention
The following steps can help you prevent noise-induced hearing loss and avoid worsening of
age-related hearing loss:
Protect your ears. Limiting the duration and intensity of exposure to noise is the best
protection. In the workplace, plastic earplugs or glycerin-filled earmuffs can help protect
the ears from damaging noise.
Have your hearing tested. Consider regular hearing tests if you work in a noisy
environment. If you've lost some hearing, you can take steps to prevent further loss.
Avoid recreational risks. Activities such as riding a snowmobile, hunting, using power
tools or listening to rock concerts can damage your hearing over time. Wearing hearing
protectors or taking breaks from the noise can protect your ears. Turning down the music
volume is helpful too.
