Hearing loss is common and often goes untreated
Toolbox
By JANE E. BRODY The New York Times - Published: October 1, 2006
Conversations with my elderly aunt alternate between being comical and frustrating. I might say to her, "My grandsons are now swimming like fish," and she will reply, "My friend's dog died yesterday." If I should ask, "What is your granddaughter doing this summer?" she is likely to reply with something like, "I went shopping in Brooklyn yesterday."
Though her mind remains razor sharp and she maintains an independent life in her late 80s, her hearing is so poor that most people soon give up trying to engage her in conversation, unless they happen to enjoy such non sequiturs. But though family members have been urging her for years to get a hearing aid, she has refused, saying, "They're too much trouble," or that a friend had one and didn't like it (although this friend wears hers every day).
My aunt is one of 31.5 million Americans who suffer from hearing loss. They include a third of Americans over 60 and up to half of those over 75, most of whom have age-related hearing loss, a condition known medically as presbycusis. Hearing loss is the third most common chronic condition among older Americans, after hypertension and arthritis. Hearing difficulties in older people can have serious consequences, including social isolation, functional decline and depression. Hearing loss can also impair memory and cognitive function, according to a study by neuroscientists at Brandeis University.
A survey of 2,000 hearing-impaired adults conducted in 1999 by the National Council on Aging found that those using aids had better feelings about themselves, greater independence, improved mental health and better relationships with their families. Yet only one person in five with hearing loss wears a hearing aid — partly because of their cost, which is not covered by Medicare and rarely by private insurance. I can't help wondering why the computer on which I'm writing this column costs less than most hearing aids.
Some people do not know — or they deny — that they have a hearing problem, complaining instead that everyone seems to mumble or talk too fast. Even those who get a yearly physical rarely have their hearing checked. Others are embarrassed to wear a hearing aid. About 30 percent of people who have hearing aids don't wear them daily.
Hearing aids have improved vastly in the past decade, in both design and selection. Even so, some people, having once had a bad experience, refuse to explore the many new options.
As with the eye and vision, there are many steps between the ear and hearing, a process that takes but a tiny fraction of a second. Sound entering the ear canal causes the eardrum to vibrate. These vibrations are picked up by three tiny bones in the middle ear that connect the drum to the cochlea, a snail-shell-like structure with three tubes filled with fluid. The resulting waves in the fluid signal hair cells in the cochlea that transmit electrical signals to the auditory nerve that connects to the brain stem. These signals then travel to the brain's auditory center, where the message is processed.
Disruption or damage at any stage in this chain can result in hearing loss. Among factors that can damage hearing are trauma, chronic infection, wax buildup, fusion of ear bones, diseases like diabetes and medications like the antibiotics vancomycin and gentamicin. Some anti-cancer drugs are also toxic to the ear. Heredity, too, plays a role; some people carry gene mutations that make them more susceptible to hearing loss.
The most common environmental factor is loud noise, either a sudden very loud noise like an explosion or gunshot next to the ear or, more commonly, repeated exposure to loud noises like those produced by rock bands or earbuds and headphones. Some rockers and countless rock fans have developed hearing problems.
Hearing loss associated with aging most often results from cumulative damage to the hair cells in the cochlea, which, like other body parts, suffer the wear and tear of age. The first to decline are those in the outer part of the cochlea that are sensitive to high-frequency sounds, including those produced by the consonants f, sh, ch, p, s and t, which are crucial to clarity in perceiving speech. The low-frequency vowel sounds are the last to go.
Detection of a hearing problem is the first step. Hearing specialists have long urged family physicians to check the hearing of patients over 60 at every annual visit by doing a whisper test in each ear or administering a short written quiz.
Anyone with a suspected hearing problem should be referred to an audiologist for detailed testing, or to an otolaryngologist if the cause is medical. Anyone experiencing sudden loss of hearing in one or both ears should consult an otolaryngologist without delay. That could be a reversible problem if treated quickly.
Audiologists are certified clinicians trained to analyze a hearing problem, prescribe hearing aids and help people adjust to their use. In areas where there is no audiologist, look for a licensed hearing aid specialist who is trained to fit and dispense hearing aids.
Four styles of aids are now available, ranging in price from about $400 to $3,000:
Audiologists can help patients select the most appropriate model based on their hearing and living needs and dexterity.
When circumstances change, audiologists can also reprogram hearing aids. New designs help patients distinguish speech in noisy environments; some adjust automatically while others require the user to make adjustments. For people with severe hearing loss who need a lot of amplification, new devices have been designed to suppress the high-pitched whistle that can be produced by a hearing aid turned to high volume amplification.
Most important for anyone getting a hearing aid is to take the time needed to adjust to its use. No hearing aid can replace normal hearing, but when properly fitted and adjusted, an aid can greatly improve quality of life.
For more information on hearing aids and preventing hearing loss: "Save Your Hearing Now" by Michael D. Seidman and Marie Moneysmith.
The National Institute on Deafness and Other Communication Disorders offers this simple test of hearing acuity. If you answer yes to one or more of these questions, you should be checked by a hearing professional.
Do you have problems hearing on the telephone?
Do you have trouble hearing when there is noise in the background?
Do you have to strain to understand a conversation?
Do many people you talk to seem to mumble or not speak clearly?
Do you misunderstand what others say and respond inappropriately?
Do you often ask people to repeat themselves?
Do you have trouble understanding the speech of women and children?
Do people complain that you turn the TV volume up too high?
Do you often hear a ringing, roaring or hissing sound?
Do some sounds seem too loud?
29