Now Hear This
No matter how slight or profound a hearing loss you are told you have (by loved ones who are tired of over-enunciating) there is a solution. No more excuses. Get tested and diagnosed so you can hear what you have been missing.
About one in 10 Americans have hearing loss. The number is expected to double by the year 2030 as the Baby Boomer generation reaches senior status.
Whether the loss is sensorineural or conductive-based, a variety of treatments are available, reassures Dr. C. Y. Joseph Chang, professor and chairman of the Department of Otolaryngology—Head and Neck Surgery at The University of Texas Medical School at Houston.
Some causes of hearing loss can be corrected with office procedures or outpatient surgery. Most correctable causes of hearing loss are conductive: sound that cannot enter the ear. These conditions include
- wax buildup
- a hole in the eardrum
- fluid in the ear
- problems with the hearing bones or ossicles.
Most hearing losses, however, are sensorineural, a problem with the inner ear or hearing nerve. The most common adult sensorineural loss is noise-induced and occurs with age (presbycusis) which has much to do with family history.
Hearing loss is common as we age, and usually begins in our 50s. Not all hearing loss is created equal, either. Some can hear normally into their 80s while others begin to lose hearing after 40. The severity of noise-induced hearing loss depends on intensity and duration of noise exposure and one’s physical tolerance. Some people just naturally are more assaulted by noise.
Other causes can be
- hearing impairment at birth
- side effects of certain medications that can be toxic to the ears
- bacterial or viral infection
- a rare but benign tumor (acoustic neuroma).
The only way to obtain a diagnosis is to see a physician who will take a detailed medical history, perform a physical exam and an audiogram (hearing test).
Treatments are plentiful. Most cases can be treated with hearing aids. “Unlike previous devices, the current hearing aids can match the configuration of the patient’s hearing loss more accurately because they are programmable,” Chang says. Programmable hearing aids are available in both the traditional “analog” system and the newer, more adaptable digital aids.
Trisha Dibkey, MA, chief audiologist and clinical assistant professor at UT Medical School says “technological advances of ‘completely-in-the-canal’ (CIC) hearing aids, which are not very noticeable, have helped alleviate the stigma some patients associate with wearing hearing aids.”
She adds that improvements in sound quality have also been noted with digital signal processing. “Directional microphones are easy to use and improve understanding in the presence of background noise.”
Hearing aids with multiple programs can provide choices in tonal quality in “various listening environments.” In other words, you can adjust for chaotic dinner conversation or for quiet movie dialogue.
For those deaf in one ear only, science has figured out a way to balance sound. A wireless device known as CROS (Contralateral Routing of Signals) is worn on both sides to distribute sound evenly. Patients can hear on the bad side without having to turn their heads. The hearing aid can be worn behind the ear or inside the ear, depending on the model.
Only patients with severe to profound hearing loss in both ears are candidates for cochlear implants, which are designed for individuals who get almost no benefit from a hearing aid, Chang says. The implant bypasses the damaged auditory hair cells and converts speech and environmental sounds into electrical signals, which are sent to the hearing nerve.
Cochlear implant technology has improved over the 30 years that it has been available in the U.S. Originally, the implant was placed on only one side, but now, in certain cases, it can be placed on both sides, providing a better sense of where the sound is coming from. “This also solves a safety issue,” Chang says.
This outpatient surgery takes one to two hours. The device is implanted under the skin with the electrode passing through the mastoid bone through a small hole drilled by the surgeon and then into the inner ear. The implant goes right into the cochlea and stimulates the nerve. An external computer sends the signals to the implanted device.
Children and cochlear implants
“The kids need to be implanted as early as possible, with age 6 being on the late side,” says Chang. The implants should occur during that critical period when language begins to develop. Ideally, pediatric implants are done at 1 to 2 years of age. If a child does not have speech function by adolescence, the implants are not helpful.
Children born in Texas are being diagnosed earlier because of a state-wide neonatal auditory screening that went into effect about 5 years ago.
Another implant is the bone-anchored hearing aid (BAHA), which is surgically placed in the skull. A titanium post is seated in the skull and remains exposed on the surface of the skin. A device attaches to the post and stimulates the inner ear directly through bone vibration. Nothing goes into the ear. This implant works well for conductive loss only:
- for people who cannot wear a hearing aid
- for the patient whose ear gets infected if plugged
- for those born without an ear canal.
Other causes of hearing loss
- In children, the most common cause of hearing loss is from fluid that cannot drain from the ear because of a misshapen or malfunctioning eustachian tube. This condition can be reversed with placement of a ventilating tube if necessary.
- Otosclerosis is a progressive conductive hearing loss due to abnormal bone formation around the stirrup bone. This condition can be treated with a hearing aid or surgical correction called stapedectomy, which removes the immobile stirrup bone and replaces it with an implant. This outpatient surgery is performed through the ear canal and takes 30 to 40 minutes. The results are usually very good, Chang says.
- Tympanoplasty is a procedure used to fix holes in ears, which often can cause infections. The patient’s own tissue is grafted under the hole, which has a remarkable heal rate.
- Another condition, cholesteatoma, is serious but uncommon. It most likely results from multiple ear infections in which a skin cyst forms from the ear canal and gets sucked into the middle ear. The outpatient surgical correction is called tympanomastoidectomy.