By Dr Nazar Moopan
Hearing loss that occurs gradually as you age (presbycusis) is common. Doctors believe that heredity and chronic exposure to loud noises are the main factors that contribute to hearing loss over time. Other factors, such as earwax blockage, can prevent your ears from conducting sounds as well as they should. You can’t reverse sensorineural hearing loss. However, you don’t have to live in a world of muted, less distinct sounds. You and your doctor or hearing specialist can take steps to improve what you hear.
Symptoms
* Muffling of speech and other sounds.
* Difficulty understanding words, especially against background noise or in a crowd of people.
* 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.
When to see a doctor?
Talk to your doctor if difficulty in hearing is interfering with your daily life. Your hearing may have deteriorated if you find that it’s harder to understand everything that’s said in conversation, especially when there’s background noise; if sounds seem muffled; or if you find yourself having to turn the volume higher when you listen to music, the radio or television.
Causes
Some causes of hearing loss include damage to the inner ear, a buildup of earwax, infections or a ruptured eardrum. To understand how hearing loss occurs, it can be helpful to understand how you hear.
How you hear …
Hearing occurs when sound waves reach the structures inside your ear, where the sound wave vibrations are converted into nerve signals that your brain recognises as sound. Your 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: the hammer, anvil and stirrup amplify the vibrations as they travel to the inner ear. There, the vibrations pass through fluid in the cochlea, a snail-shaped structure in the inner ear.
Attached to nerve cells in the cochlea are thousands of tiny hairs that help translate sound vibrations into electrical signals that are transmitted to your brain. The vibrations of different sounds affect these tiny hairs in different ways, causing the nerve cells to send different signals to your brain. That’s how you distinguish one sound from another.
How hearing loss can occur …
Damage to the inner ear: Ageing and prolonged 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 to you. It may become difficult for you to pick out words against background noise. Heredity may make you more prone to these changes. This type of hearing loss is known as sensorineural hearing loss, which is permanent.
A gradual buildup of earwax: Earwax can block the ear canal and prevent conduction of sound waves. Earwax blockage is a cause of hearing loss among people of all ages. This causes conductive hearing loss, which usually can be restored with earwax removal.
Ear infection and abnormal bone growths or tumours: 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 your eardrum with an object and infection can cause your eardrum to rupture and affect your hearing.
Risk factors
Factors that may damage or lead to loss of the hairs and nerve cells in your inner ear include:
* Ageing: Exposure to sounds over the years can damage the cells of your inner ear.
* Heredity: Your genetic makeup may make you more susceptible to ear damage.
* 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 your ear.
* Recreational noises: Exposure to explosive noises, such as from firearms and fireworks, can cause immediate, permanent hearing loss. Other recreational activities with dangerously high noise levels include snowmobiling, motorcycling or listening to loud music. Personal music players, such as MP3 players, can cause lasting hearing loss if you turn the volume up high enough to mask the sound of other loud noises, such as those from a lawn mower.
* Some medications: Drugs, such as the antibiotic gentamicin and certain chemotherapy drugs, can damage the inner ear. Temporary effects on your hearing, ringing in the ear (tinnitus) or hearing loss can occur if you take 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.
Complications
Hearing loss can have a significant effect on your quality of life. Among older adults with hearing loss, commonly reported problems include:
* Depression
* Anxiety
* An often false sense that others are angry with you.
* Family and friends of people who have begun using a hearing aid are even more likely to report these improvements in shared quality of life.
Preparing for your appointment
Only a small minority of people with hearing loss seek treatment, but those who do report dramatic improvements in their relationships and quality of life. If you suspect you may have hearing loss, call your doctor. After an initial evaluation, your doctor may refer you to a hearing specialist (audiologist).
Here’s some information to help you prepare for your appointment and to know what to expect from your doctor.
What you can do …
Summarise your work history, including any jobs, even those in the distant past that exposed you to high noise levels.
Take a family member or friend along. Someone who accompanies you can help you absorb all the information from the doctor.
Write down questions to ask your doctor. Having a list of questions in advance can help you make the most of your time with your doctor.
For hearing loss, some basic questions to ask your doctor include:
* What are the possible causes of my symptoms or condition?
* Other than the most likely cause, what else might be causing my symptoms?
* What tests do you recommend?
* Should I stop taking any of my current medications?
* Should I see a specialist?
* Don’t hesitate to ask other questions.
Tests and diagnosis
Tests to diagnose hearing loss may include:
* General screening tests.
* Tuning fork tests.
* Audiometer tests.
* Tympanogram
Treatments and drugs
If you have hearing problems, help is available. Treatment depends on the cause and severity of your hearing loss. Options include:
* Removing wax blockage.
* Hearing aids.
* Cochlear implants.
* Consulting a doctor.
* Coping and support.
These tips can help you to communicate more easily despite your hearing loss:
* Position yourself to hear: Face the person with whom you’re having a conversation.
*Turn off background noise: For example, noise from a television may interfere with conversation.
* Ask others to speak clearly: Most people will be helpful if they know you’re having trouble hearing them.
* Choose quiet settings: In public, such as in a restaurant or at a social gathering, choose a place to talk that’s away from noisy areas.
* Consider using an assistive listening device: Hearing devices, such as TV-listening systems or telephone-amplifying devices can help you hear better while decreasing other noises around you.
Prevention
Hearing loss prevention consists of steps you can take to help you prevent noise-induced hearing loss and avoid worsening of age-related hearing loss:
* Protect your ears in the workplace.
* Have your hearing tested.
* Avoid recreational risks.
* Dr Nazar Moopan is a
specialist -ENT and Medical Director
at Aster Medical Centre, C-Ring Road.)
