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Hearing Loss

More than just an inconvenience

Approximately 28 million Americans have a hearing impairment. Hearing loss is one of the most prevalent chronic health conditions in the United States, affecting people of all ages, in all segments of the population, and across all socioeconomic levels.

Hearing loss affects approximately 17 in 1,000 children under age 18. Incidence increases with age: approximately 314 in 1,000 people over age 65 have hearing loss.

Hearing loss can be hereditary, or it can result from disease, trauma, or long-term exposure to damaging noise or medications. Hearing loss can vary from a mild but important loss of sensitivity, to a total loss of hearing.

Hearing problems are serious. The most important thing you can do if you think you have a hearing problem is to go see a doctor. Your doctor may refer you to an otolaryngologist, a doctor who specializes in the ear, nose, and throat.

An otolaryngologist will try to find out why you have a hearing loss and offer treatment options. He or she may also refer you to another hearing professional, an audiologist or hearing instrument specialist.

An audiologist or hearing instrument specialist can measure your hearing. Sometimes otolaryngologists and audiologists work together to find the treatment that is right for you. If you need a hearing aid, an audiologist can help you find the right one.

What causes hearing loss?

Hearing loss happens for many reasons. Some people lose their hearing slowly as they age. This condition is known as presbycusis. Doctors do not know why presbycusis happens, but it seems to run in families.

Another reason for hearing loss may be exposure to too much loud noise. This condition is known as noise-induced hearing loss. Many construction workers, farmers, musicians, airport workers, tree cutters, and people in the armed forces have hearing problems because of too much exposure to loud noise. Sometimes loud noise can cause a ringing, hissing, or roaring sound in the ears, called tinnitus.

Hearing loss can also be caused by a virus or bacteria, heart conditions or stroke, head injuries, tumors, and certain medicines.

There are different types of hearing loss. Conductive hearing loss occurs when sound waves are prevented from passing to the inner ear. This can be caused by a variety of problems including buildup of earwax, infection, fluid in the middle ear, or a punctured eardrum.
Sensorineural hearing loss develops when the auditory nerve or hair cells in the inner ear are damaged by aging, noise, illness, injury, infection, head trauma, toxic medications, or an inherited condition.

Mixed hearing loss is a combination of both conductive and sensorineural hearing loss. A conductive hearing loss can often be corrected with medical or surgical treatment, while sensorineural hearing loss usually cannot be reversed.

People with hearing loss may experience numerous problems, including: difficulty hearing conversations, especially when there is background noise, hissing, roaring or ringing in the ears, difficulty hearing the television or radio at a normal volume, fatigue or irritation cause by the effort to hear, as well as dizziness or balance problems.

Treatment options

Your treatment will depend on your hearing problem, so some treatments will work better for you than others. Some of the most common include:

- Hearing Aids are tiny instruments you wear in or behind your ear. They make sounds louder. Things sound different when you wear a hearing aid, but an audiologist or hearing instrument specialist can help you get used to it.

To find the hearing aid that works best for you, you may have to try more than one. Ask your audiologist whether you can have a trial period with a few different hearing aids. You and your audiologist can work together until you are comfortable.

- Personal listening systems help you hear what you want to hear while eliminating or lowering other noises around you. Some, called auditory training systems and loop systems, make it easier for you to hear someone in a crowded room or group setting. Others, such as FM systems and personal amplifiers, are better for one-on-one conversations.

- TV listening systems help you listen to the television or the radio without being bothered by other noises around you. These systems can be used with or without hearing aids and do not require you to use a very high volume.

- Direct audio input hearing aids are hearing aids that can be plugged into TVs, stereos, microphones, auditory trainers, and personal FM systems to help you hear better.

- Telephone amplifying devices. Some telephones are made to work with certain hearing aids. If your hearing aid has a T switch, you can ask your telephone company about getting a phone with an amplifying coil (T-coil). If your hearing aid is in the T position, this coil is activated when you pick up the phone. It allows you to listen at a comfortable volume and helps lessen background noise. You can also buy a special type of telephone receiver and other devices to make sounds louder on the phone.

Types of hearing aids

A hearing aid is an electronic, battery-operated device that amplifies and changes sound to allow for improved communication. Hearing aids receive sound through a microphone, which then converts the sound waves to electrical signals. The amplifier increases the loudness of the signals and then sends the sound to the ear through a speaker.

There are several types of hearing aids. Each type offers different advantages, depending on its design, levels of amplification, and size. Before purchasing any hearing aid, ask whether it has a warranty that will allow you to try it out. Most manufacturers allow a 30- to 60-day trial period during which aids can be returned for a refund.

There are four basic styles of hearing aids for people with sensorineural hearing loss:

- In-the-Ear (ITE) hearing aids fit completely in the outer ear and are used for mild to severe hearing loss. The case, which holds the components, is made of hard plastic. ITE aids can accommodate added technical mechanisms such as a telecoil, a small magnetic coil contained in the hearing aid that improves sound transmission during telephone calls.ITE aids can be damaged by earwax and ear drainage, and their small size can cause adjustment problems and feedback. They are not usually worn by children because the casings need to be replaced as the ear grows.

- Behind-the-Ear (BTE) hearing aids are worn behind the ear and are connected to a plastic earmold that fits inside the outer ear. The components are held in a case behind the ear. Sound travels through the earmold into the ear. BTE aids are used by people of all ages for mild to profound hearing loss. Poorly fitting BTE earmolds may cause feedback, a whistle sound caused by the fit of the hearing aid or by buildup of earwax or fluid.

- Canal Aids fit into the ear canal and are available in two sizes. The In-the-Canal (ITC) hearing aid is customized to fit the size and shape of the ear canal and is used for mild or moderately severe hearing loss. A Completely-in-Canal (CIC) hearing aid is largely concealed in the ear canal and is used for mild to moderately severe hearing loss. Because of their small size, canal aids may be difficult for the user to adjust and remove, and may not be able to hold additional devices, such as a telecoil. Canal aids can also be damaged by earwax and ear drainage. They are not typically recommended for children.

- Body Aids are used by people with profound hearing loss. The aid is attached to a belt or a pocket and connected to the ear by a wire. Because of its large size, it is able to incorporate many signal processing options, but it is usually used only when other types of aids cannot be used.

What to expect

Using hearing aids successfully takes time and patience. Hearing aids will not restore normal hearing or eliminate background noise. Adjusting to a hearing aid is a gradual process that involves learning to listen in a variety of environments and becoming accustomed to hearing different sounds.

Your audiologist will teach you to use and care for your hearing aids. Also, be sure to practice putting in and taking out the aids, adjusting volume control, cleaning, identifying right and left aids, and replacing the batteries with the audiologist present.

Your own voice may sound too loud. This is called the occlusion effect and is very common for new hearing aid users. Your audiologist may or may not be able to correct this problem; however, most people get used to it over time.

Your hearing aid may whistle. When this happens, you are experiencing feedback, which is caused by the fit of the hearing aid or by the buildup of earwax or fluid. See your audiologist for adjustments.

Information provided by The National Institute on Deafness and Other Communication Disorders