The joy of hearing

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Understanding hearing loss and steps to improvement?
By Alexander G. Bien, MD*
Hearing loss affects millions of people. In fact, it is the most common disability in the United States but often goes unnoticed because it is often impossible to tell that someone has a hearing loss just by looking at a person.
Those affected are impacted in many ways. Children with hearing loss can have trouble developing language and can have difficulty in school. People of all ages who are affected by hearing loss can withdraw from social activities and become increasingly isolated. It has been shown that older individuals with hearing loss are at increased risk of developing memory loss and dementia.
Fortunately, there is help! There are several different types and various causes of hearing loss. Once the type and the particular cause have been identified, steps toward improvement can be taken to help restore hearing.

Types of hearing loss
• Sensorineural hearing loss is a “nerve” hearing loss caused by abnormalities in the inner ear hearing apparatus. The hearing portion of the inner ear consists of the cochlea and the hearing nerve. This is the most common cause of hearing loss and can affect a person from birth (congenital) or as a person ages. Presbycusis, or a hearing loss of aging, is the most common type of hearing loss. Another cause of this type of hearing loss is exposure to loud noise. Certain diseases can also cause a sensorineural hearing loss, including Meniere’s disease, sudden hearing loss (usually caused by a virus), and tumors of the balance nerve (acoustic neuroma).
• Conductive hearing loss is caused by the inability of sound waves to reach the inner ear. In the simplest cases, this can be caused by blockage of the ear canal with cerumen (ear wax) or an infection of the external ear canal. It can also be caused by a hole in the tympanic membrane (eardrum) or by an abnormality of the ear bones (erosion or fixation). Abnormalities of the ear bones are most often caused by chronic ear infections or as a result of fixation of the third ear bone, the stapes bone, in a condition called otosclerosis.
• Mixed hearing loss is a combination of a sensorineural hearing loss and a conductive hearing loss. This occurs in special situations when a person may already have a nerve hearing loss and also has a condition that affects the hearing bones. This type of hearing loss may also occur as a result of trauma.
The best way to determine what type of hearing loss a person has is to have an audiogram, or hearing test. A hearing professional, often an audiologist, can perform this test. Depending on the type and severity of hearing loss, referral to an otolaryngologist (ENT) may be the next step. An ENT surgeon with special training in hearing loss and surgery of the ear is called an otologist, or neurotologist.

Hearing loss solutions
• Hearing aids work by taking sound waves and amplifying them so that a person with hearing loss hears the sounds louder. There are several different types of hearing aids (completely-in-the-canal, in-the-canal, in-the-ear, receiver-in-the-ear, behind-the-ear). Hearing aid technology is constantly changing and has come a long way, with hearing aids becoming much less noticeable.
• Assistive listening devices consist of various amplifying devices and can be used in specific situations. These devices include those for use with a telephone, the television, and even with the radio. There are also special devices to help around the home to ensure safety—alerts for the doorbell, an alarm clock, or the fire alarm.
• Surgery can be performed in people with a conductive hearing loss or a mixed hearing loss. When there is a hole in the eardrum, a procedure to repair the hole—called a tympanoplasty—may help to improve hearing. If there is an abnormality of the ear bones, sometimes hearing can be improved by replacing one or more of the ear bones during a middle ear reconstruction procedure. In the special case of otolsclerosis, or a stiffening of the stapes bone (third ear bone), this ear bone can be remove and replaced with a prosthesis in a procedure called a stapedectomy.
• Cochlear implants are for those people with a severe to profound hearing loss. They work by converting sound waves into electrical signals that directly stimulate the hearing nerve. Cochlear implants are placed surgically and take hearing practice after surgery to obtain full benefit. With practice, a person with a cochlear implant can hold normal conversations and can often talk on the telephone.
Accurate diagnosis of the type and degree of hearing loss is the first step in the treatment of hearing loss. By consulting with your hearing health professional and an ENT physician or otologist, the negative impact of hearing loss can be lessened and quality of life improved.
*Alexander G. Bien, MD, of Albany ENT & Allergy Services, practices Otology, Neurotology, & Skull Base Surgery. Albany ENT is located at 400 Patroon Creek Blvd., Suite 205, Albany; 701.2085; www.albanyentandallergy.com.


Helpful tips to protect your hearing
Not only can noise distract, disturb and interfere with communication and sleep, it can affect your performance, behavior and hearing.
In many cases, hearing loss can be prevented by recognizing sources of damaging noise levels and using appropriate protective equipment. However, excessive noise exposure can cause permanent hearing loss that cannot be treated with medication, or can result in constant ringing in your ears called tinnitus. Impaired hearing can reduce your ability to recognize your surroundings and listen for cues of potential danger.
Learn how to protect yourself from future hearing damage with this advice from Guard Your Health, a health education campaign by the Army National Guard:
• Know the safe volume limit to protect yourself from future hearing damage. Noise that is 0 to 80 decibels is generally safe, while noise that is 140 to 200 decibels can be dangerous.
• Noise that exceeds safe parameters, even if it’s under 140 decibels, can still cause damage to your hearing over time. A general rule of thumb is the “three feet rule.” If you have to shout to someone who is three feet away (about an arm’s length), the noise level in that location could be damaging.
• Be aware that a single exposure to a very loud sound (such as weapon fire) can cause permanent hearing loss.
• Using proper hearing protection for the environment can help prevent damage to your eardrum and hearing. There are several types of hearing protection devices available, including foam earplugs, silicone earplugs and earmuffs.
• Foam earplugs should be pinched when inserted, allowing the foam to expand in your ear until you achieve a tight, non-painful seal. Silicone earplugs should be inserted only until you feel a slight resistance to avoid damaging your inner ear. To wear ear plugs properly, straighten your ear by gripping the cartilage and stretching it away from your body. Insert the earplug then release your ear. Do a few jumping jacks to test the security of the earplugs; if they fall out, try again or get a smaller size.
• Earmuffs should rest about two finger widths from your jawbone and completely cover your ears for a tight seal on the side of your face. If you notice signs of hearing problems, ask your doctor to test your hearing. Common symptoms include a muffled sound in your ears after leaving a noisy area or event such as a car race, concert, woodworking or hunting; prolonged ringing or buzzing in your ears after exposure to noise; and difficulty understanding what people are saying although you can hear them talking.
For more health-related tools and information, visit www.guardyourhealth.com.

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