How Your Doctor Can Help Your Hearing Health

All about hearing health

Fifteen percent of Americans suffer from some kind of hearing loss, the risk of which increases with age and has been linked to dementia, diabetes and heart health. Not hearing well can have a broad detrimental impact on overall health. People suffering from auditory loss not only struggle to hear, but they can also experience health issues including vertigo, communication difficulties, increased emotional and mental health issues and a decline in social skills and self-esteem. Struggling to hear can also be hard on relationships and the ability to succeed in the workplace. 

Whether you can’t hear out of one ear or both ears, hearing loss can have a pervasive negative impact on life. This is why it’s important to get a baseline hearing loss test and take steps to keep your hearing healthy.

Here's what you need to know. 

Myths

• Hearing loss is inevitable with aging:  Presbycusis, a slow decline in high-pitched hearing in both ears, is age-related hearing loss that develops gradually over time starting between ages 50 and 60 and is one of the most common conditions for people ages 65-75, affecting 1 in 3 people, according to the National Council on Aging. But it is not inevitable, and many live a long life with their hearing intact.
• Hearing loss only affects older people:  Two thirds of the estimated 48 million Americans living with hearing loss are under 65, with one in five children 12 to 19 years old showing signs of hearing deficits per data sets examined by the Journal of the American Medical Association.
• Hearing loss doesn't impact overall health: Left untreated, loss of hearing  an increase risk of depression, cognitive decline and dementia, social isolation, falls and fractures. 
• Hearing aids whistle, hum and buzz: Older analog hearing aids were know to broadcast annoying sounds directly in the ears. But today's sophisticated digital hearing aids can distinguish background noise from speech and tune out unnecessary sounds without causing squealing in the ears. 

Fast Facts

According to the National Institute on Deafness and Other Communication Disorders (a division of the National Institutes of Health): 

• 37.5 million American adults 18 and over (about 15 percent) report some trouble hearing.
• Men in the 20-69 age bracket are almost twice as likely as women to have hearing loss.
• About five percent of adults age 45-54 have disabling hearing loss. The rate increases to 10 percent for adults age 55-64, 22 percent for those age 65-74, and 55 percent of those 75 and older. 
• Among adults age 70 and older with hearing loss who could benefit from hearing aids, fewer than 30 percent (1 in 3) has ever used them and only 16 percent age 20-69. 
• As reported in the most recent Lancet Healthy Longevity report, regular use of hearing aids is associated with a 24 percent decrease in risk of early death.  

Types of hearing loss

Sensorineural

The ear consists of three parts: the inner, middle and the outer ear. When the inner ear is damaged, this results in sensorineural hearing loss (SNHL), the most common type of permanent hearing loss. Most permanent hearing loss occurs gradually over time starting at age 50 to 60 due to a slow decline of high-pitched hearing in both ears known as presbycusis. It affects one in three people aged 65–74 and nearly half of Americans over age 75.

SNHL can also occur due to problems with or damage to the hairs and nerves in the cochlear – a spiral-shaped, fluid-filled cavity in the inner ear that plays a vital role in auditory processing – and nerve pathways that communicate signals from the inner ear to the brain, making it hard to hear soft sounds and causing loud sounds to seem muffled. Other causes include, hereditary hearing loss, ear infections, blunt head trauma, exposure to extremely loud noises, some medications, and illnesses including chickenpox, mumps and measles and medications.

Unfortunately, sensorineural hearing loss cannot be treated with surgery or medicine and may require hearing aids. 

Conductive Hearing Loss

CHL is a loss of hearing caused by damage anywhere from the outer ear to the ossicles in the middle ear – three tiny bones that allow the transmission of sound waves by connecting the ear drum (the tympanic membrane that sits between the outer and middle ear) to the inner ear, conducting sound for processing. Because of the complexity and sensitivity of the middle ear, conductive hearing loss is prevalent as it affects a wide swath of demographics from children who’ve suffered ear infections to the adults with nasopharyngeal tumors.

Mixed (sensorineural and conductive)

Mixed hearing loss is a combination of sensorineural and conductive meaning there is damage or a problem in both the outer and middle ear (conductive) as well as the inner ear (sensorineural). This causes difficulty in hearing speech, especially when someone is speaking softly or there’s a lot of background noise.

Auditory neuropathy spectrum disorder

A complex hearing disorder known as auditory neuropathy spectrum (ANSD) is the rarest and least understood form of hearing loss. ANSD occurs when hearing is normal and travels successfully through the middle ear to the inner ear after entering the outer ear, but is impaired somewhere between the inner ear and the brain due to a breakdown in the signal communication pathway. Scientists believe it’s due to the malfunction of the specialized inner hair cells in the inner ear that transmit hearing signals to the brain through the nervous system. Hearing loss may be mild or severe, but in all cases, people have trouble understanding speech and recognizing words, and sounds can be out of sync, fading in and out.

Signs and symptoms of hearing loss

Babies and children 

Low birth weight or a family history of hearing impairment are the most common risk factors for infant hearing loss. Signs include a newborn baby not startling at loud noises and older infants not being responsive to familiar voices, which may also be the case if they are not using single words by 15 months or two-word sentences by age two. Because of the difficulty in ascertaining hearing deficits in infants, it may not become apparent until they are in school and exhibit common signs like falling behind with class work and inattention during activities.

Teens and young adults

Noise-induced hearing loss due to excessive exposure to loud noises is the most common cause of hearing loss in teens and young adults. The following are key signs and symptoms:

• Repeatedly asking others to speak or repeat what they said louder, more clearly or slowly. 
• Difficulty hearing high-pitch sounds such as phones, doorbells and alarms. 
• Trouble hearing over the phone even at a high volume.
• Turning the TV, radio or music volume up beyond what seems normal. 
• Difficulty understanding conversation in loud places. 
• Trouble hearing non-vowel sounds and speech consonants including differences between 'th,' 'ch' and 'sh,' and between f and s and p and t. 

Middle-aged adults

Changes to the inner ear and the complex pathways of nerves connecting the inner ear and brain are common causes of hearing loss for adults aged 50 to 60. Long-term loud noise exposure and some common adult health conditions such as diabetes and high blood pressure can also impact hearing, as well as medications toxic to the ears’ sensory inner hair cells.

A less common cause is otosclerosis, abnormal hardening and scarring of bone and tissue in the middle ear, when structural deformities disrupt sound traveling between it and the inner ear. More than three million Americans suffer from otosclerosis; middle-aged white women are most at risk.

Common signs and symptoms include the following: 

• People's speech seems mumbled or muffled. 
• Hearing is impacting your ability to enjoy social events or meeting with family and friends. 
• You have difficulty hearing on the phone, listening to the radio or TV, and/or constantly need to turn up the volume. 
• Family members get frustrated in conversation having to repeat themselves. 
• Men's voices are easier to understand than women's.
• You have difficulty distinguishing between 'th' and 's' sounds. 
• You start to notice and feel frustrated that you can't hear as well as you used to. 

Age 60 and over

About 30 percent of older adults suffer from hearing loss, which increases to more than 80 percent for seniors over 85. Age-related hearing loss, called presbycusis is the most common form, affecting one in three adults 65 and older. Signs and symptoms are the same as those above for middle-aged adults but may be more pervasive, pronounced, noticeable, frustrating and/or emotional to cope with, raising the danger of depression and isolation.

How hearing loss impacts your overall health

An increasing body of research is linking hearing loss to major health conditions, most notably cardiovascular disease (CVD), depression, diabetes and dementia.

• Cardiovascular disease: Around 92 million Americans (more than a third of the population) suffer from a form of CVD, and while it's proving difficult for science to determine a direct link with hearing loss, it's believed restrict blood flow to the small arteries that supply the complex mechanisms of our ears and auditory processing system with blood's necessary nutrients. 
• Dementia: People with mild hearing impairment (unable to hear whispering) are twice as likely to develop dementia compared with those with typical hearing. While hearing loss is a condition often mistaken for dementia, the risk increases threefold for those with moderate hearing loss (unable to hear talking), and five-fold for those with severe impairment (unable to hear a doorbell). Ongoing research to get to the root cause is ongoing, but researchers believe it’s related to the strain required to decode sounds and the resulting overload on the brain’s cognitive capacity.
• Depression:  A National Health and Nutrition Examination Survey found that depression among individuals with hearing loss is 2.3 times greater than those without any hearing impairment and impacts women more than men. Even though hearing loss is the third most chronic condition impacting older adults, in the past five years only 20 percent have had their hearing checked and only 11 percent sought treatment to improve their hearing. Many suffer in silence, stay home, decline social invitations and withdraw into an ever-shrinking world of quiet which can cause severe emotional distress, especially for seniors over 65. Along with other age-related sensory losses including sight and taste, this combination often leads to depression.

• Diabetes:  The National Institutes of Health found that hearing loss is twice as common among people with diabetes compared with those who do not have the disease. Of the estimated 79 million adults with prediabetes, the hearing loss rate is 30 percent higher than for people with normal blood sugar levels. The link is not yet fully understood, but research points to diabetes causing hearing impairments by damaging blood vessels and nerves in the inner ear. 

  The Centers for Disease Control reports that low blood sugar can over time disrupt nerve signal transmissions to the brain from the inner ear, and likewise, high blood sugar can begin to damage the nerves and small blood vessels that supply the inner ear.

• Falls and fractures:  Reports reveal that even mild hearing deficits increase the risk of falling threefold. Some scientists feel this is clinically significant because of the high risk of fall fractures, especially in the elderly, due to the shared pathology between our vestibular system that gives us our sense of balance and helps us safely navigate our position in space related to objects, and the cochlear function of the inner ear which contributes to balance.

Protecting your hearing

Prevention

Gradual age-related hearing loss (presbycusis) is hard to prevent. So, it’s best to focus on what you can control, which is taking proactive measures and following healthy hearing practices to minimize your risk for noise-induced hearing loss (NIHL).

• Reduce exposure to loud environments.
• Turn down the volume, especially as most listening devices, music systems, gaming devices and TVs today are manufactured with volume outputs exceeding the 85-decibel safe listening threshold.
• Cover your ears, especially when the noise level exceeds 85 decibels, such as mowing the lawn (mower typically output 106 decibels), attending a concert (120 decibels) or viewing fireworks display (150 decibels). 
• Invest in newer products such as power tools designed to limit noise output. 
• Invest in protective ear gear. 
• Always wear hearing protection when exposed to loud places, especially if the noise output is over 85 decibels. 
• Give your ears a break and learn to enjoy frequent quiet and silence. 

Preservation 

Most adults haven't had a hearing loss test since they were in grade school. But it's important to get an audiology exam at some point between your 20s and turning 60 so you have a baseline for comparison. Then it's recommended to have your hearing checked annually. If your symptoms are noted, further hearing loss tests can be performed to ascertain appropriate treatment. If your hearing is fine, you don't need another audiology exam unless your hearing changes. 

Treatment Options

For sensorineural hearing loss: 

• Customize hearing aids (worn in or behind the ears), that mimic normal hearing levels by minimizing sounds you don't want to hear and amplifying those you do.
• Cochlear implants: these are complex electronic devices including a microphone, speech processor and transmitter that are surgically implanted into the head. 

For conductive hearing loss:

• Medical intervention be an ENT (ear-nose-throat specialist) is usually required to find out of an anatomical abnormality is disrupting the passage of sound in the inner ear, such as otosclerosis (see above). 
• Hearing aids may help. 
• If they don't, a bone-anchored hearing system (BAHS) may be surgically implanted. Different from a cochlear implant (see above), a BAHS sends sound vibrations to the inner ear via bone conduction. 

Auditory rehabilitation and training:

• Like physical therapy, this is typically recommended whether you have hearing aids or an implant to help retrain your brain to process sounds and noise and help you adjust and avoid listening fatigue. (Check out MDVIP’s Brain Health Quiz here).

Assistive listening devices (ALDs):

• These include amplified phones, hearing loops often provided at public venues directing sound directly to your hearing aid, captioned phones and using TV subtitles.

How your primary care doctor can help you manage your hearing health

To get the best care and start feeling better, be open with your physician about your hearing-related concerns. Share your health history, your current lifestyle habits and any specific hearing-related symptoms you’re experiencing. Discuss any health problems or medication side effects that may be affecting your hearing health, and be open to medication changes and new treatments. The key is to be honest and transparent with your doctor so he or she can guide you to your goal.

Be completely honest with your doctor

Sometimes, it’s tempting to be less than truthful with our doctors, especially when it comes to fraught topics like sexual activity, reproductive health and weight. Though we may not immediately think of it as a taboo topic, hearing loss does carry a stigma, particularly for older adults. It is understandable and common to be embarrassed or even ashamed if you’re struggling with issues related to your hearing.

Your doctor has seen it all: You won’t be their first patient to struggle with their hearing. You can also communicate to your doctor that you are anxious or embarrassed about these topics and that you could use reassurance.

Make a list of your question and concerns

It’s easy to forget important questions at the doctor, especially if your appointment is short or rushed. A simple solution is to write out your questions and concerns ahead of time. You could even keep a list on your phone or a pocket notebook and add to it whenever you think of something else you want to bring up.

If you are planning to make (or have already made) major lifestyle changes, it’s recommended that you check with your doctor to ensure these changes are safe and appropriate for you. Good general questions to ask include:

• What steps do you recommend for managing my symptoms?
• Should I be tested for hearing-related diseases?
• Do you have patients who successfully reversed their hearing loss or hearing-related symptoms?
• Is there any medication I should try?
• Are there hearing loss books, podcasts or literature I should check out?
• What lifestyle changed do you recommend?

Bring a spouse or trusted friend

Not everyone knows that you are allowed to bring someone with you when you go to the doctor. Having a confidante by your side can make you feel more secure and help you remember what you want to talk about with your doctor. It also shows your doctor that you have a strong support system and research has shown that strong social and emotional support are associated with better health.

Take notes

Doctor’s appointments can be overwhelming. In order to remember your doctor’s recommendations, it can be helpful to take notes during your appointment. If you bring someone with you, you can ask them ahead of time to take notes for you. You should also get a visit summary from your doctor after each appointment. If you are not sure how to access this summary, ask your doctor or a member of their front desk staff.

Conclusion

Whether mild or severe, any form of hearing loss can be a devastating change that takes a lot of getting used to. But with a little time, effort and medical care, you can still thrive and enjoy a normal life. While science advances to better understand the causes and new treatments for hearing loss and assistive hearing devices continue to advance, it’s key to get a baseline hearing loss test and work with your healthcare provider and audiologist if you notice any changes to your hearing.

FAQ About Hearing Loss

Are AirPods bad for your ears?

AirPods use radiofrequency waves – a type of radiation – that are well within the limit set by the Federal Communication Commission. Listening at high volume can cause hearing damage but most have a volume safety limit. The World Health Organization recommends limiting use to 60 minutes a day.

Does noise canceling protect hearing?

Noise-cancelling protection devices typically block external noise to focus on the sound you’re intentionally listening to, for example through headphones. They can still cause damage when listening at high volumes.

Is hearing loss a disability?

Hearing loss is considered a disability under the Americans with Disabilities Act. However, stringent requirements must be met to qualify for Social Security disability benefits.

Why can't I hear out of one ear?

If you experience sudden hearing loss and can’t hear out of one ear or both, it could indicate excessive ear wax or a serious health problem that may require immediate attention. Contact your doctor immediately in order to have the best chance of preserving your hearing.

Can hearing loss be reversed? 

While regenerative therapies are on the cusp of potentially being able to restore hearing loss, age-related hearing loss is permanent and irreversible but can be treated with assistive hearing devices. The exception to this is if your hearing loss is due to earwax build-up that can be removed.

Does hearing loss cause dementia?

The relationship between dementia and hearing loss is not yet fully understood. But research shows a link between hearing loss and increased risk of dementia, as well as hearing loss possibly being an early sign of dementia’s onset.