Sound Advice
Don’t close your ears to the signs of hearing loss. Life is far richer when you can appreciate every sound.

By Alyson Black

A baby’s giggle … a bark from your favorite furry friend ... the pitter-patter of rain on the pavement … the crack of the bat at a Little League game … soft bird chirps outside your window … a car’s horn alerting you to danger.

Forget the songs on your iPod; this is the real soundtrack of your life. But for millions of people suffering from hearing loss, the world is much quieter—and more difficult to navigate.

“Hearing loss is the most devastating of all sensory deprivations,” says otolaryngologist Robert I. Oberhand, MD, of Westfield Ear, Nose & Throat Surgical Associates. “In children, multiple periods of hearing loss over a period of a few years can have deleterious effects on cognitive development. In both children and adults, hearing loss seriously affects social adjustment. People as they get older frequently will not admit to hearing loss. They will sit in a room and nod and smile and laugh when everyone else does—but they actually are withdrawing more and more.”

Common Causes

In many cases, hearing loss is temporary, the result of colds, congestion, or a buildup of earwax. But most permanent hearing loss results from damage to the cochlea, a snail-shaped structure in the inner ear. Tiny hairs in the cochlea that connect with nerve cells may degenerate. When this happens, hearing loss occurs: higher-pitched tones may become muffled, or it may become difficult to pick out words against background noise. Other causes of hearing loss include abnormal bone growths or tumors of the outer or middle ear, a ruptured eardrum, and genetic defects. Trauma to the head can cause permanent ringing in the ears as well as hearing loss. Infections can be to blame (“The most severe post-infection hearing losses we see are with meningitis,” says Oberhand), as can medications. “Physicians are becoming more aware of ototoxicity, the toxic reaction of the inner ear to medications, and they are prescribing with caution,” explains Oberhand. “This is an especially common problem with chemotherapy agents.”

Coping With Hearing Loss

In many cases, even total hearing loss can be treated. A successful cochlear-transplant program has been developed at Overlook, providing the most modern surgical procedure and postoperative auditory rehabilitation. But nothing can be done to reverse nerve-related hearing loss; that’s why it’s crucial to preserve and protect the hearing you have.

“There are many ways to enter into hearing health,” says Oberhand. “At birth, there is mandatory state screening in the nursery. Abnormal tests are repeated, and infants have been fitted with hearing aids as early as six months of age. Many deaf children actually were born with hearing that deteriorated over the first year of life. We can’t do anything to stop the loss, but the earlier it is detected and aided, the better speech development will be over a lifetime. Schools have done a tremendous job of screening children early in their education.”

Among the adult population, however, it is more challenging to pick up on hearing loss because patients fail to tell their physicians about hearing-related problems. “People of all ages will wear eyeglasses but resist wearing hearing aids,” says Oberhand. “Hearing aids have been associated with old age. A person who wears a hearing aid may feel that they are identified differently, socially.”

In many cases, the patient may not realize there is a problem; family and friends may notice signs of trouble first and try to compensate. Explains Susan Maltese, coordinator of audiology for Overlook Hospital, “If people start to accommodate by speaking louder or in closer proximity, the hearing-loss patient may not get the frustration of the situation. They don’t pick up on the communication difficulty.”

Fortunately, hearing loss is relatively easy to diagnose and treat. “The physician should be the point of entry into evaluating any hearing loss,” says Oberhand. “He or she can assess the physical condition—wax, nerve damage, a problem with the eardrum, et cetera. Audiologists play a tremendous role in diagnosis. Otolaryngologists rely on audiologists for extensive testing.”

Within Overlook’s audiology department, patients are able to have hearing tests, which consist of identifying the softest level of sound a patient is able to hear. “We test the full range of functionality,” says Maltese, “and we assess all components—the outer, middle, and inner ear.”

What differentiates Overlook’s audiology services from other centers is that the hospital offers a full range of diagnostic and hearing-aid services. “Patients are seen by doctoral-level audiologists,” explains Dan Whelan, manager of rehabilitation services at Overlook. “The department is made up of audiologists who are also hearing-aid dispensers—they hold dual licenses. That’s what’s so great. We’re not just selling hearing aids; we’re diagnosing problems and providing patients with the right fit.”

Complete Care

Following a hearing test, treatment depends on each patient’s personal communication needs and listening environments. “Once we complete the evaluation,” says Maltese, “we counsel patients on hearing aids and the effects of amplified hearing.”

Unlike the hearing aids of years ago, today’s devices are much smaller—even miniaturized. “Years ago you had to get a bigger hearing aid to fit a profound loss,” Maltese says, “but that’s not necessarily the case anymore.” Hearing aids are also much quieter and do a much better job of filtering out background noise. There are even hearing aids that can be coupled with wireless devices to assist in hearing the television or telephone while at home.

At Overlook, patients are able to demo hearing aids on site. “It’s important to try a device before you commit to it,” says Whelan. Following the purchase of a device, the patient is seen several times within the first month to adjust the hearing aid to his or her needs and comfort level, and is then seen on an as-needed basis. Explains Maltese, “Patients who first receive a hearing aid have to retrain the brain to filter out sounds that haven’t been heard in a while. We adjust the aid to a more conservative level initially. We want the patient to get accustomed to a hearing aid so it’s not too overwhelming.”

A person with a hearing aid is suddenly hearing things for seemingly the first time. “Suddenly a person is driving and they hear road sounds. They can be distracting if you haven’t heard these noises for a while. This can be a quality of life issue and a safety issue,” says Whelan.

An Ounce of Prevention

Doctors report a widespread increase in hearing deficiencies, and at much younger ages. “We’re starting to see hearing loss in people in their thirties and forties,” says Oberhand. “People in recent decades have been exposed to very loud music. There are lifestyle changes that contribute, too.”

Fortunately, simple measures can help preserve and protect hearing. Oberhand recommends avoiding loud noise exposure and limiting the volume of listening devices. Protective devices are available to filter out loud sounds for occasional use, as with a firing range or at concerts, or for people who are exposed occupationally to loud noises over longer periods (landscapers, for example, or construction workers).

Parents should monitor their children’s noise exposure, too, says Maltese. “If they are wearing well-fitting earphones, and you as the parent can hear it, it’s too loud,” she says. “If they’re playing music in their bedroom and you can’t have a conversation, it’s too loud.”

Cautions Oberhand, “It is important for parents to understand that children of all ages can experience hearing loss. It’s important to know the difference: Is your child not listening, or is she not hearing?”

All the physician members of the Department of Audiology at Overlook Hospital are board certified and qualified to diagnose and treat hearing loss. For a referral to an otolaryngologist or an audiologist, please call (866) 388-6346. For information on hearing screenings in your area, turn to the “Health & Wellness” section of this month’s Community Health Calendar, beginning on page 34.