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Your Hearing and Hearing Loss

They say your eyes are the window to your soul….but did you know that your ears are the gateway to your brain????  Keeping your ears and hearing healthy contributes to keeping your mind sharp and in tune. Recent research has shown that even a mild hearing loss can contribute to depression, anxiety, isolation, cognitive decline and decreased earning potential.  So, exactly what can you do to keep your hearing healthy and what can you do if you find out you do have a hearing loss?  

First, some facts about hearing loss: 

       •    Hearing loss affects more than 31.5 million Americans—most of
             whom are below retirement age

        •   Three in ten people over age 60 have hearing loss

        •   Among Americans ages 41 to 59, about 15 percent already have
             hearing problems—that’s one in six baby boomers

        •   7.4 percent—or one in 14—Generation Xers, ages 29 to 40, suffer
             from hearing loss

        •   At least 1.4 million children, 18 or younger, have hearing problems

        •   It’s estimated that 3 in 1,000 infants are born with serious to
             profound hearing loss


Signs of Hearing Loss

The signs of hearing loss can be subtle and emerge slowly, or they can be significant and come on suddenly.  Either way, there are common indications.            

Socially, individuals with hearing loss may:  
      •   require frequent repetition
      •   have difficulty following conversations involving more than two
      •   think that other people sound muffled or like they're mumbling
      •   have difficulty hearing in noisy situations, like conferences,
               restaurants, malls, or crowded meeting rooms
      •  have trouble hearing children and women
      •  keep the TV or radio turned up to a high volume
      •  answer or respond inappropriately in conversations
      •  have ringing in their ears
      • read lips or more intently watch people's faces when in conversation.   
Emotionally, individuals with hearing loss may:       
      •  feel stressed from straining to hear what others are saying
      •  feel annoyed at others because they can't hear or understand them
      •  feel embarrassed to meet new people or from misunderstanding
               what others are saying

      •  feel nervous about trying to hear and understand
      • withdraw from social situations that they once enjoyed

Medically, individuals with hearing loss may:       
      •  have a family history of hearing loss
      •  take medications that can harm the hearing system (ototoxic drugs)
      •  have diabetes, heart, circulation or thyroid problems

      •  have been exposed to very loud sounds over a long period
                or single exposure to explosive noise.

If you think you may have a hearing loss, just click here and take the 5-Minute Hearing Test

How We Hear

Hearing is one of the five senses. It is a complex process of picking up sound and attaching meaning to it. The ability to hear is critical to understanding the world around us. The human ear is a fully developed part of our bodies at birth and responds to sounds that are very faint as well as sounds that are very loud. Even before birth, infants respond to sound.

So, how do we hear?

The ear can be divided into three parts leading up to the brain – the outer ear, middle ear and the inner ear.

The outer ear consists of the pinna, or auricle, and the ear canal (external auditory meatus). The pinna – the part of the "ear" that we see on each side of our heads – is made of cartilage and soft tissue so that it keeps a particular shape but is also flexible. The pinna serves as a collector of sound vibrations around us and guides the vibrations into the ear canal. It helps us decide the direction and source of sound.  Sound travels down the ear canal, striking the eardrum and causing it to move or vibrate.

The middle ear is a space behind the eardrum that contains three small bones called ossicles. This chain of tiny bones is connected to the eardrum at one end and to an opening to the inner ear at the other end. Vibrations from the eardrum cause the ossicles to vibrate which, in turn, creates movement of the fluid in the inner ear.

The inner ear contains the sensory organs for hearing and balance. The cochlea is the hearing part of the inner ear. The semicircular canals in the inner ear are part of our balance system. The cochlea is a bony structure shaped like a snail and filled with two fluids (endolymph and perilymph). The Organ of Corti is the sensory receptor inside the cochlea which holds the hair cells, the nerve receptors for hearing. The mechanical energy from movement of the middle ear bones pushes in a membrane (the oval window) in the cochlea. This force moves the cochlea's fluids that, in turn, stimulate tiny hair cells. Individual hair cells respond to specific sound frequencies (pitches) so that, depending on the pitch of the sound, only certain hair cells are stimulated. Signals from these hair cells are changed into nerve impulses. The nerve impulses are sent out to the brain by the cochlear portion of the auditory nerve. The auditory nerve carries impulses from the cochlea to a relay station in the mid-brain, the cochlear nucleus. These nerve impulses are then carried on to other brain pathways that end in the auditory cortex (hearing part) of the brain.  The brain then interprets these electrical signals as sound. Also housed within the inner ear are the semicircular canals, the utricle, and the saccule.  These structures help control one’s sense of steadiness or balance. These balance organs share the temporal bone space with the cochlea.  These organs also share the same fluid that is in the cochlea.

The audiological exam

The audiological exam tells us the type of hearing loss and how much loss you have. It also helps us to plan your personalized treatment. 

The first step in a complete evaluation is a personal case history.
On your first visit, the audiologist will ask several questions to better understand your (or your child’s) medical and hearing background. Questions about ear pain, ear surgeries, general health, medications, etc. help us to determine possible causes of hearing loss. Questions on lifestyle will help us to determine the most appropriate treatment options.

For children, some questions will deal with birth history, academic progress, speech and language development, etc. 

Then the audiologist will look in your ears using an otoscope to see if there are any physical problems, such as wax.

For the hearing test, you will ask to sit in a sound treated booth. During this test, earphones are worn so that information can be obtained for each ear.

The hearing test consists of two basic parts: Pure tone testing and Speech testing.

A pure-tone hearing test determines the faintest tones a person can hear at selected pitches (frequencies), from low to high. You will hear these sounds through earphones or ear inserts,known as air conduction, and through a special vibrator placed behind your ear, known as bone conduction. Air conduction measures the response of the entire ear and is important to tell us your functional hearing. Bone conduction testing measure the response of the inner ear independently of the outer and middle ears. This test helps the audiologist determine the type of hearing loss you may have.

The audiologist will also conduct tests of listening and speech.  One test that the audiologist conducts during a hearing test is the speech reception threshold (SRT).  The SRT records the faintest speech that can be heard half the time. Then the audiologist will also record word recognition or the ability to correctly repeat back words at a comfortable loudness level.

Speech testing may be done in a quiet or noisy environment. Difficulty understanding speech in background noise is a common complaint of people with hearing loss, and this information is helpful.

The results of the test are recorded on your audiogram.

In some instances, the audiologist may also take measurements that will provide information about how the middle ear is functioning. These measurements include tympanometry, acoustic reflex measures, and static acoustic measures. This type of testing is particularly important in preschool children (ages 3–5), for whom hearing loss is more often associated with middle ear disease.

classification OF HEARING LOSS

Hearing loss is classified according to: TYPE, DEGREE , CONFIGURATION and EAR.

There are FOUR TYPES of Hearing Loss: Sensorineural, Conductive, Mixed and Central.

SENSORINEURAL – or “nerve deafness” - is caused by damage to the delicate nerves of the inner ear and reduces the LOUDNESS and/or CLARITY of speech.  It is the most common type of loss due to aging. 

CONDUCTIVE is caused by damage or blockage in the outer and/or middle ears, such as an infection or earwax, and reduces the LOUDNESS of speech.


CENTRAL occurs when there is damage to the brain, such as from a stroke, head injury, or disease, and can reduce LOUDNESS, CLARITY, and PERCEPTION of speech.   It is important to know which type of hearing loss is present as treatment for each is different. Only a complete audiological evaluation by a licensed audiologist will reveal the type of loss as well as how much hearing is lost.

Degree of Hearing Loss refers to the severity of the loss as measure in decibels (dB). The graph shows the different degrees of hearing loss. The range of normal hearing for an adult is generally considered from -10 dB to 25 dB.

The configuration, or shape, of the hearing loss refers to the degree and pattern of hearing loss across frequencies (tones) as illustrated in a graph called an audiogram. For example, a hearing loss that only affects the high tones would be described as a high-frequency loss. Its configuration would show good hearing in the low tones and poor hearing in the high tones. On the other hand, if only the low frequencies were affected, the configuration would show poorer hearing for low tones and better hearing for high tones.  Some hearing losses are flat meaning that there is similar loss across high and low frequencies.

Examples of the different configurations of hearing loss:

Graph showing Hearing Loss Degrees

Hi Frequency Hearing Loss

Lo Frequency hearing Loss

flat hearing loss

And lastly, a hearing loss can be either unilateral - meaning in one ear, or bilateral - meaning in both ears.
Treatment for Hearing Loss
Once all your testing is complete, the audiologist will work with you to determine the most suitable course of treatment for your hearing loss and your particular needs and wants.

There are several options available for treating hearing loss:
          Hearing Aids
          Hearing Assistive Technology
          Aural Rehabilitation
          Cochlear Implants

Hearing Aids and Cochlear Implants
Hearing aids are small electronic devices designed to fit your ear.  Generally, they make sounds louder, but newer advanced hearing aids can process sounds to help you hear and communicate better, even in background noise. Hearing aids hold such great potential to positively change so many lives, yet only one in five people who could benefit from hearing aids currently wears them

Hearing Assistive Technology
Often, it is beneficial to use additional items called assistive listening devices to improve hearing in specific situations ― such as for telephones, smoke alarms,  doorbells, television listening, lecturers, and other specialized settings. An assistive listening device can be used with or without hearing aids, and can help extend the benefits of all hearing treatments.

Aural Rehabilitation
Aural Rehab is designed to help you develop the necessary skills, such as Speechreading, to maximize your residual hearing whether or not you choose to wear hearing aids. 
Auditory Processing Disorders
For more information on children and hearing loss, click here
What is Auditory Processing?
Auditory Processing is a term used to describe what happens when your brain recognizes and interprets the sounds around you.  Sounds travel from the inner ear through the central nervous system to the brain.  Each component of the sound, e.g., rhythm, tone, duration, is decoded by various parts of the brain. Auditory processing is a very complex action involving many different processes.  

How is an Auditory Processing Disorder Diagnosed?
Typically, an audiologist and a speech language pathologist work together to determine if someone has an auditory processing disorder (APD). A full audiological examination is usually needed in conjunction with a speech and language evaluation for a proper diagnosis to be made. Children with APD may exhibit a variety of listening and related complaints.  There are also many types of APDs.  Therefore, it is very important that a variety of tests be administered that evaluate the different components of sound, and how they are processed by your child to determine the type of auditory deficit. Then, an individualized management and treatment plan may be recommended.

Most of the tests of APD require that a child be  at least 7 or 8 years of age because the variability
in brain function is so marked in younger children that test interpretation may not be possible.  

Symptoms of APD
can range from mild to severe and can take many different forms. Children with auditory processing difficulty typically have normal hearing and intelligence. However, they have also been observed to:
                     §  Have trouble paying attention to and remembering information presented orally
                     §  Have problems carrying out multistep directions
                     §  Have poor listening skills
                     §  Need more time to process information
                     §  Have low academic performance
                     §  Have behavior problems 
                     §  Have language difficulty (e.g., they confuse syllable sequences and have problems developing
                               vocabulary and understanding language)
                     §  Have difficulty with reading, comprehension, spelling, and vocabulary

Five main problem areas

Auditory Figure-Ground Problems: difficulty paying attention when there's noise in the background.  

Auditory Memory Problems: difficulty remembering information such as directions, lists, or study materials. 

Auditory Discrimination Problems: difficulty hearing the difference between sounds or words that are similar.  

Auditory Attention Problems: difficulty maintaining focus for listening long enough to complete a task or requirement .  

Auditory Cohesion Problems: difficulty with higher-level listening tasks.

Hearing Loss and Dementia
Findings of a study at Johns Hopkins with the National Institute on Aging, show that brain shrinkage seems to be accelerated in people with hearing loss. Previous research from other studies had linked hearing loss with marked differences in brain structure compared to those with normal hearing, both in humans and animals. In particular, structures that process information from sound tended to be smaller in size in people and animals with impaired hearing. But shrinkage has also been noticed in those areas of the brain responsible for memory and sensory integration and have been shown to be involved in the early stages of mild cognitive impairment and Alzheimer's disease. Hearing loss also leads to social isolation. A loss of engagement and loneliness are risk factors for cognitive decline.

Diagnosing and Treating hearing loss early - even a mild loss -rather than ignoring it, is an easy way to slow down these negative changes.