Hearing loss

DEFINITION

Hearing loss that occurs gradually as you age (presbycusis) is common. About one-third of people in the United States between the ages of 65 and 75 have some degree of hearing loss. For those older than 75, the number of people with some hearing loss is almost 1 in 2.

Doctors believe that heredity and chronic exposure to loud noises are the main factors that contribute to hearing loss over time. Other factors, such as excessive earwax, can temporarily prevent your ears from conducting sounds as well as they should.

You can’t reverse hearing loss. However, you don’t have to live in a world of muted, less distinct sounds. You and your doctor or hearing specialist can take steps to improve what you hear.

CAUSES

Some causes of hearing loss include damage to the inner ear, a buildup of earwax, infections and a ruptured eardrum. To understand how hearing loss occurs, it can be helpful to understand how you hear.

How you hear

Hearing occurs when sound waves reach the structures inside your ear, where the sound wave vibrations are converted into nerve signals that your brain recognizes as sound.

Your ear consists of three major areas: outer ear, middle ear and inner ear. Sound waves pass through the outer ear and cause vibrations at the eardrum. The eardrum and three small bones of the middle ear — the hammer, anvil and stirrup — amplify the vibrations as they travel to the inner ear. There, the vibrations pass through fluid in a snail-shaped structure in the inner ear (cochlea).

Attached to nerve cells in the cochlea are thousands of tiny hairs that help translate sound vibrations into electrical signals that are transmitted to your brain. The vibrations of different sounds affect these tiny hairs in different ways, causing the nerve cells to send different signals to your brain. That’s how you distinguish one sound from another.

How hearing loss can occur

Causes of hearing loss include:

• Damage to the inner ear. Aging and prolonged exposure to loud noise may cause wear and tear on the hairs or nerve cells in the cochlea that send sound signals to the brain. When these hairs or nerve cells are damaged or missing, electrical signals aren’t transmitted as efficiently, and hearing loss occurs. Higher pitched tones may become muffled to you.
• It may become difficult for you to pick out words against background noise. Heredity may make you more prone to these changes. This type of hearing loss is known as sensorineural hearing loss, which is permanent.
• A gradual buildup of earwax. Earwax can block the ear canal and prevent conduction of sound waves. Earwax blockage is a cause of hearing loss among people of all ages. This can be restored with earwax removal.
• Ear infection and abnormal bone growths or tumors. In the outer or middle ear, any of these can cause hearing loss.
• Ruptured eardrum (tympanic membrane perforation). Loud blasts of noise, sudden changes in pressure, poking your eardrum with an object and infection can cause your eardrum to rupture and affect your hearing.

SYMPTOMS

Signs and symptoms of hearing loss may include:

• Muffling of speech and other sounds
• Difficulty understanding words, especially against background noise or in a crowd of people
• Trouble hearing consonants
• Frequently asking others to speak more slowly, clearly and loudly
• Needing to turn up the volume of the television or radio
• Withdrawal from conversations
• Avoidance of some social settings

When to see a doctor

Talk to your doctor if difficulty hearing is interfering with your daily life. Your hearing may have deteriorated if:

• You find that it’s harder to understand everything that’s said in conversation, especially when there’s background noise
• Sounds seem muffled
• You find yourself having to turn the volume higher when you listen to music, the radio or television