Classifying Hearing Loss

As with any scientific discipline, at a basic level audiology is founded on categorization. Observing phenomena, then organizing that reality so as to make the complex more understandable, is the core of the scientific method.

The fact that October is National Audiology Awareness Month is a good time to review how hearing conditions are broken down into four comprehensive categories —conductive, sensorineural, auditory processing, and mixed.

When seeing a new patient, one of the first things an audiologist will do is attempt to pinpoint the exact type of hearing loss the person is suffering from:

  • Conductive Hearing Loss — In many ways the simplest type, this is a situation in which something is blocking or intruding into the physical structure of the ear canal and/or its components. It could be earwax, swollen tissue, fluid from an infection, a tumor or fibrous dysplasia (abnormal bone growth), or a tear of the eardrum.
  • Sensorineural Hearing Loss — This is when the normal communication channel between the ear and the brain is damaged, degraded, or flawed. This occurs in the inner ear when either cochlea or vestibulocochlear nerve fail for any reason.
  • Auditory Processing Disorder — Hearing loss that is not because of anything happening — or not happening — in the ear. It’s when the brain fails to process the information it is receiving — or at least process it within the range of what is considered “normal.” People with such issues usually hear sounds, just not the same ones that the vast majority of people do. It is a condition with striking similarities to dyslexia.
  • Mixed Hearing Loss — As the name implies, when some combination of the above come into play simultaneously. Figuring out what’s happening is even harder when more than one thing is happening.

When working with a hearing health professional, this is the framework he/she will have in the back of their mind while trying to help you.

Allergies Can Wreak Havoc

With the change of season — even though COVID can make it seem like it’s been March forever — another allergy season upon us. Although the physical response to these annual transition periods is usually marked by respiratory issues, allergies can also adversely affect your hearing.

An allergic reaction is basically your body’s immune system overreacting. During allergy season, your body gets kind of overdramatic about pollen and other irritants (heating systems that have gotten dusty over the summer are another instigator) and acts like it’s under attack. Countermeasures are released. This usually results in swelling and the buildup of fluids.

And all of that can happen in your ears.

The proper functioning of the ear is founded on a number of things — an unobstructed ear canal and consistent air pressure around the eardrum are two of those things. Congestion, phlegm, and inflammation can wreak havoc with normal operating procedures in the ear.

This is especially true when the Eustachian tubes — which do the work of regulating air pressure and providing a path for fluid outflow by connecting the middle ear and the throat — get clogged up by those countermeasures that your body has unleashed.

Allergies can also, in many cases, cause the body to crank up the production of earwax, since it is actually part of the ear’s defense mechanism. It’s produced in the outer ear to guard the inner ear against debris.

All of this gets in the way of hearing.

Luckily, treating an allergic outbreak with over-the-counter medications usually reduces symptoms — including hearing loss or ringing in the ears. More severe reactions may require prescription medications and, if hearing issues linger for more than a week, then visiting your hearing health professional is a good idea.

 

Hearing: A Core Aspect of Sociability

If the past few months have brought any issue to the forefront, it’s the concept of social connectedness. As our ability to get together and socialize — to undertake the rituals of the every day — has been restricted, it’s become ever more apparent what social animals we are.

And for the vast majority of humans, hearing is a crucial part of that equation. This isn’t news to researchers and, for that matter, people who have struggled not fully participating in conversations due to hearing loss issues.

Studying this fact — especially as it relates to aging — has been a significant part of the work of Barbara E. Weinstein, who is a professor of audiology at the Graduate Center CUNY and an adjunct professor at the New York University Langone Medical Center. She is the author of the textbook Geriatric Audiology, published in 2012.

As part of her research, she developed the Hearing Handicap Inventory for the Elderly, now an industry-standard diagnostic tool.

In a recent interview, Weinstein goes in-depth about her life’s work. When she began, things were different (and not just technologically).

“It was a time when audiologists were just starting to dispense hearing aids. Theoretically, the early 80s wasn’t that early in the profession, but just, people were not focused on the person, they were focused on the new and emerging technology!” she explains. “After developing the Hearing Handicap Inventory, every single study in which I was engaged, was to get people to buy into the importance of the patient and how our interventions can improve the lives of older adults with hearing loss.”

That work that has culminated in today’s audiological philosophy, with the importance of hearing health to people’s overall health fully realized.

“Physicians know that isolation/loneliness is a bad thing, and that loneliness has negative effects on morbidity and mortality,” says Weinstein. “If they recognize that age-related hearing loss is a potentially modifiable risk factor for social isolation/loneliness and that we can make a difference in people’s lives by intervening with hearing aids, I think that’s the whole goal and that is the way to increase referrals to optimize hearing health and overall well-being.”

The full interview can be found at the Audiology Blog of the hearing aid maker Phonak.

Hearing Aids Weren’t Always So Easy

Today, hearing aids are the embodiment of Moore’s Law. That was a predictive observation made in the 1960s that the number of transistors a microchip could contain would double every couple of years, which would lead to generation after generation of smaller yet more powerful computers.

This is why, as far as computer processing goes, a contemporary hearing aid does what a computer that would have taken up a couple of suitcases did in the 1950s.

But hearing aids didn’t always require computer technology.

The first ones were basically just horns — first those of animals, then customized from brass like a trumpet — with the narrow end held in the ear while the wide end cast a wider net for sound waves. So it was for centuries.

But when the telephone was invented it didn’t take long to adapt it to the hard-of-hearing. The basic premise of the telephone — electrical currents taking sound from a transmitter on one end to a receiver on the other, with an amplifier to boost volume — is the foundation of all modern hearing aids.

But some hardy souls had to literally do the “heavy lifting” in the early days to pave the way for today’s models, which are so small that users can forget they’re even using one.

The first widely available hearing aid — the Vactuphone made by the Western Electric Company — hit the market in 1921. It sold for the equivalent of $1,500 today and was … the size of a suitcase. And really too heavy to take out of the house.

It wasn’t until the invention of the transistor in 1948 that hearing aids easily integrated into everyday life became possible. Slowly but surely they became both better and smaller — though it wasn’t until the digital age that in-the-ear hearing aids with superb performance and interconnectivity with a wide range of other wireless devices became a reality.

Alcohol and Hearing Function

The negative effects of drinking too much are pretty well advertised. Less obvious is that drinking too much over both the short-term and long-term can also cause hearing issues.

Believe it or not, too much alcohol in the bloodstream can cause stress on the tiny hairs inside the ears that send electronic signals to the brain. One of the reasons hearing loss is common in many older people is because these hairs stop regenerating. And alcohol can cause the same kind of damage.

On the other hand, this one is not so hard to believe — alcohol affects the brain. This includes the auditory cortex, where the sound transmitted from the ears is processed. Long-term drinking can shrink the auditory cortex.

Temporary or permanent tinnitus — an incessant ringing in the ears — can also result from alcohol consumption. This is due to the increased blood flow that drinking causes, which throws the inner ear mechanism awry. And since that blood is full of alcohol, the fluid within the ear that is an important part of its functioning is infused with alcohol. This has a number of repercussions, including altering one’s sense of balance — which is why the room starts to spin and “falling down drunk” is a thing.

And there’s a term for getting oblivious about how loud an environment is. It’s called “cocktail deafness.” Getting drunk at a concert or in a loud bar can result in basically forgetting to process how loud it really is. This leads to one of the worst things for hearing health — prolonged exposure to high-decibel sound that can do permanent damage.

Hearing health, another reason to be mindful of your alcohol consumption.

A Not Subtle Hearing Issue

Though rare, sudden hearing loss (SHL) is not unknown. And though the medical community does not fully understand the phenomena, any abrupt cessation of hearing in an ear is cause to seek urgent medical attention.

SHL can be temporary or permanent. Only time will tell. It can also affect one or both ears. Early intervention is key.

The cause of SHL is not clearly understood but there are a number of factors believed to be at play, either singly or in combination. These include the delayed effects of ear infections or spinal injuries; issues stemming from chronic blood circulation problems like obesity, blood clots, arteriosclerosis, and diabetes; and bouts of stress that curtail blood flow.

The “sudden” part of SHL is meaningful. Oftentimes hearing loss is clearly related to disease — meningitis, mumps, or chickenpox for example — or exposure to high-decibel sound that directly damages the inner ear. SHL happens suddenly, with no clear cause or even an earache of any kind.

A bout of tinnitus — an unremitting ringing sound that is heard but not produced by anything in the hearer’s environment — does sometimes happen as part of a SHL event. Fluctuating pressure in the ear and numbness also are accompanying symptoms.

As a first step, medical care providers will deliver treatment that produces better blood circulation to the head, since this sometimes clears up the problem. If this isn’t successful, then further testing will be required. An ear microscopy and/or MRI can find evidence of the underlying issue that has caused the SHL.

The key is to seek immediate medical care. SHL is a medical crisis and can be a sign of other underlying medical issues. Don’t wait for it to “clear up” on its own.

 

High-Tech Awards for Hearing Aids

Showing just how high-tech the hearing aid industry has become, Phonak was recently the recipient of two awards for innovation in New York at CES, which is the tech tradeshow sponsored by the Consumer Technology Association.

One of their two CES 2019 Innovation Awards was for the accessibility features of the Audéo Marvel. The other was for the 3D-printing technology that was part of the manufacturing process of the Virto B-Titanium.

The CES brings over 4,000 exhibitors — consumer-tech developers and manufacturers — and is attended by over 182,000 people from 160 countries. The Innovation Awards highlight innovative products that span 28 categories that are judged on design, functionality, consumer appeal, and engineering.

The rechargeable Phonak Audéo Marvel was recognized for its universal Bluetooth accessibility — including Bluetooth Classic — and its support of direct stereo streaming from Android smartphones and iPhones. The Marvel is also programmed to automatically recognize and make adjustments between streamed speech — newscasts, e-books, podcasts, etc. — and music streaming.

Cutting-edge 3D printing technology is used in the production of the Phonak Virto B-Titanium. Phonak claims it is “the world’s first 3D-printed titanium hearing aid.” This is not the only recognition this top-of-the-line hearing aid has received. It was also the recipient of a Red Dot Design Award for product design and a Gold Stevie (a business award) for Best New Product or Service of the Year in the Health and Pharmaceutical Industry.

“Our entire team is honored to have Phonak’s industry-leading hearing aids recognized for excellence in both Accessibility and 3D Printing,” proclaimed Phonak’s Senior Vice President of Marketing Thomas Lang. “These award-winning hearing solutions continue to illustrate Phonak’s boundless commitment to helping people live a life with no limitations.”

Things To Do For Healthier Hearing

Hearing loss can be an inevitability for some people. Only so much can be done about accidental exposure to extremely loud noise or a genetic predisposition for hearing loss. But for most people, hearing loss is not a sure thing and there are a number of activities that can actually help maintain hearing health.

The most obvious is exercise. The biological fact is that the inner ear and brain are very dependent on the healthy flow of oxygen-rich blood. The neurotransmitters in the brain that process sound can atrophy over time when blood flow is degraded. Likewise, the inner ear — especially the crucial cochlea — is a finely tuned part of the body that requires a base level of overall cardiovascular health. In long-term studies spanning decades, as little as two hours of exercise a week has been found to lower the risk of hearing loss.

This can include obvious exercising like walking, jogging, and swimming — but activities like yoga and meditation have also been found to have positive outcomes on hearing health. Yoga not only improves blood circulation, but research has shown that people suffering from tinnitus have used yoga as an effective means of reducing its severity. Stress is also a known risk factor for hearing loss, so meditation practices that lessen anxiety levels can help with some hearing issues.

Even just mindfully exercising your hearing in everyday situations can help. When standing in line or basically in any “just waiting” situation, concentrate on the particulars of the soundscape you’re stuck in. Focus on a specific sound, then move onto another distinct sound — rinse and repeat. This kind of listening calisthenics actually exercises the parts of your brain that process sound and can heighten the ability to follow conversations in noisy locations later on.

Some Myths About Hearing

There are any number of myths — widely held assumptions — about hearing issues. Here are a few of them.

Hearing Loss Is For the Oldsters

Actually, over 60 percent of the approximately 50 million people in the United States with hearing loss issues are under the age of 65. It’s obviously not an issue that you’ll only find at an AARP convention.

Currently, a number of factors seem to be making hearing loss an issue earlier in life. These include the widespread use of personal audio devices and the earbuds/headphones that come with them, the rising regularity of loud sound systems in public places, and the generally high volume of modern life (and increasing rarity of relative silence). It has been reported that in the 12- to 19-year-old age bracket, 1 in 5 already show signs of some kind of hearing loss issue.

Hearing Loss Is an Isolated Problem

Hearing is its own subdivision of overall health, right? Not really. There are now numerous studies linking hearing loss — especially when left untreated — with a series of negative outcomes, especially regarding mental health. Hearing loss can lead to social isolation and depression, which are directly linked to cognitive decline and dementia (which may also be linked to degraded brain activity due to the loss of sound inputs).

On the prevention of hearing loss side of the equation, there is also ample evidence that better overall cardiovascular health usually leads to healthier hearing. The inner ear is very dependent on good blood circulation and a degrading of overall physical health can lead to hearing issues.

Hearing Loss Is Inevitable

Not really. Like so much about one’s health, genetics plays a huge part. In some cases, hearing loss will happen. But in many cases, preventive strategies may make hearing loss far less likely. As mentioned above, good cardiovascular health will help (so, smoking is a clear risk factor for hearing loss). But the most obvious way to prevent hearing loss is to avoid exposure to high-decibel noise and, if you know you will be exposed, then to use ear protection. Loud noise damages the ear and avoiding it can mean avoiding hearing loss issues.

You Really Want To Ignore Your Hearing Problem?

Ignoring the reality of hearing loss is not a good long-term strategy. Studies have found any number of bad outcomes stem from an unwillingness to treat hearing-related issues. These include not only health effects, but also emotional and economic repercussions.

One of the most troubling findings is that hearing loss correlates with higher incidences of Alzheimer’s and dementia. There are several working theories as to why this is the case.

One theory is that there is a long-term strain on the brain when having to interpret words that are not inputted clearly, causing it to have to overcompensate. Another possibility is that when much of the sound spectrum is no longer heard the brain is deprived of needed stimulation.

Studies have also found that general health is lower in people with untreated hearing loss, compared to those who have had their hearing issues treated.

In addition, it has been found that adults with hearing issues who use hearing aids report higher levels of happiness than those who refuse them. A whole host of issues — sadness, anxiety, insecurity, even paranoia — occur at higher rates in people not dealing directly with hearing loss. Social isolation is also unhealthy in and of itself.

And a study sponsored by the Better Hearing Institute showed that hearing loss could negatively impact household income by up to as much as $12,000 annually. The findings suggest that hard-of-hearing employees are apt to make more errors at work and thus miss out on promotion opportunities — or even end up losing their jobs.

Considering that treatment for hearing issues will ultimately cost only pennies per day, refusing to deal with hearing loss is not a good long-term financial strategy. That’s even before considering the health and emotional satisfaction aspects of such stubbornness.