Combating Hearing Loss
New therapies and advances in hearing aid technology are helping eliminate the stigma of hearing loss.
As 23-year-old Army gunner Richard Uzuanis blacked out after his tank exploded underneath him, he assumed he was dying. Instead, he woke up in a hospital with permanent hearing loss.
“When I first came to, I was both deaf and blind,” recalls Uzuanis, now executive director of the Americans for Better Hearing Foundation in Downers Grove, of the military training exercise accident almost 50 years ago. “My sight came back fine, but my hearing only came partway back, and it’s been bad ever since. That’s the problem with noise-related hearing loss. Once the hairs in your cochlea (inner ear) are destroyed, they never grow back.”
While most hearing-impaired people don’t compromise their inner ear mechanisms in just a few seconds, noise damage does account for the lion’s share of the 37.5 million hearing loss victims in the U.S. today, doctors agree. “Our ears weren’t built for this society and the noise it subjects them to,” asserts Dr. Ronna Fisher, a doctor of audiology and founder of Hearing Health Center’s four Chicago-area clinics, including locations in Oak Brook and Naperville. “In the jungle, the natives don’t suffer hearing loss because the loudest thing they hear is thunder.”
When sound waves hit a person’s eardrum, that’s just the first step in the process of turning them into nerve impulses that the brain can interpret as words, music or other noises. The eardrum, or tympanic membrane, transmits the sound wave vibrations to the three tiny bones in the middle ear: the malleus (hammer), which vibrates against the incus (anvil), which then vibrates against the stapes (stirrup). These bones amplify the vibrations’ force while transmitting them to the inner ear.
The stapes bone sends the vibrations into the cochlea, the part of the inner ear that converts them into electrical signals that travel to the brain through the cochlear nerve. Fluid inside the spiraled, snail-shaped cochlea carries the vibrations as waves to thousands of tiny hairs that move in response. Microscopic chemical “generators” at the base of each hair use that movement to create electrical impulses, which the cochlear nerve delivers to the brain’s auditory cortex.
Since louder noises produce more powerful waves than softer noises, they’re more likely to crush the delicate cochlear hairs, making them unable to convert wave pressure to the electrical signals that the brain interprets as sound. It doesn’t take an exploding tank to destroy cochlear hairs. Constant exposure to even routine noises caused by air conditioners, machinery or heavy traffic can wreak damage that builds up over time.
Worse, new research shows that damaged hearing can cause more harm than missing the punchline of a joke — especially for older people. A study recently released by Johns Hopkins University proves that untreated hearing loss leads to dementia, which ultimately shortens patients’ lives. Other studies link hearing loss with depression, due to the social isolation caused by not being able to converse, and balance problems that stem from missing aural locating cues. “Elderly people with untreated hearing loss have a 300 percent greater risk of falling because the brain often maintains balance by orienting itself based on localized sounds,” Uzuanis explains. “If the brain doesn’t have those cues, it can’t respond properly and prevent falling.”
“In the last couple of years we’ve learned a lot more about the connection between untreated hearing loss and the decline of cognitive ability,” notes Michael Siefert, an audiologist and founder of Naperville Hearing Services. “When the sounds stop reaching the brain, the parts of the brain that process hearing don’t get the stimulation they need to function properly. They start to deteriorate, and eventually the damage spreads to other areas of the brain.”
“The longer you wait to treat the hearing loss, the more your brain deteriorates — and often you can’t bring that function back,” Fisher adds. “The Johns Hopkins study shows that 83 percent of Alzheimer’s disease patients have serious untreated hearing loss. When those patients are fitted with hearing aids, 33 percent of them improve (in cognitive skills) enough that they’re reclassified in a less severe stage of dementia.”
The catch-22 is that, unlike other senses such as sight, smell and touch, hearing loss can be hard for its victims to detect — even for professionals in the field.
“Genetic hearing loss runs in my family, but it took me several years to notice that it was happening to me,” Fisher recalls. “My kids started complaining that I turned up the TV volume too loud, and I started complaining that they were mumbling when they talked to me. What really clued me in was a conversation at a dinner party when I asked the woman sitting across from me at the table how her father was doing. She said, ‘He died,’ and I answered, ‘That’s great!’ because I thought she’d said that he was fine. I was humiliated for months about it, but that’s what finally made me decide to get my hearing checked.”
Even people who aren’t averse to seeking treatment often take up to a decade to realize that they need it. “There’s a reason hearing loss is called the ‘invisible disability’,” Siefert states. “The average time it takes someone to realize he has a hearing deficiency is seven years. When the waiter at a restaurant hands you a menu and you can’t read it, it’s obvious that you need to have your vision checked. But you don’t know that you’re not hearing the things you can’t hear.”
Hearing loss victims who resist treatment usually have two reasons, doctors agree. They don’t want to be stigmatized as old and “over the hill,” plus they don’t want the hassle and expense of buying hearing aids.
“There are over 37 million people with hearing impairment in the U.S., but only 20 percent do anything about it because we don’t have good education about hearing,” observes Dr. Linda Burba of Audiologic Services in Glen Ellyn and Carol Stream. “People are scared to try hearing aids because all they see are unsatisfied hearing aid users and horrible ads for low-end products that don’t work.”
While a good hearing aid doesn’t come cheap — most cost between $2,000 and $4,000 — new technological advances give patients a lot more bang for those bucks. Unlike the staticky, buzzing “one size fits all” appliances available 10 years ago, many of today’s hearing aids boast multidirectional microphones, customized fits and computer chips that filter out background noise like highway traffic and office machinery, helping the user focus on conversations or TV dialogue.
To ensure hearing aid users get the most out of their new appliances, most reputable hearing aid vendors now include follow-up testing and auditory therapy with each purchase.
“After suffering hearing impairment for years before treatment, people need to relearn how to listen and process the sounds they start hearing again once they have a hearing aid,” explains Uzuanis, whose charitable foundation sells hearing aids at a steep discount to low-income patients. “Often people can’t interpret sounds because their (auditory) neural pathways have atrophied, but they blame the hearing aid for the fact that they still can’t understand what people are saying.” Most patients recover their sound processing ability after a few months of therapy, he adds.
As hearing loss strikes people at younger and younger ages, many patients are looking for hearing aids and accessories to help them continue working and excel at their jobs. Bluetooth streaming technology now offers those people a wide range of discreet options to improve their hearing at the office.
“The day will come when Bluetooth technology will be small enough to fit inside a hearing aid along with the microphones and other stuff,” Siefert predicts. “Right now you can get Bluetooth transmitters that plug into your phone to help you pick up what your caller is saying, and Bluetooth microphones that you can wear or put on a conference table during a meeting that filter out the background noise, pick out what people are saying, and transmit it wirelessly to your hearing aid.”
When Uzuanis’ hearing loss forced him out of the military, he and his wife teamed up with an engineer friend to start a hearing accessory design company called HI-Tech Group. While he’s no longer involved in that firm — now called ClearSounds and headquartered in Naperville — it stayed in the family. His daughter, Michele Ahlman, serves as CEO.
“The stigma of being seen using a hearing aid or accessory is a roadblock that keeps many people from getting the help they need to maintain their quality of life,” Ahlman asserts. “We’re working to design accessory devices that are discreet and stylish so that people are comfortable using them, and to manufacture and sell them at an affordable price so they’re available to anyone who needs them.
“I hope,” adds Ahlman, “that having these tools and others like them available on the market encourages people with hearing loss to seek the treatment they need to stay healthy.”
Causes of Sudden Hearing Loss
If you’ve noticed over the last few years that car engines are quieter but most people mumble annoyingly when they talk to you, you probably have noise- or age-related hearing loss.
If you wake up one morning and notice that one ear works but the other doesn’t, or that everything sounds muffled and distorted like you’re hearing it underwater, you might have a medical problem that will require a doctor’s help to fix.
“It’s very important to diagnose a sudden hearing loss promptly, because whatever’s causing it could result in permanent hearing loss if it’s not treated,” cautions Dr. Griffith Hsu, an otolaryngologist at DuPage Medical Group.
Two of the most common causes of sudden hearing loss are localized ear infection and earwax buildup, area doctors agree. “Earwax blockages are especially common in senior citizens because our ears start producing more wax as we age,” notes Dr. Ronna Fisher, founder of Hearing Health Center in Oak Brook and Naperville. “People shouldn’t try to remove a blockage themselves or remove one from a relative, because if they don’t know what they’re doing they can damage the eardrum.”
A sore, inflamed ear also needs medical attention. “The pressure of built-up lymph and pus can rupture the eardrum if the infection isn’t treated,” Hsu says. “Not only can that rupture be extremely painful, it can lead to permanent hearing damage if it’s left to heal improperly. Though some ruptures require surgery, it’s a relatively quick office procedure that can save a lot of grief down the road.”
A common age-related hearing condition is otosclerosis, a form of arthritis in which the stapes — the tiny bone in the middle ear that transmits sound waves to the inner ear — fuses to its neighboring bone and can no longer vibrate effectively. The cure is a surgical procedure called a stapedectomy, which replaces the fused bone with a prosthesis. Seating the prosthesis in just the right position is a tricky procedure that can take multiple surgeries.
Hsu, however, has changed his stapedectomy process to spare patients from having to go through additional surgeries. “About 20 percent of the time the surgeon has to adjust the prosthesis once he’s positioned it to restore the patient’s full range of hearing, but you can’t know if that’s necessary or how it should be repositioned until you’ve done postoperative testing,” he explains. “But the auditory center of the brain can detect and respond to sounds even when the patient is under anesthesia, so I have
an audiologist in the operating room to test the patient’s hearing [by reading the brain’s electrical signals] before and after the procedure so I can make any needed adjustments then and there.”
Some prescription medications can also cause hearing problems by damaging the cochlear hairs that convert sound waves to electrical signals that the brain can interpret, or by blocking the brain’s ability to process the signals. They include large doses of broad-spectrum antibiotics, some allergy medications and extremely high doses of aspirin.
“When one of my patients whose hearing was normal two years before came in with a sudden hearing loss, I knew something was wrong,” recalls Fisher. “I asked her about what medications she was taking, and advised her to stop taking Xyban (a smoking cessation aid). After she went off that drug, her hearing returned to normal almost immediately.”
And sometimes sudden hearing loss can reveal a serious medical condition. “Brain injuries like strokes or tumors can cause sudden hearing loss by damaging cranial nerves,” notes Hsu. “In particular there’s a benign, slow-growing inner ear tumor called a vestibular schwannoma that I look for when a patient reports hearing loss in one ear, accompanied by ringing in that ear.”
"It doesn’t happen often, but I’ve found 15 or 20 patients with undiagnosed brain tumors after they’ve come in with sudden hearing loss in only one ear,” Fisher adds. “That’s why people should seek professional help when they experience a sudden unexplained hearing loss. It could save their lives.”