Speak Up

BY Karen Fuller

Missing out on more than just a word here or there during dinner conversation or a line or two from your favorite TV show?

Even minor hearing loss may be frustrating enough to friends and family that you find yourself left out of the loop.

Because hearing loss is so closely associated with the stigma of aging its tempting to put off diagnosis until the condition worsens. But less-than-adequate hearing poses its own health and safety hazards and while it may hide from public knowledge for some time a doctor cant help unless you speak up.

Why does hearing loss happen?

In a nutshell age and exposure to loud noise are the common culprits of hearing loss. Throughout a lifetime ears are exposed to all sorts of environmental sounds. These sounds break down hair cells that line the spiral-shaped auditory portion inside the ear the cochlea. Once damaged the hair cells do not regenerate so eventually and exponentially hearing becomes impaired.

“Because of this constant exposure everyone at some point in their lives will suffer hearing loss ” says David Gagliardi Wilmington Health audiologist. The breakdown accelerates for those who work with equipment in machine shops or on construction sites.

Dr. Michael Parker a Wilmington Health ear nose and throat doctor agrees. “Overwhelmingly the most common cause of hearing loss is exposure ” Parker says. From an early age he says its important to wear earplugs or earmuffs before exposure to loud noises and to keep entertainment earphones turned down. “Take responsibility to anticipate exposure and wear protection ” Parker says. “If you like to skeet shoot or are attending NASCAR or go to see loud music in bars or are a musician you should consider wearing ear protection.”

When is it time to get help?

Symptoms of hearing loss can be as blatant as having extreme difficulty hearing and understanding people in direct conversation to turning up the volume to hear a television or radio. Because it is such a personal and individual condition it is hard to quantify symptoms across the board.

Dr. Stuart Hardy of Wilmington Ear Nose and Throat Associates PA suggests a hearing test if hearing difficulty is affecting the quality of life. “I ask questions about their frustration level ” he says “if they experience problems attending movies or if they avoid social situations because they are embarrassed.”

If you are noticing a difference in the way you hear or your friends and family are complaining about your hearing its probably time to see a doctor audiologist or hearing aid specialist.

Whom to see

Its not as simple as just calling your primary care physician and having them peek into your corncobs. Once youre ready to talk to a professional about your hearing you need a diagnostic evaluation from someone trained to perform it.

Ear nose and throat doctor (ENT) This is a medical doctor who specializes in diseases and disorders of the ear nose and throat: otolaryngology. Its a good place to start when you want a full medical investigation of your hearing issues. After all your hearing loss could be caused by wax buildup a physical problem with the workings of the ear Menieres disease (ringing in the ears) fluid buildup (often also causing dizziness) or a host of obscure medical conditions. Depending on the findings this doctor will either pursue a medical or surgical treatment or recommend you to an audiologist (often one on staff) for further tests and the fitting of a hearing aid.

“Ear nose and throat docs look deep into the medical aspects ” Hardy says. “Is it genetic noise loss nerve loss? It may be something that can be fixed surgically.” An ENT doctor surgically repairs things a general audiologist cannot but audiologists and ENT doctors work together to solve the whole hearing puzzle.

Audiologist If youve already seen an ENT or other doctor they may recommend an audiologist or you may decide to start with one. If an audiologist finds a condition that needs to be treated medically or surgically he will refer patients to an ENT doctor.

Audiologists are like doctors of hearing. They usually have a four-year undergraduate degree plus a four-year doctorate focused on hearing and ear health. “An audiologist is specifically trained in testing identification and nonmedical treatment of hearing loss and balance disorders ” explains
Dr. Mary Maddock a board-certified audiologist with Wilmington Health. An audiologist also spends a year of residency working in the field.

Hearing Aid Specialist These specialists are board certified and licensed to sell hearing aids. They are trained in using evaluation equipment and are quite familiar with the hearing aid industry. Hearing aid specialists must pass state board examinations and also must serve as an apprentice before hanging their shingle.

“A hearing aid specialists sole scope is hearing aids ” explains Clell Hamm of the Hamm Hearing Aid Center. “Audiologists do very similar testing but ours is devoted to determining if the patient is a hearing aid candidate and then finding the right technological solution for that patients hearing loss.” He says that if his testing reveals a medical cause he refers patients to an audiologist or ENT doctor.

The hearing examination

Once you decide to discuss hearing loss with a professional he or she will need to conduct a diagnostic hearing test to determine the nature and extent of the loss and what to do next.

Maddock says the three most common types of hearing loss are classified as conductive sensorineural and mixed or a combination of the first two. Conductive hearing loss is usually an amplification problem that can be corrected surgically but sensorineural includes damage to nerves in the ear; and in about 98 percent of cases hearing aids are the only option. Mixed hearing loss is sometimes partially correctable with medical procedures but is also usually treated with a hearing aid.

Hearing aids

There are two basic kinds of hearing aids worn over the ear or in the ear. The choice depends largely on the type of hearing loss and partially on personal preference.

“Severe to profound hearing loss usually has to be treated with a behind-the-ear model or you can get whistling [sounds] ” Gagliardi says. But these days both types are designed with vanity in mind and are smaller and less noticeable than in years past. In fact the fully submersible units sit invisibly in the ear canal and may be removed with a tethered (also invisible) string at the wearers discretion.

Regardless of design hearing aids treat hearing loss by clarifying sounds and words instead of simply amplifying them. “Hearing loss is a function of someone not able to hear certain frequencies or pitches ” Hamm explains. “Its not just that things arent loud enough its that parts of what you are hearing are not being interpreted by the brain.”

While hearing aids are fully customizable and can begin working the minute you put them on they are not a fix-it and forget-it solution. Frequent communication with your provider to adjust the settings and fit will help to fine tune the device to your needs. And even if you wear it for some time with no trouble modifications may be required if your hearing changes. “It is a collaborative process ” says Gagliardi. So be sure to choose a provider you like and with whom you have an easy time communicating.

New technology

As with any technology these days hearing aid design and effectiveness is changing rapidly. And aside from the aesthetic improvements new technology providesdevices are getting smaller and more invisible each generationhearing aids are more adaptable than ever.

Wireless devices may be synchronized to video audio or computer appliances to receive audio output directly to the hearing aid. While watching television with a group the audio is being played directly into the device so there is no longer a need to turn up the volume thats bothersome to others.

Next on the horizon say Madden Hamm and Gagliardi is Bluetooth technology. “Well be able to program the device to respond to your cell phone ” Gagliardi explains. “When the phone rings your hearing aid will serve as your phone earpiece.”

Surgical Options

While not yet the most common technique for correcting hearing loss surgical treatments are becoming more and more prevalent. Dr. George Brinson of Wilmington Ear Nose and Throat Associates PA says that cochlear implants are a good option for people who have gotten to the point where hearing aids are no longer effective. “We can implant a device that directly stimulates the hearing nerve ” he explains “helping children and adults with progressive hearing loss that is sometimes genetic.”

Fellowship trained in Otology/Neurotogy Brinson says that most of the surgeries he performs are for older adults but that often people in their 70s and 80s are reluctant to consider surgery. “I tell them that at this stage of life many of their activities involve visiting and conversing. If they cant do that it can be very isolating.”

Cochlear implants work for specific candidates only based on FDA guidelines that identify people with a certain level of hearing loss and are based particularly on the amount of distortion or lack of clarity the patient is experiencing. However there is another surgical option: implantable hearing aid devices. These devices are invisible on their own but must be connected to an external device to function. Certain hearing loss candidates may benefit more from hearing aid implants than from traditional hearing aid devices.

A trained professional can help determine the best approach. Dr. Brinson suggests “If you have been turned down as a candidate for implants check back with your doctor every few years.” He says that FDA guidelines change and so can hearing loss levels. “There could come a time when you are a candidate for one of these treatments.”