Hearing loss is typically a slow, gradual onset disorder that silently (pardon the pun) affects the individual. The most common symptoms experienced by most (perhaps not all) patients are difficulty hearing in background noise, tinnitus, and thinking most people mumble or speak softly! Most people who experience the initial symptoms of hearing loss do not even realize it is happening. It is far easier to blame the acoustics of the room, the volume of the background noise, or the person speaking (i.e. “they mumble”) than it is to accept that it’s your hearing that is lacking. It is also difficult for many patients to rationalize the need for medical treatment of hearing loss because in some (ideal listening) situations (i.e. sitting at a table one-on-one in a perfectly quiet environment) may not be much of a challenge. But the truth is…
A Mild Hearing Loss is a Major Problem!
The first symptom of hearing loss for most patients is difficulty hearing in complex listening environments. If you take the time to reflect truly and deeply on your communication breakdown, I believe you will begin to recognize some of the initial symptoms of hearing loss. Are you having any difficulty when there are a few people at the kitchen table? Or when the kids come over? Or when communicating with your grandchildren? Or when you are at a social gathering (i.e. sharing a meal with friends and you can’t seem to follow the conversation, yet all the other people seem to be enjoying themselves and following the conversation)? It is in these types of scenarios when hearing loss can really start to rear its ugly head and you realize that you are no loner an active part of the conversation. The result is a slow retraction from contributing to the conversation because you may feel embarrassed, and thus you continue to further isolate yourself and find yourself not truly engaging in conversations and relationships. And this is how even a mild hearing loss can really begin to impact your quality of life and relationships with others. In addition to the importance of maintaining an active, engaged life with family and friends, early treatment of mild hearing loss is important for maintaining proper brain health. Simply put: Hearing Care is Health Care. Your hearing drives your conception of everything and everybody around you; thus, hearing is essentially driving cognition at all times. It’s driving memory. It’s driving your image of the environment around you. You don’t turn hearing on or off; you can’t close your ears like you can close your eyes. There really isn’t a sense or portion of your brain that isn’t connected to your auditory system. And I believe this speaks to how important hearing is to live and to thrive. We are bombarded with sound at all times and the brain is constantly, in real-time, making decisions as to whether or not certain sounds are important, trying to figure out how to categorize the sound and if it is important to store away and remember it for reference at a later date. A mild hearing loss can take away significant portions of the auditory world around you- and is likely the reason behind why patients with untreated hearing loss are at a significantly higher risk of experiencing a devastating fall. The lack of cognitive stimulation that accompanies even a mild hearing loss is also associated with cognitive decline and dementia. Reports from Johns Hopkins Medical Center (and others) indicate that a mild hearing loss can increase the risk of developing dementia by 200% (up to a 500% increase for those with a severe hearing loss).
Like every major medical condition, the key to successful management of the disorder is early intervention. “Catch it early and treat it early!”
I believe most people can relate to my story: I watched my grandmother degrade as she crossed over from her seventies to her eighties. As she got older, her hearing got worse, and as the hearing got worse, her cognitive abilities declined. As a result, our ability to communicate with her was significantly strained. This is when I first knew that hearing loss must be correlated to cognitive decline (AKA dementia). Communication is truly the basic building block of every relationship we have at work, at home with our loved ones, with our children, etc. Communication is a vital part of establishing and maintaining relationships. Watching my grandmother decline helped push me to be a better student, a better teacher, and a better clinician. When I decided to veer from Communication Disorders for several years to focus on my studies at University of Minnesota, I decided to point my efforts at understanding the neuroscience of how we hear at the most basic level-from vibrating molecules of air to neural activity in the brain. Armed with this knowledge, I have been able to advance my patients’ care to the highest level and help to set standards for testing and treatment protocol.
Let’s be honest. Everybody hates hearing aids. In fact, when you make a reference to old-fashioned volume-enhancing hearing aids, I think you could go so far as to say, “Some hearing aids suck!” There you have it-I said it! I’ve been working with hearing-impaired patients for nearly twenty years and although my patients love improved hearing, they hate their hearing aids. I don’t see a reason to tip-toe around this subject or ignore the fact that patient generally do not like using hearing aids. Nobody wants a medical disorder that requires physically tethering a device to his or her body to treat the medical condition. People who wear glasses do not actually want to wear glasses (although I do know some people who wear non-prescriptive glasses because they feel that they look “cool”). I remember growing up in a time where people who wore glasses were sometimes referred to as “four-eyes” or other derogatory terms-fortunately glasses are now commonplace for people of all ages. I know that in the next few years, I will likely begin to hold the restaurant menu farther and farther away from my face in a dimly lit restaurant and when that happens, I will need to invest in the proper treatment of visual impairment-whether I want to wear glasses or not. For some people, hearing aids carry the stigma of meaning “I’m old and ready to die.” And nearly every day I see a patient try and talk him or herself out of investing in hearing health care treatment because “eh, I won’t be around much longer anyway.” My response is always the same: if you live for three more days, three more months, three more years, or even thirty more years (which is not unreasonable to expect from my fifty-eight-year young patients), isn’t it worth wanting to hear and understand everything and everyone else in your life? I also point out to patients that they will appear to look much older if they continue to say “What?” or “Huh?” all the time or, perhaps even worse, start to isolate themselves from the conversation. I get it, and I respect that patients don’t want to use a hearing aid, whatever the reason may be. Any reputable hearing health care provider will realize this, also, and understand the difference between traditional hearing aids and advanced NeuroTechnology. Features in NeuroTechnology are specifically designed to treat the medical condition of hearing loss, improve cognitive function, and improve overall quality of life. As an added benefit, NeuroTechnology is incredibly discrete and comes in several invisible styles (more on invisible hearing-loss treatment options later ).
We all know somebody, perhaps and family member or friend, who has spent a significant amount of money on a hearing aid gizmo only to use it as a paperweight or to leave it in his or her sock drawer. And the reason is because the glorified over-priced amplifier that he or she has purchased was never truly designed to improve hearing or clarity-it was designed to just make sounds louder. This truly angers me, and while I do believe that the patient plays a significant in his or her health care decisions and follow-up care, the health care provider also must have a significant responsibility to the patient-even after the patient has left the office. I have heard many horror stories about patients spending upwards of $10,000.00 on a pair of hearing aid gizmos-YIKES! More often than not, this very high retail transaction very likely took place in one of the chain hearing aid sales shops (i.e. the “Miracle Hearing” and “Bellstone” shops. FYI the real names of these retail establishments have been altered in an attempt to reduce my chances of being sued!) And, sadly, all the patient got in return for his or her money was a hearing aid amplifier capable of making things louder. When a practice and the providers are committed to the medical treatment of hearing loss, you can trust that you are in good hands. I believe that a hearing specialist must meet the strict standards required of the medical model of treating hearing loss. I have always believed that the patient needs options to help him or her invest in the proper hearing health care. A reputable hearing care practice understands that for some people, the upfront investment in hearing healthcare can be prohibitive. Patients must be provided with options. We will offer reputable creditors/banks to help establish a payment plan (some with 0% interest for up to 18 months, or even a longer-term payment plan with fixed interest rates). Recently I established an affordable subscription plan at my offices, called Hear4Life, which provides individuals with the opportunity to pay a one-time down payment and a small monthly fee thereafter with the advantage of full warranty (loss, damage, and repair coverage for life), complete access to supplies, batteries and service appointments for life, and no-cost automatic upgrades in NeuroTechnology for life.
Hidden Cost What about the cost of not treating hearing loss? While research has yet to make the definitive finding that hearing loss can cause dementia (causality is often difficult in clinical science), the evidence that the relationship exists is overwhelming. Even more important is the mounting evidence that treating hearing loss may significantly reduce the risk of developing dementia. Every day, 10,000 people turn sixty-five years young. This trend is expected to continue for at least the next fifteen years. And it is almost a guarantee that over the next fifteen years, science will continue to reduce the mortality rate and increase the average life expectancy. As a result, our health care system will be pushed to its capacity to deal with diseases such as cancer, diabetes, cardiovascular disease, etc. Perhaps the most prevalent, most costly, and most disabling of all diseases we will see sharply rise over the ensuing decades is dementia-the mind-robbing mental disease that interrupts and interferes with every aspect of life. Dementia is not a normal part of aging. Every three to four seconds, another patient is diagnosed with dementia. Rates of dementia are estimated to triple in the next thirty years. Unlike the other diseases listed above, a physical body with dementia is estimated to outlive the individual’s mental capabilities by ten or more years! It is estimated that the average cost per family, to manage the medical treatment and care of a loved one with dementia can exceed $57,000.00 per year. There is no cure for this catastrophic disease, but there are treatments available, including several ways to decrease your risk of developing dementia. In fact, a study published in the Lancet Journal indicated that the treatment of hearing loss as the single most effective means of preventing dementia.
It’s like magic-once you turn the respectful age of sixty, you notice that the content of your mailbox seems to change. Nearly every week, you are “blessed” (I’m being sarcastic!) to have a full mailbox (both your physical and electronic mailbox) with literature about “essential vitamins for seniors,” “how to choose the right assisted living residence,” “how to invest your retirement money,” “join AARP,” and “which digital technology widget is best for your hearing loss.” Somewhere along the line, hearing health care started down the dangerous road of becoming a retail transaction. Heck, I’ve even seen some hearing widgets sold at big-box retailers and chain pharmacies…. Although I don’t know who would ever consider buying medical treatment for progressive degenerative disorder alongside a giant vat of peanut butter! Like I ask my patients: “Would you get your colonoscopy performed at one of the big-box chains? NO. So why would you treat your hearing loss there?” I don’t blame the patient for sometimes entering the office thinking he/she is going to be “sold” something. My best advice is to steer clear of anybody trying to sell you something. If we go back to Reason #1 above, the patient is likely already nervous because he or she knows the medical diagnosis before ever stepping foot in the office. Combine that with the fear of “being sold something” and that makes for a pretty nervous patient with his or her guard up. Unfortunately, much of modern medicine is turning into a commercial advertisement seen on TV that marginalizes the process of treating a medical disorder; and hearing health care is not immune to this. In my office, and the Excellence in Audiology member-clinics across the country, our belief is in the medical evaluation and treatment of hearing loss. I believe strongly that the proper medical treatment of hearing loss is best left to the clinicians specially trained to understand, diagnose, and treat your hearing loss.
Regardless of when you read this blog and which administration is running our country, insurance is a complex world to attempt to meddle through, and when it comes to hearing health care coverage, it can be even more murky. BUT… nearly every insurance company I have come across allows for coverage of one hearing evaluation per year by a trained hearing health care specialist (and more testing can be covered if medically necessary, i.e. if the patient notices a significant sudden change in hearing.) A hearing evaluation is often considered “preventative” and, in many cases, does not require a referral from your physician. While it is nearly impossible to speak for every patient and every insurance plan, that is intended to help ease the stress of navigating the process of hearing health care coverage. In fact, I believe any reputable hearing health care practice will have a deep understanding of the insurance regulations in its area and will be able to readily answer any questions you may have about your insurance coverage- or at least be willing to help you find the answer. In my twenty years of experience in the hearing health care field, I have watched first hand as patient benefits for treatment of hearing loss have evolved- fortunately, in a direction that benefits the patient. Yes, medical treatment of your hearing loss may have an out-of-pocket cost associated with it, but I have seen insurance cover anywhere from 10% to 100% of the costs. And even if you were in the position of having 0% insurance coverage, treating hearing loss can be affordable- and you will learn throughout this book that treating hearing loss is truly priceless and can hardly be assigned a monetary value.
Individuals with hearing loss have a tendency to wait nearly seven years before raising their hand and admitting they have a problem. Or perhaps it takes a family member nearly seven years to push his or her loved one through our office door! Either way, seven seems to be the “unlucky” number – I say “unlucky” because chances are very high that by the seventh year of experiencing the symptoms of hearing loss, significant damage has been done to the auditory system, which can lower treatment outcomes. I try to explain to all of my patients that hearing loss is a progressive degenerative disorder with neurologic involvement which undoubtedly requires early intervention. In lay terms, that simply means that your hearing will continue to degrade as you age, and the key to maintaining clarity and a higher level of hearing function (i.e. hearing in noisy environments) is to “catch it early and treat it early.” I have empathy for the new patient who comes to my office to get his or her first hearing evaluation since grade school because I know, as does the patient, what the results will likely be. It is very brave for a patient to knowingly enter a medical office with the understanding that he or she is likely to receive the diagnosis of progressive degenerative age-related hearing loss. And that this disorder is neither reversible, nor is there a cure. However, there are restorative treatments available that can help the patient stay connected at home, at work, and in the community, and that can help stimulate the brain, improve cognitive function, and even reduce the risk of developing dementia (more on the connections of hearing loss and dementia later!).
Once upon a time, hearing aids meant big, heavy, ugly “beige bananas” worn on the ear to make sounds louder. They were hard to put on, hard to make adjustments to, and frankly, they were pretty terrible at doing anything other than making all sounds louder…this includes speech, background noise, loud ventilation machines, dogs barking, plates changing, etc.! For the majority of patients, wearing an old-fashioned hearing aid meant avoiding certain social situations, restaurants, family gatherings, playing with grandchildren, etc. Many people still cling to the unfounded notion that all hearing aids are created equal and perform the same way they did back in 1982! The fact of the matter is that Hearing Science and clinical science of treating hearing loss is more than just hearing aids. How much more? Hearing Science and the medical treatment of hearing loss is devoted to restoring an individual’s clarity, restoring personal independence, improving cognitive aspects of hearing loss that can increase the risk of developing dementia. Maintaining proper hearing and cognitive health has a significant impact on an individual’s life – including all of his or her family, friends, and community members. Properly stimulating cognitive function and maintaining connections from the ear to the brain goes a long way in keeping a patient mentally competent, helping the patient remain autonomous, and helping keep at bay the mind-robbing diseases associated with cognitive decline (i.e. Alzheimer’s). Treating hearing loss is a wonderful investment with life-long returns, and yet people still fear walking into a hearing health care provider’s office for one simple reason – fear of the unknown! In the next 5 blogs, we are going to list the top 5 reasons people avoid seeing a hearing care specialist, identified by Dr. Keith Darrow in his book “Stop Living In Isolation”. Hope all of us understand the importance of hearing loss treatment.
Your eyes are itchy and your nose is runny – typical for allergy season, you tell yourself. But could your allergies also account for your diminished sense of hearing? Yes, say hearing health professionals, with symptoms that can include itching, swelling, vertigo and fullness in the ear.
Allergies and hearing loss Your immune system responds to allergens by producing antibodies that release histamine. The release of histamine produces an allergic response. The resulting sneezing, itching and congestion also increases mucus production, which can cause conductive hearing loss.
Conductive hearing loss occurs when something, such as fluid or earwax, prevents sound waves from flowing through the ear and into the tiny bones of the middle ear. Conductive hearing loss is curable, but it makes it temporarily difficult to hear.
Remember, it’s never advisable to attempt to scratch an itch by putting anything inside your ear canal such as a hair pin or cotton swab. Instead, wash your ear gently with a warm, wrung-out washcloth and dry it thoroughly. If that doesn’t help, see your doctor. He or she will be able clean your ear and examine it to determine what is causing the itching.
Three types of allergy-related hearing loss Your ear has three major sections, all of which can be affected by allergies.
Outer ear: Allergic skin reactions can cause itching and swelling of both the outer ear and ear canal. Some individuals may be allergic to their laundry detergent, fragrance or earrings. Others may have allergies to household pets, especially dogs and cats.
Middle ear: If swelling blocks the opening to your middle ear, your Eustachian tube may not be able to drain properly. This can cause fluid and pressure to build up, giving you a feeling of fullness in the affected ear and providing a perfect breeding ground for bacteria and subsequent infection. This fluid buildup may also trigger balance problems, such as vertigo, giving you a feeling of being dizzy and light headed.
Inner ear: Allergies may also contribute to hearing loss for people who have Meniere's disease.
Allergy and hearing aids In addition to causing you some discomfort, allergens can also clog the microphone ports in your hearing aids, affecting the way your hearing aids function. You can replace the covers of microphone ports easily. Of course, regular cleaning of your hearing aid is always advisable, especially during allergy season.
Some people seem to experience an allergic reaction to their hearing aids. If this is the case, be sure to talk to your hearing health professional. The allergy may be caused by poor fit, moisture in the ear, wax accumulation, dry skin or an allergy to the earmold material. Many hearing aid manufacturers have options for people with sensitive ears such as hypoallergenic shell materials or coatings that provide relief.
The good news Seasonal allergies can make certain times of the year difficult for many people who experience symptoms. Most of the time, allergy misery, including any decrease in hearing you experience, is typically temporary. Normal hearing usually returns after your symptoms subside or your infection clears. If your hearing loss persists well past your other allergy symptoms or you experience ear pain, see your hearing care professional or ENT to make sure your condition doesn’t need long-term treatment. If you don’t have a trusted hearing health professional, visit our directory to find one in your community.
Contributed by Debbie Clason, staff writer, Healthy Hearing July 13, 2017
There are times when you purposely plug your ears -- think fingers or earplugs -- and then there are, well, other times when your ears feel clogged for no good reason. Why is sound muffled when there doesn’t appear to be anything inside your ear canal? Here are four of the most common reasons why your ears might feel clogged.
Impacted earwax Normally, earwax is the body’s way of protecting the ear. Its sticky consistency traps dirt and other pollutants, act as a lubricant, and because it naturally falls out of the ear canal on its own, serves as a natural self-cleaning agent. On occasion, however, it can become impacted and affect your ability to hear.
The only way to know for sure -- and to remove the earwax safely from the affected ear -- is to see a physician or your hearing healthcare professional. Please note that it is never appropriate to try and remove the earwax yourself using a cotton swab, baby oil, or hydrogen peroxide. Not only could you accidentally puncture your eardrum or push the earwax deeper into the canal and cause impaction, removing this natural protective lubricant can lead to the development of dry, itchy ears. It’s best to let a professional determine whether or not your ears need a more thorough cleaning beyond what you can safely do with a warm, soapy washcloth.
Fluid in the ear Avid swimmers are likely too familiar with this painful condition; however, even non-swimmers can suffer from fluid in the ear, too. Fluid can develop in the ear for a couple of different reasons:
Ear infection -- children and adults who develop middle ear infections may experience a plugged ear sensation due to fluid build-up behind the eardrum. Although this condition usually clears on its own, it can be painful. It’s time to call a doctor if the pain is severe, you notice a fluid discharge or symptoms persist for more than a day. Children younger than six months should be seen immediately.
Swimming or bathing -- here’s another reason to appreciate earwax. It acts as a deterrent for water to enter the ear when you swim or bathe. Even so, there are times water can become trapped inside the Eustachian tubes from swimming, bathing or moist environments. If it does, try these simple techniques to encourage it to drain.
Tilt your head sideways and pull the earlobe gently.
Use a warm compress. This helps open up the Eustachian tubes so water can drain naturally.
Yawn, chew, take a deep breath or use the valsalva maneuver by holding your nose and blowing gently.
Sinus pressure You may be familiar with stuffed nasal passages and facial tenderness brought about by sinus pressure, but did you know it can also cause temporary hearing loss? The sinus cavities, hollow spaces located in your bones near the nose and between the eyes, are also located beside the ear canal. When you experience an inflammation in your sinus cavities, it can cause your Eustachian tubes to swell. When that happens, the connection between the middle ear and throat is closed which puts pressure on the eardrum causing that clogged ear feeling -- or worse -- pain and hearing loss.
Fortunately, most hearing loss caused by sinus infection, pressure or sinusitis is temporary and hearing returns to normal once the sinus congestion clears. Even so, if you experience pain or sudden hearing loss due to sinus congestion, see your family doctor. They can determine the cause of your discomfort and prescribe medication to alleviate the pain and swelling.
If your ears feel clogged or you hear ringing in your ears (tinnitus) after an evening with friends at the club or an afternoon in a rowdy sports stadium, it’s likely due to excessive noise exposure. Although these symptoms typically clear within 48 hours, you can prevent permanent hearing loss by taking precautions the next time you know you’ll be in a noisy environment:
Wear earplugs or other hearing protective devices when you’re involved in an activity where sound measures more than 85 decibels (dB).
Turn down the volume on the television, car radio or any personal electronic device with which you use ear buds.
If you can’t protect your hearing from the noise or reduce the volume, move as far away from it as possible.
Before trouble starts...Although we’ve covered four of the most common reasons you ears may feel clogged, it’s always wise to seek the advice of a hearing healthcare professional whenever you are having trouble hearing. Unclogging your ears at home using home remedies or a cotton swab is never a good idea. Here’s a tip: find a clinic in your community and have your hearing evaluated before trouble starts. The baseline information the initial test provides will be a good benchmark for your medical team to use in an emergency situation and to monitor your hearing health.
Contributed by Debbie Clason, staff writer, Healthy Hearing June 21, 2018