1. What Are the Signs of Hearing Loss?

Like so many things in life, our hearing changes, but the transition to a quieter world happens so slowly that it can easily go unnoticed. That is why it is important to be able to recognize the telltale signs.

These questions cover a whole range of everyday listening situations, and will help you to make a quick assessment of your own hearing, or that of someone you love. If it reveals problems, make an appointment for a diagnostic hearing evaluation. As with most health conditions, the earlier you get a clear diagnosis, the more successful the outcome is likely to be.

  1. Do people seem to be mumbling?
  2. Do you have to strain to hear when someone talks or whispers?
  3. Do you have difficulty hearing when someone calls from behind or from another room?
  4. Do you need to watch a speaker’s lips more closely to follow the conversation?
  5. Do you find it hard to keep up in meetings, in restaurants, or in lectures?
  6. Do you listen to the TV or radio at a level that frustrates those around you?
  7. Do you find it hard to hear clearly on the telephone?
  8. Do you miss a lot of the dialogue when going to the theatre, cinema, or other entertainment venues?
  9. Do you find it hard to hear in noisy environments like in the street, in a car, or at family gatherings?
  10. Do you tend to limit your social activities because it is difficult to hear and communicate?
  11. Do family, friends, or colleagues mention that they often have to repeat themselves?

Only a hearing test can confirm a hearing loss. Have your hearing treated professionally for your own peace of mind and for the benefit of the relationships that are important to you.

2. What Should You Expect from a Diagnostic Hearing Evaluation?

A diagnostic hearing evaluation is a comprehensive assessment of your hearing ability done by someone professionally trained to identify various types and causes of hearing loss, answer your questions, refer for medical treatment where appropriate, and to discuss your options for managing your hearing health. It should include a history of your general health, and your hearing health in particular (noting any unusual symptoms or events that may affect your hearing). You will usually be given a hearing health history form to fill out, and your audiologist or hearing healthcare provider will ask further questions at the beginning of your evaluation. You can expect have your ear canals and eardrums visually inspected using a device called an otoscope. The health of your eardrum and middle ear should be evaluated. You will also be asked to sit in a sound-proof room with headphones of one kind or another on your ears and to raise your hand or press a button when you hear a variety of sounds. This allows the examiner to determine how loud sounds of various frequencies must be in order for you to barely hear them. Your tolerance to loud sounds, your ability to understand and repeat words, and any tinnitus you experience should also be assessed. Once your evaluation is completed, your audiologist or hearing healthcare provider should discuss the results with you and answer any questions you may have. Recommendations may be made regarding treatment or management of any hearing loss identified.

In contrast, a hearing screening primarily assesses your ability to hear soft sounds of various frequencies. If any issues are identified, or in order to proceed with any amplification solutions for hearing loss, further testing will be recommended. A hearing screening is generally not sufficient to identify the type or cause of a hearing loss.

3. How Do My Ears Work?

The anatomy of the ear is precisely shaped to capture sound waves and amplify them. When sound waves enter the ear they follow what might seem like a long and arduous path. But every "station" has a precise function. This is how it works:

  1. Sound waves are picked up by the outer ear, which is made up of the pinna and the ear canal.
  2. Sound is channeled to the eardrum, which vibrates when the sound waves touch it.
  3. The vibrations are picked up by three tiny bones known as the "ossicles", which create a bridge from the eardrum to the inner ear.
  4. The vibrations move on to the cochlea – a spiral-shaped capsule housing a system of fluid-filled tubes.
  5. When the sound waves read the fluid it begins to move, setting thousands of tiny hair cells in motion.
  6. The movements of the hair cells are transformed into electrical impulses that travel along the auditory nerve to the brain.
  7. The brain decodes and interprets the electronic impulses, turning a stream of speech sounds into separate, recognizable words.

4. What Are the Types of Hearing Loss?

There are two basic types of hearing loss: conductive hearing loss, and sensorineural hearing loss. They differ in where in your hearing system the problem has occurred, and in how we treat the resulting hearing loss.

Conductive hearing loss results from diseases or disorders of the ear canal, ear drum, or middle ear. This can be anything from a plug of wax blocking your ear canal, to a significant ear infection, to any number of other problems. In general, conductive hearing losses are medically treatable. If we remove the wax plug, or deal with the ear infection or other issue, the hearing most often returns to normal or near normal. For people suffering a conductive hearing loss, sound is usually too soft, but what they do hear is clear. Often only one ear is affected by conductive hearing loss, depending on the cause.

Sensorineural hearing loss results from diseases or disorders of the inner ear or neural pathways to where sound is interpreted in the brain. The two most common causes of sensorineural hearing loss are noise damage and aging, but again, a variety of other factors can contribute to sensorineural hearing loss. For people with sensorineural hearing loss, sounds are too soft (though loud sounds can be too loud), and are often not completely clear. Sensorineural hearing losses generally affect both ears and are most often permanent. Because of this, the management of sensorineural hearing losses includes fitting appropriate hearing aids. You can protect yourself from acquiring a sensorineural hearing loss to some extent by consistent use of hearing protection devices like ear plugs or ear muffs when exposed to high noise levels, not listening to music at high volumes, and maintaining a healthy lifestyle.

5. What Are Some Causes of Hearing Loss?

Common Causes of Hearing Loss

1. Age-induced hearing loss:

The most common type of hearing loss is called presbycusis, or age-induced hearing loss. This is caused by a gradual deterioration of hair cells, which is part of the normal aging process. The degree to which hair cell loss occurs varies from one individual to another. Some people experience a significant loss of sensory cells by the age of 50, while others only have a negligible loss even at the age of 80. Hearing problems associated with presbycusis can be significantly reduced with the right hearing devices.

2. Noise-Induced Hearing Loss:

Another common type of hearing loss is noise induced, arising from exposure to excessive noise for extended periods of time. Most commonly this is industrial noise, but it can also be recreational exposure to noise from lawnmowers and other yard maintenance tools, chain saws, snow-mobiles, firearms, music, and concerts, etc. The noise causes damage to both the inner and outer hair cells of the cochlea. People with noise-induced hearing loss typically have difficulty hearing high frequency sounds, but hear better in the low frequencies. Hearing devices are ideal solutions for noise-induced hearing loss. This type of hearing loss is completely preventable by taking care to protect the hearing by using appropriate ear plugs or ear muffs when in excessive noise. Unfortunately the hearing loss resulting from noise damage is permanent, so protection is imperative.

Less Common Causes of Hearing Loss

Perhaps you or a friend or family member have been diagnosed with a less common cause of hearing loss. Here is a little information on some of those disorders. If you have questions or would like further information, email or phone us so we can direct you to a source of reliable information.

1. Acoustic neuroma:

This less common cause of hearing loss is a small benign (non-cancerous) tumour that grows on the auditory nerve and by pressuring the nerve, can cause sensorineural hearing loss, tinnitus, decreased ability to understand speech, and/or balance problems. It usually affects only one ear. Diagnosis usually involves a diagnostic hearing evaluation and a CT scan or MRI. Treatment is usually surgical removal and symptoms are often largely reduced, depending on the size and location of the tumour and how early treatment is provided.

2. Cholesteotoma:

Cholesteotomas are uncommon benign growths affecting the eardrum and middle ear portions of the ear. As the tumour grows it can result in large perforations of the eardrum and erode the ossicles, resulting in conductive hearing loss. Untreated, it can invade the brain. Diagnosis involves a diagnostic hearing evaluation, a consultation with an ear, nose, and throat specialist, and possibly a CT scan or MRI. Treatment involves a surgical removal of the growth and may result in permanent hearing loss depending on how early it is diagnosed and treated. Following treatment, hearing instruments are a good solution in dealing with any resulting hearing loss.

3. Otitis Media:

Many parents and children have far too close an acquaintance with this common cause of hearing loss in young people. Otherwise known as an ear infection, it can result in a build-up of fluid in the middle ear which prevents the eardrum from vibrating normally, causing conductive hearing loss. In many cases hearing loss from otitis media resolves on its own without medical intervention, but in some cases the fluid does not drain on its own, and surgery becomes necessary to place a tube in the eardrum and drain the fluid. Following tube placement, hearing usually returns to normal with no need for further intervention.

4. Otosclerosis:

Otosclerosis occurs when the joints between the ossicles (little bones) of the middle ear get stiffened by bony growth preventing the normal vibrations from occurring. It results in gradually increasing conductive hearing loss and can often be surgically treated. Following treatment, there may be some residual hearing loss which normally responds well to amplification with appropriate hearing instruments. This disorder is more common in women and can tend to run in families, so both a diagnostic hearing evaluation and a careful family medical history are important in the diagnosis of otosclerosis.

5. Ménière's Disease:

This is a difficult disorder to cope with for both the affected person and his or her family. It is characterized by episodes of violent dizziness or vertigo, tinnitus, and, progressive sensorineural hearing loss. Ménière's disease, or endolymphatic hydrops, is most likely caused by a build-up of fluid in one of the chambers in the cochlea, which eventually bursts the membrane surrounding it allowing the fluid to mix with the different fluids in adjoining chambers. The reaction between the fluids is thought to produce the symptoms. Diagnosis is primarily based on a diagnostic hearing evaluation and a history of the symptoms. There are no known cures, but your doctor may prescribe medications to help minimize the symptoms. Amplification with appropriate hearing instruments will provide significant benefit.

6. Impacted cerumen:

This is just a fancy way of saying that your ear is plugged full of earwax. The ear canal normally produces a waxy substance called cerumen, which lubricates and protects the ear canal. There are tiny hairs called cilia lining the outer portion of the ear canal where cerumen is produced, and these normally trap the wax and gradually move it to the outside of the ear canal. When people use things like Q-tips® to clean their ears, they remove some of the cerumen, but push much of it deeper into the canal where there are no cilia to move it toward the outside. Eventually this results in the ear canal becoming completely blocked with cerumen, and produces a sudden and substantial conductive hearing loss. Occasionally a person has small or curvy ear canals and produces enough cerumen to cause a blockage without any help from "cleaning". Diagnosis is often as simple as a quick look in the ear canal and a tympanogram (a simple test done in an audiologist's office) or hearing screening. Treatment is also simple: removal of the wax from the ear canal by either using a do-it-yourself kit from a drugstore or pharmacy, or a quick visit to your doctor's office. Once the cerumen is removed, the hearing loss it caused disappears.

6. What about Noise...?

Throughout our lives we are bombarded with a steady stream of sound – In schools, at home, at work, and out and about. And sometimes these sounds get so loud that they begin to damage our hearing.

Today, nearly one in two people over the age of 50 often has difficulty understanding what people say when it is noisy, and that number is likely to increase in the future. Young people are at risk of losing their hearing faster than previous generations due to more exposure to loud music and noisy environments.

Our hearing helps us get educated, find jobs, and build families and lasting friendships, which is why it is worth taking care of.

The intensity of sound is measured in decibels sound pressure level (dB SPL). A soft whisper might be no higher than 30 dB SPL, while a firecracker might be as loud as 150 dB SPL.

Sounds are considered harmful when they exceed 85 dB SPL, which is about the loudness of heavy traffic. But at nightclubs and rock concerts, sound levels soar to more than 100 dB SPL. Over time this can lead to hearing loss and tinnitus (permanent ringing or buzzing in the ears).

When Is It Time to Protect Your Hearing?
Noise can be harmful virtually anywhere. The blast of a gun or fireworks can cause instant impairment, whereas the steady drone of heavy machinery can to damage in the long run. In most cases this happens gradually, so you still have time to care about your hearing and learn to protect it! If there is too much noise, this is how you will experience it:

  • You cannot hear someone talking, even though they are within an arm's length away.
  • Your ears hurt after leaving a noisy area.
  • You hear ringing or buzzing in your ears during or after exposure to noise.
  • After exposure to noise, you can hear people taking but their speech sounds muffled or blurred.

The human auditory system contains delicate and complex mechanisms. The inner ear is home to a sea of tiny sensory cells and nerve fibres that pick up sound vibrations and turn them into electrical impulses for the brain to process.

Too many strong vibrations will damage these cells and fibres, and the more you lose, the worse your hearing will get. Broken cells and fibres cannot heal themselves, so any damage will be permanent. This can take the form of tinnitus and/or noise-induced hearing loss.

Some Simple, Protective Steps
Think about your total sound exposure during the day. The simplest way to start protecting your hearing is by limiting the amount of time you expose your ears to loud noise. But there are other methods as well:

  • Move away
  • Stay as far away from the source of noise as possible
  • Walk away when sounds get too loud
  • Turn things down
  • At home, turn down the volume on the television radio, stereo, and MP3 players
  • Reduce the number of noisy appliances running at the same time
  • Buy quieter products (compare dB ratings – the smaller the better)
  • Cover your ears
  • Use ear protection wherever possible
  • When you are exposed to sudden loud noises (like a jackhammer), cup your hands over your ears or put a fingertip into each ear canal

Earplugs for All Occasions!
Ear protectors come in all shapes and sizes. Even though they might feel strange at first, getting used to wearing them does not take long.

  • Disposable earplugs – Crafted in expandable foam or silicone, and available from any pharmacy and many hearing clinics, disposable earplugs come in one size that fits most ears.
  • Reusable plugs – Made of rubber or silicon, reusable plugs are often cone-shaped, with a safety cord. They can be cleaned with warm soapy water and worn safely for months, but as soon as they become hard or damaged they should be replaced.
  • Earmuffs – Resembling stereo headphones, these cushioned earmuffs are available from sporting goods, safety equipment stores or do-it-yourself retailers, along with many hearing clinics. Worn alone they should tightly cover year ears, but they can also be combined with earplugs in extremely noisy situations.
  • Custom-fit musician's earplugs – these handcrafted earmolds sound more natural because they attenuate all sounds to the same degree. If you are in frequent need of protection, these are the best option.
  • Custom-fit industrial ear plugs – these are also handcrafted earmolds that precisely fit the shape of your ear and offer excellent protection from industrial noise, with a high level of comfort for full-day wear.

7. What Training Does My Hearing Healthcare Provider Have?

There are generally two types of professionals that deal with hearing loss in a hearing clinic setting. The first is an audiologist, the second, a hearing instrument practitioner.

Audiologists have a minimum of 6 years of university training and are comparable for your hearing to what optometrists are for your vision. They are not medical doctors, but do have specialized training in the prevention, diagnosis and rehabilitation of hearing loss, tinnitus, and related communication and counselling issues. They primarily work in hospitals, schools, health units, and hearing clinics.

Hearing instrument practitioners have two years of post-secondary education and are comparable in the hearing world to what opticians are in the vision world. They also test hearing and fit hearing aids, but do not have the extensive training that audiologists do.

8. Why Buy Local?

The decision to get your hearing evaluated and purchase hearing aids is a large one with a significant impact on your communication for the next several years. What is at stake is your ability to connect and maintain relationships with the people important to you like family, friends, and co-workers. When you purchase and are first fit with hearing instruments, you are only beginning a journey of adjustment and learning that will improve over the months to give you the optimum communication available to you, but that requires a good working relationship with your audiologist or Hearing Instrument Practitioner, since you will need adjustments and support as you learn to hear and interpret all the sounds you've been missing over the years your hearing loss developed. This level of hearing health care cannot be provided over the internet or at a long distance where contact with your provider is limited. It does not make good sense to invest in hearing instruments, but not in the process by which you will benefit the most from them. You should find a professional with whom you are comfortable, and in whom you have confidence at the beginning of your journey to better hearing.

9. What Should Be My Next Step?

Making the decision to have your hearing tested is the first step towards improving your quality of life. Just think what it would mean to you and your family if you could:

  • Hear and understand much more
  • Laugh with (and get closer to) the people you love
  • Feel relaxed rather than drained after a long conversation
  • Hear and understand the soft voices of children
  • Enjoy birdsongs and the rustle of leaves in the wind
  • Tell where sounds are coming from
  • Listen to TV or radio at a normal volume
  • Be the first to answer the telephone instead of the last
  • Keep up and participate in meetings

If, like us, you feel your hearing is worth fighting for, call today for a consultation. Be good to yourself and your loved ones, and take that next step!

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