Dear friends,
Welcome back to Dr Euan's TGIF Blog!
This week, we are going to look at HOW we can tell / suspect that we may have hearing loss?
What are the signs to look out for? Also, what should we do if we suspect that we have a hearing impairment? Do read on!
Q: What are the signs of hearing loss?
It's not always easy to tell if you're losing your hearing.
Anyone can experience hearing loss, not just the elderly. It can even come on suddenly or be idiopathic.
Some common signs include:
difficulty hearing other people clearly and misunderstanding what they say, especially in noisy places
asking people to repeat themselves
listening to music or watching TV with the volume higher than other people need
difficulty hearing on the phone
finding it hard to keep up with a conversation
finding yourself reading people's lips, instead of listening to their words to understand what they are saying
feeling tired or stressed from having to concentrate while listening
On occasion, people affected by hearing loss may also experience tinnitus, a persistent ringing sound in the ear when there is no noise present, or even vertigo and dizziness in some cases.
Sometimes someone else might notice problems with your hearing before you do. So do listen to feedback from your spouse/ children/ family members.
Q: What are the common causes of hearing loss?
There are lots of possible causes of hearing loss. It may be caused by something treatable, or it may be permanent.
Your symptoms may give you an idea what could be causing it. But do not self-diagnose, see a GP for further advice.
Common causes of hearing loss and related symptoms:
Possible Symptoms Cause (you can click on the links below for further advice)
Gradual hearing loss in both ears Ageing or damage from loud noise over many years
Difficulty hearing in 1 ear, earache, Ear infection
a feeling of pressure in your ear,
discharge coming out of the ear
Difficulty hearing in 1 ear, itchiness, Earwax build-up
feeling like your ear is blocked
Sudden hearing loss after an ear infection, Perforated eardrum
a very loud noise or a change in air pressure
(for example, from flying)
Sudden hearing loss along with dizziness, Labyrinthitis or Ménière's disease
a spinning sensation (vertigo)
or ringing in your ears (tinnitus)
Q: What are some treatments for hearing loss?
Treatment for hearing loss depends on the cause of the loss.
Sometimes a GP may be able to treat the cause, for example:
an ear infection that might be treated with antibiotics
an earwax build-up that might be treated with ear drops or removal of the wax build-up
If your hearing loss is not caused by something a GP can treat, they may refer you to an ENT or an audiologist for further tests and treatment.
Q: How about hearing aids and inner ear implants?
If you have permanent hearing loss, a specialist may recommend hearing aids.
These will not make your hearing perfect, but they make sounds louder and clearer.
You can read about an audiologist's advice on hearing aids in this blog post by Dr Shermin Lim.
Some people may need a cochlear or inner ear hearing implant.
These are devices that are attached to your skull or placed deep inside your ear.
If you are concerned / worried that you might have hearing loss, consult your GP or make an appointment to see an ENT Specialist. If you would like to consult with Dr Euan, you can contact us at Euan's ENT Surgery & Clinic to book an appointment.
Meanwhile, here are some useful references if you wish to read / study more on hearing loss issues:
Have a great weekend! Dr Euan
REFERENCES
1. Chou R, Dana T, Bougatsos C, Fleming C, Beil T. Screening for hearing loss in adults ages 50 years and older: a review of the evidence for the U.S. Preventive Services Task Force. Rockville, MD: Agency for Health Policy and Research, 2011. [Google Scholar]
2. GBD 2015 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet 2016; 388:1545–602. [PMC free article] [PubMed] [Google Scholar]
3. Agrawal Y, Platz EA, Niparko JK. Prevalence of hearing loss and differences by demographic characteristics among US adults: data from the National Health and Nutrition Examination Survey, 1999–2004. Arch Intern Med 2008;168:1522–30. [PubMed] [Google Scholar]
4. Lin FR, Thorpe R, Gordon-Salant S, Ferrucci L. Hearing loss prevalence and risk factors among older adults in the United States. J Gerontol A Biol Sci Med Sci 2011;66:582–90. [PMC free article] [PubMed] [Google Scholar]
5. Bainbridge KE, Wallhagen MI. Hearing loss in an aging American population: extent, impact, and management. Annu Rev Public Health 2014;35:139–52. [PubMed] [Google Scholar]
6. Kamil RJ, Lin FR. The effects of hearing impairment in older adults on communication partners: a systematic review. J Am Acad Audiol 2015;26:155–82. [PubMed] [Google Scholar]
7. Mick P, Kawachi I, Lin FR. The association between hearing loss and social isolation in older adults. Otolaryngol Head Neck Surg 2014;150:378–84. [PubMed] [Google Scholar]
8. Genther DJ, Frick KD, Chen D, Betz J, Lin FR. Association of hearing loss with hospitalization and burden of disease in older adults. JAMA 2013;309:2322–4. [PMC free article] [PubMed] [Google Scholar]
9. Contrera KJ, Betz J, Genther DJ, Lin FR. Association of hearing impairment and mortality in the National Health and Nutrition Examination Survey. JAMA Otolaryngol Head Neck Surg 2015;141:944–6. [PMC free article] [PubMed] [Google Scholar]
10. Fisher D, Li CM, Chiu MS, et al. Impairments in hearing and vision impact on mortality in older people: the AGES- Reykjavik Study. Age Ageing 2014;43:69–76. [PMC free article] [PubMed] [Google Scholar]
11. Lin FR, Ferrucci L. Hearing loss and falls among older adults in the United States. Arch Intern Med 2012;172:369–71. [PMC free article] [PubMed] [Google Scholar]
12. Viljanen A, Kaprio J, Pyykko I, et al. Hearing as a predictor of falls and postural balance in older female twins. J Gerontol A Biol Sci Med Sci 2009;64:312–7. [PMC free article] [PubMed] [Google Scholar]
13. Lin FR, Metter EJ, O’Brien RJ, Resnick SM, Zonderman AB, Ferrucci L. Hearing loss and incident dementia. Arch Neurol 2011;68:214–20. [PMC free article] [PubMed] [Google Scholar]
14. Lin FR, Yaffe K, Xia J, et al. Hearing loss and cognitive decline in older adults. JAMA Intern Med 2013;173:293–9. [PMC free article] [PubMed] [Google Scholar]
15. Gallacher J, Ilubaera V, Ben-Shlomo Y, et al. Auditory threshold, phonologic demand, and incident dementia. Neurology 2012;79:1583–90. [PubMed] [Google Scholar]
16. Li CM, Zhang X, Hoffman HJ, Cotch MF, Themann CL, Wilson MR. Hearing impairment associated with depression in US adults, National Health and Nutrition Examination Survey 2005–2010. JAMA Otolaryngol Head Neck Surg 2014;140: 293–302. [PMC free article] [PubMed] [Google Scholar]
17. Mener DJ, Betz J, Genther DJ, Chen D, Lin FR. Hearing loss and depression in older adults. J Am Geriatr Soc 2013;61: 1627–9. [PMC free article] [PubMed] [Google Scholar]
18. Starr A, Rance G. Auditory neuropathy. Handb Clin Neurol 2015;129:495–508. [PubMed] [Google Scholar]
19. Allen PD, Eddins DA. Presbycusis phenotypes form a heterogeneous continuum when ordered by degree and configuration of hearing loss. Hear Res 2010; 264:10–20. [PMC free article] [PubMed] [Google Scholar]
20. Wangemann P Supporting sensory transduction: cochlear fluid homeostasis and the endocochlear potential. J Physiol 2006;576:11–21. [PMC free article] [PubMed] [Google Scholar]
21. Hood LJ. Auditory neuropathy/dyssynchrony disorder: diagnosis and management. Otolaryngol Clin North Am 2015;48:1027–40. [PubMed] [Google Scholar]
22. van Rooij JC, Plomp R. Auditive and cognitive factors in speech perception by elderly listeners. III. Additional data and final discussion. J Acoust Soc Am 1992; 91:1028–33. [PubMed] [Google Scholar]
23. Dubno JR, Lee FS, Matthews LJ, Ahlstrom JB, Horwitz AR, Mills JH. Longitudinal changes in speech recognition in older persons. J Acoust Soc Am 2008;123: 462–75. [PubMed] [Google Scholar]
24. Dubno JR, Eckert MA, Lee FS, Matthews LJ, Schmiedt RA. Classifying human audiometric phenotypes of age-related hearing loss from animal models. J Assoc Res Otolaryngol 2013;14:687–701. [PMC free article] [PubMed] [Google Scholar]
25. Schuknecht HF, Gacek MR. Cochlear pathology in presbycusis. Ann Otol Rhinol Laryngol 1993;102:1–16. [PubMed] [Google Scholar]
26. Griffith AJ, Friedman TB. Hereditary hearing loss In: Wackym PA, Snow JB Jr, eds. Ballenger’s otorhinolaryngology head and neck surgery. 18th ed. Shelton, CT: People’s Medical Publishing House, 2017: 329–45. [Google Scholar]
27. Morton NE. Genetic epidemiology of hearing impairment. Ann N Y Acad Sci 1991;630:16–31. [PubMed] [Google Scholar]
28. Christensen K, Frederiksen H, Hoffman HJ. Genetic and environmental influences on self-reported reduced hearing in the old and oldest old. J Am Geriatr Soc 2001;49:1512–7. [PubMed] [Google Scholar]
29. Richardson GP, de Monvel JB, Petit C. How the genetics of deafness illuminates auditory physiology. Annu Rev Physiol 2011;73:311–34. [PubMed] [Google Scholar]
30. Friedman RA, Van Laer L, Huentel-man MJ, et al. GRM7 variants confer susceptibility to age-related hearing impairment. Hum Mol Genet 2009;18:785–96. [PMC free article] [PubMed] [Google Scholar]
31. Hammer MS, Swinburn TK, Neitzel RL. Environmental noise pollution in the United States: developing an effective public health response. Environ Health Perspect 2014;122:115–9. [PMC free article] [PubMed] [Google Scholar]
32. Carroll YI, Eichwald J, Scinicariello F, et al. Vital signs: noise-induced hearing loss among adults — United States 2011–2012. MMWR Morb Mortal Wkly Rep 2017;66:139–44. [PMC free article] [PubMed] [Google Scholar]
33. Sha SH, Schacht J. Emerging therapeutic interventions against noise-induced hearing loss. Expert Opin Investig Drugs 2017;26:85–96. [PMC free article] [PubMed] [Google Scholar]
34. Kujawa SG, Liberman MC. Acceleration of age-related hearing loss by early noise exposure: evidence of a misspent youth. J Neurosci 2006;26:2115–23. [PMC free article] [PubMed] [Google Scholar]
35. Kujawa SG, Liberman MC. Adding insult to injury: cochlear nerve degeneration after “temporary” noise-induced hearing loss. J Neurosci 2009;29:14077–85. [PMC free article] [PubMed] [Google Scholar]
36. Liberman MC, Kujawa SG. Cochlear synaptopathy in acquired sensorineural hearing loss: manifestations and mechanisms. Hear Res 2017;349:138–47. [PMC free article] [PubMed] [Google Scholar]
37. Liu L, Wang H, Shi L, et al. Silent damage of noise on cochlear afferent innervation in guinea pigs and the impact on temporal processing. PLoS One 2012; 7(11):e49550. [PMC free article] [PubMed] [Google Scholar]
38. Shi LJ, Chang Y, Li XW, Aiken SJ, Liu LJ, Wang J. Coding deficits in noise-induced hidden hearing loss may stem from incomplete repair of ribbon synapses in the cochlea. Front Neurosci 2016;10: 231. [PMC free article] [PubMed] [Google Scholar]
39. Liberman MC, Epstein MJ, Cleveland SS,Wang H, Maison SF. Toward a differential diagnosis of hidden hearing loss in humans. PLoS One 2016;11(9):e0162726. [PMC free article] [PubMed] [Google Scholar]
40. Mehraei G, Hickox AE, Bharadwaj HM, et al. Auditory brainstem response latency in noise as a marker of cochlear synaptopathy. J Neurosci 2016;36:3755–64. [PMC free article] [PubMed] [Google Scholar]
41. Hickox AE, Larsen E, Heinz MG, Shinobu L, Whitton JP. Translational issues in cochlear synaptopathy. Hear Res 2017; 349:164–71. [PMC free article] [PubMed] [Google Scholar]
42. Forge A, Schacht J. Aminoglycoside antibiotics. Audiol Neurootol 2000;5:3–22. [PubMed] [Google Scholar]
43. Duggal P, Sarkar M. Audiologic monitoring of multi-drug resistant tuberculosis patients on aminoglycoside treatment with long term follow-up. BMC Ear Nose Throat Disord 2007;7:5. [PMC free article] [PubMed] [Google Scholar]
44. Garinis AC, Cross CP, Srikanth P, et al. The cumulative effects of intravenous antibiotic treatments on hearing in patients with cystic fibrosis. J Cyst Fibros 2017;16: 401–9. [PMC free article] [PubMed] [Google Scholar]
45. Al-Malky G, Dawson SJ, Sirimanna T, Bagkeris E, Suri R. High-frequency audiometry reveals high prevalence of aminoglycoside ototoxicity in children with cystic fibrosis. J Cyst Fibros 2015;14:248–54. [PubMed] [Google Scholar]
46. Frisina RD, Wheeler HE, Fossa SD, et al. Comprehensive audiometric analysis of hearing impairment and tinnitus after cisplatin-based chemotherapy in survivors of adult-onset cancer. J Clin Oncol 2016;34:2712–20. [PMC free article] [PubMed] [Google Scholar]
47. Theunissen EA, Zuur CL, Bosma SC, et al. Long-term hearing loss after chemo-radiation in patients with head and neck cancer. Laryngoscope 2014;124:2720–5. [PubMed] [Google Scholar]
48. Lambert EM, Gunn GB, Gidley PW. Effects of radiation on the temporal bone in patients with head and neck cancer. Head Neck 2016;38:1428–35. [PubMed] [Google Scholar]
49. Cruickshanks KJ, Nondahl DM, Dalton DS, et al. Smoking, central adiposity, and poor glycemic control increase risk of hearing impairment. J Am Geriatr Soc 2015;63:918–24. [PMC free article] [PubMed] [Google Scholar]
50. Bainbridge KE, Hoffman HJ, Cowie CC. Risk factors for hearing impairment among U.S. adults with diabetes: National Health and Nutrition Examination Survey 1999–2004. Diabetes Care 2011;34:1540–5. [PMC free article] [PubMed] [Google Scholar]
51. Mijovic T, Zeitouni A, Colmegna I. Autoimmune sensorineural hearing loss: the otology-rheumatology interface. Rheumatology (Oxford) 2013;52:780–9. [PubMed] [Google Scholar]
52. Harris JP, Weisman MH, Derebery JM, et al. Treatment of corticosteroid-responsive autoimmune inner ear disease with methotrexate: a randomized controlled trial. JAMA 2003;290:1875–83. [PubMed] [Google Scholar]
53. Stachler RJ, Chandrasekhar SS, Archer SM, et al. Clinical practice guideline: sudden hearing loss. Otolaryngol Head Neck Surg 2012;1463 Suppl:S1–S35. [PubMed] [Google Scholar]
54. Hoffman HJ, Dobie RA, Losonczy KG, Themann CL, Flamme GA. Declining prevalence of hearing loss in US adults aged 20 to 69 years. JAMA Otolaryngol Head Neck Surg 2017;143:274–85. [PMC free article] [PubMed] [Google Scholar]
55. Pacala JT, Yueh B. Hearing deficits in the older patient: “I didn’t notice anything.” JAMA 2012;307:1185–94. [PubMed] [Google Scholar]
56. Bogardus ST Jr, Yueh B, Shekelle PG. Screening and management of adult hearing loss in primary care: clinical applications. JAMA 2003;289:1986–90. [PubMed] [Google Scholar]
57. Rubel EW, Furrer SA, Stone JS. A brief history of hair cell regeneration research and speculations on the future. Hear Res 2013;297:42–51. [PMC free article] [PubMed] [Google Scholar]
58. Crowson MG, Hertzano R, Tucci DL. Emerging therapies for sensorineural hearing loss. Otol Neurotol 2017;38:792–803. [PMC free article] [PubMed] [Google Scholar]
59. Fukui H, Raphael Y. Gene therapy for the inner ear. Hear Res 2013;297:99–105. [PMC free article] [PubMed] [Google Scholar]
60. Staecker H, Rodgers B. Developments in delivery of medications for inner ear disease. Expert Opin Drug Deliv 2013;10: 639–50. [PubMed] [Google Scholar]
61. Askew C, Rochat C, Pan B, et al. Tmc gene therapy restores auditory function in deaf mice. Sci Transl Med 2015;7:295ra108. [PMC free article] [PubMed] [Google Scholar]
62. Akil O, Seal RP, Burke K, et al. Restoration of hearing in the VGLUT3 knockout mouse using virally mediated gene therapy. Neuron 2012;75:283–93. [PMC free article] [PubMed] [Google Scholar]
63. Pan B, Askew C, Galvin A, et al. Gene therapy restores auditory and vestibular function in a mouse model of Usher syndrome type 1c. Nat Biotechnol 2017;35: 264–72. [PMC free article] [PubMed] [Google Scholar]
64. Isgrig K, Shteamer JW, Belyantseva IA, et al. Gene therapy restores balance and auditory functions in a mouse model of Usher syndrome. Mol Ther 2017;25:780–91. [PMC free article] [PubMed] [Google Scholar]
65. Lentz JJ, Jodelka FM, Hinrich AJ, et al. Rescue of hearing and vestibular function by antisense oligonucleotides in a mouse model of human deafness. Nat Med 2013; 19:345–50. [PMC free article] [PubMed] [Google Scholar]
66. Shibata SB, Ranum PT, Moteki H, et al. RNA interference prevents autosomaldominant hearing loss. Am J Hum Genet 2016;98:1101–13. [PMC free article] [PubMed] [Google Scholar]
67. Cox RM, Johnson JA, Xu J. Impact of advanced hearing aid technology on speech understanding for older listeners with mild to moderate, adult-onset, sensorineural hearing loss. Gerontology 2014;60:557–68. [PMC free article] [PubMed] [Google Scholar]
68. Blazer DG, Domnitz S, Liverman CT, eds. Hearing health care for adults: priorities for improving access and affordability. Washington, DC: National Academies Press, 2016. [Google Scholar]
69. Chien W, Lin FR. Prevalence of hearing aid use among older adults in the United States. Arch Intern Med 2012;172: 292–3. [PMC free article] [PubMed] [Google Scholar]
70. Wyatt JR, Niparko JK, Rothman ML, deLissovoy G. Cost effectiveness of the multichannel cochlear implant. Am J Otol 1995;16:52–62. [PubMed] [Google Scholar]
71. Saunders JE, Francis HW, Skarzynski PH. Measuring success: cost-effectiveness and expanding access to cochlear implantation. Otol Neurotol 2016;37(2):e135–40. [PubMed] [Google Scholar]
72. Wilson BS, Dorman MF. Cochlear implants: a remarkable past and a brilliant future. Hear Res 2008;242:3–21. [PMC free article] [PubMed] [Google Scholar]
73. Tang L, Thompson CB, Clark JH, Ceh KM, Yeagle JD, Francis HW. Rehabilitation and psychosocial determinants of cochlear implant outcomes in older adults. Ear Hear 2017;38:663–71. [PubMed] [Google Scholar]
74. McKinnon BJ. Cost effectiveness of cochlear implants. Curr Opin Otolaryngol Head Neck Surg 2014;22:344–8. [PubMed] [Google Scholar]
75. Emmett SD, Francis HW. The socioeconomic impact of hearing loss in U.S. adults. Otol Neurotol 2015;36:545–50. [PMC free article] [PubMed] [Google Scholar]
76. Saunders JE, Barrs DM, Gong W, Wilson BS, Mojica K, Tucci DL. Cost effectiveness of childhood cochlear implantation and deaf education in Nicaragua: a disability adjusted life year model. Otol Neurotol 2015;36:1349–56. [PubMed] [Google Scholar]
77. Emmett SD, Tucci DL, Bento RF, et al. Moving beyond GDP: cost effectiveness of cochlear implantation and deaf education in Latin America. Otol Neurotol 2016;37: 1040–8. [PubMed] [Google Scholar]
78. PCAST recommends changes to promote innovation in hearing technologies. Washington, DC: The White House, October 26, 2015. (https://obamawhitehouse.archives.gov/blog/2015/10/26/%E2%80%8Bpcast-recommends-changes-promote-innovation-hearing-technologies). [Google Scholar]
79. Warren E, Grassley C. Over-the-counter hearing aids: the path forward. JAMA Intern Med 2017;177:609–10. [PubMed] [Google Scholar]
80. President Trump signs OTC hearing aid legislation into law. Hearing Review. August 19, 2017. (http://www.hearingreview.com/2017/08/president-trump-signs-otc-hearing-aid-legislation-law/). [Google Scholar]
81. Strom KE. HR 2013 hearing aid dispenser survey: dispensing in the age of internet and big box retailers. Hearing Review. April 8, 2014. (http://www.hearingreview.com/2014/04/hr-2013-hearing-aid-dispenser-survey-dispensing-age-internet-big-box-retailers-comparison-present-past-key-business-indicators-dispensing-offices). [Google Scholar]
82. Strom KE. Hearing aid sales rise 5% in 2013; industry closes in on 3M unit mark. Hearing Review. February 26, 2014. (http://www.hearingreview.com/2014/02/staff-standpoint-hearing-aid-sales-rise-5-2013-industry-closes-3m-unit-mark). [Google Scholar]
