Better Hearing & Speech Month: Four Families of Hearing Loss

Every May, the American Speech-Language-Hearing Association sponsors Better Hearing and Speech Month. This year’s focal point is “Communication Across the Lifespan.” So, a good time for a brief rundown of the four broad categories of hearing loss: auditory processing, conductive, sensorineural, and mixed. These are the foundation upon which a hearing health care professional will diagnose an individual’s symptoms.

When the issue is the brain’s ability to process the data being provided to it by the hearing apparatus — all the complicated things inside one’s ears — it is an auditory processing disorder. It isn’t a hearing loss problem, it’s a sound comprehension issue, one that is more common in children but will occasionally beset adults. Basically, people with auditory processing disorder just “hear” some sounds differently than the vast majority of people. It can often be mistaken for a learning disorder, so professional analysis is critical.

A more mundane problem is conductive hearing loss. This is a purely physical issue when something is interfering with the pathway between the outer, middle, and inner ear. That can be something as simple as earwax, an infection causing inflammation, or too much fluid in the ear—or something a little more extreme like a punctured eardrum or unusual bone growth.

Sensorineural hearing loss is unfortunately usually permanent. It is a situation where the information flow between the ear and the brain is irreparably compromised. This occurs when the Cochlea and/or auditory nerve are somehow damaged or genetically flawed. The vast majority of users of hearing aids suffer from sensorineural issues.

When more than one of the above is happening simultaneously — almost always conductive and sensorineural in tandem — it’s referred to as mixed hearing loss. Obviously, sorting out which issue is causing multiple symptoms can be a little more complicated.

Hear Better and Stay Out of the Hospital

Treating hearing loss will not only heighten your quality of life on a day-to-day basis. According to recent research, if you’re unfortunate enough to have a hospital stay, it will also make it less likely that you’ll make a return trip.

According to a Journal of the American Geriatrics Society article published in late 2018 entitled “Hospital Readmission Risk for Patients with Self‐Reported Hearing Loss and Communication Trouble,” people over the age of 65 with untreated hearing loss have a 32 percent higher rate of hospital readmission. This was the case regardless of why they were admitted in the first place.

The belief is that a degraded ability to communicate — and hospitals, especially emergency rooms, can be a noisy environment — leads to patients not hearing instructions about continued care or questions about how they’re currently feeling.

“Hospitals are noisy chaotic places, and people with hearing loss may have trouble understanding key information, such as what medicines they should take after discharge, or how they should watch for or manage exacerbation of their symptoms,” said Jan Blustein, one of the researchers at the Robert F. Wagner School of Public Service who worked on the study. “This puts them at risk for difficulties after they are discharged from hospital.”

This is not just a health issue either. Medicare regulations prohibit, in the case of some medical conditions, payment for readmission that occurs less than 30 days after discharge. This is obviously an issue for both the hospital and the patient.

What’s clear is that treating hearing loss is always in a person’s best interest. This study simply adds another reason why.

The Second Generation Opn

For 2019, Oticon has introduced major new capabilities to its Opn hearing aid brand. First brought to market in 2016, this is the first major upgrade of the Opn and brings features like better performance in noisy environments and an improved anti-feedback system.

The new Opn S is built around more powerful processing capabilities and the wealth of data that has been collected since the Opn line was first released. At that time, Oticon stated that their aim was to create a product that would achieve parity — including in noisy environments — between the hearing impaired and people with “normal” hearing.

That goal is getting closer. Oticon claims that the Opn S provides a 15 percent increase in speech understanding, 10 percent increase in memory recall, and 10 percent drop in listening effort compared to users’ experience with the first generation of Opn hearing aids. These figures are from Oticon’s Centre for Applied Audiology Research (CAAR) in Denmark.

Other second-generation features include a significantly improved feedback-control capability via the OpenSound Optimizer. Oticon claims it will be the first hearing aid that will inhibit feedback without directly lowering the hearing aid’s overall amplification level.

Another new feature is the OpenSound Booster, which will enable an iPhone or Android smartphone to be wirelessly linked to the Opn S and act as a booster when the user feels the need. This will be very helpful in noisy environments.

And one of the four new models — the Opn S Rechargeable — will have a long-lasting lithium-ion rechargeable battery.

Your Hearing Isn’t an Island

There’s a tendency in this era of specialization to see the functions of the body as operating in isolation. Maybe even more so hearing loss, since it is treated with very specialized and high-tech devices like hearing aids.

But recent studies make it pretty clear that overall physical health is good for your hearing — and may even put off the need for a hearing aid at all.

Studies have shown that hearing health, especially in people over age 50, is markedly better when that person’s cardiovascular health is better. In fact, data shows that people over 50 who are in good shape are likely to still have a level of hearing commonly found in people in their 30s.

The reason is that a healthy cardiovascular system will include greater blood flow to a person’s head. And healthy blood flow is crucial to the functioning of the inner ear, especially the fine hairs that are part of the cochlea, the contact point where sound waves are translated into what humans hear.

And although the term “cardiovascular health” may bring up images of gym workouts, what is required isn’t too daunting. The benchmark is large muscle movement, the kind that takes place in activities such as walking, cycling, and swimming. The time commitment to that kind of exercise is for 20 to 30 minutes, 5 days a week.

Even with busy modern lives, that’s not too much of a commitment. Especially since the benefits of maintaining a healthy circulatory system are so far-reaching, including deep into the inner ear.

The Evolution of the Hearing Aid

Today’s hearing aids are marvels of modern design. And proof positive of an aspect of Moore’s law, which states that computer-based machines will become smaller and faster as transistors continue to become more efficient. But the hearing aid goes back a long ways.

Hearing “trumpets” date back to at least the 16th century — wide at one end and narrow at the other — and were made from a variety of materials. Eventually advances in physiology led to the discovery of “bone conduction”— wherein vibrations of the bones in the skull actually transmit sound into the ear canal — and devices that were placed behind the ear to focus sound waves were developed in the 18th century.

But none of them were small and subtle.

The 19th century saw a wide variety of disguised hearing aids that weren’t exactly small, but not as obvious. British monarchs even had cunning amplifiers installed in their thrones so they could hear their subjects better without announcing to the world their loss of hearing.

But the harnessing of electricity and the development of the telephone are the direct foundation of today’s artificially amplified hearing aids. The first were boxes worn around the neck, complete with batteries. These gave the user a few hours of better hearing … and probably a sore back.

But like computers, batteries became smaller and smaller over the course of the 20th century. The invention of the transistor in the 1950s ushered in smaller and smaller amplification hardware. Although the transistor radio is what we commonly think of, transistors were actually used in hearing aids a few years before the first transistor radio hit the market.

With transistor technology, hearing aids became small enough to fit in units that could be supported by the user’s ears. The next step was the onset of digital technology, which hit the market in earnest starting in the 1990s. This not only continued the trend of units becoming smaller, but also far more powerful and feature-laden.

For the Sake of the Brain, Treat Hearing Loss

There are troubling new studies that, if nothing else, emphasize the need to take hearing health seriously. The necessity of making regular hearing checkups and related treatment a priority is clearer and clearer.

What studies are showing is a strong correlation between hearing loss — especially untreated hearing loss — and the decline of cognitive functioning.

A study published in June of 2018 in the Journal of the American Geriatrics Society entitled “Longitudinal Relationship Between Hearing Aid Use and Cognitive Function In Older Americans” found that:

“… hearing aids may enable individuals improved auditory input which may delay cognitive decline ‘by preventing the adverse effects of auditory deprivation or facilitating lower levels of depression symptoms, greater social engagement and higher self-efficacy, which protect cognitive function.’”

In other words, being able to hear is crucial to communicating with people and feeling engaged in a community — which has direct benefits to the health of the brain.

This kind of link between hearing and brain function has been noted repeatedly in recent research.

For example, a 2014 joint study by the National Institute on Aging and Johns Hopkins Medicine found similar links between better overall health, including cognitive health, and sustaining hearing.

Published in 2014 as “Association of Hearing Impairment with Brain Volume Changes In Older Adults” in Neuroimage, the study analyzed MRI brain images and found that individuals with untreated hearing loss saw a greater shrinkage in their brain size — which is a natural occurrence in aging — than others.

According to its authors, the findings of the study:

“… demonstrate that peripheral hearing impairment is independently associated with accelerated brain atrophy in whole brain and regional volumes concentrated in the right temporal lobe.”

The authors highly recommend early treatment of hearing loss in order to curtail these effects.

What’s becoming clear is that better hearing is a “better quality of life” issue on more level than one.

Studies Show the Link Between a Good Diet and Hearing Health

There are a number of well-known ways to protect one’s hearing, including wearing ear protection and not turning up the volume. But one overlooked precaution — as is the case with so much in life — is to ensure that you’re eating a proper diet.

There are now a number of formal studies that have determined that diet — and certain foods and specific nutrients — are important to your auditory system.

  • A study published in the International Journal of Audiology in 2013 concluded that poor diets are a risk factor in hearing loss. It analyzed data from the National Health and Nutrition Examination Survey, which had 21,000 participants between 1999 and 2002. It found that people with a higher “score” for a healthy diet — meaning diets that were closer to those recommended by the Department of Agriculture (USDA) — also had better hearing health outcomes.
  • In 2010 the study “A Prospective Study of Vitamin Intake and the Risk of Hearing Loss In Men” was published in the Journal of Otolaryngology: Head and Neck Surgery. It concluded that there was clear evidence that men with better diets — especially those rich in the intake of folic acid — had significantly better hearing. Foods like leafy green vegetables, fruits, beans, rice, pasta, and bread and cereals are good sources for folic acid.
  • Researchers at Brigham and Women’s Hospital published a study in 2018 in the Journal of Nutrition after analyzing the questionnaires of 71,000 women who had participated in the Nurses’ Health Study II between 1991 and 2013. They found that those with eating habits that fell into the healthiest categories — the Mediterranean Diet (AMED) and the Dietary Approaches to Stop Hypertension (DASH) — had a 30 percent lower risk for hearing loss.
    The AMED diet is based on fish, olive oil, nuts, whole grains, legumes, and fresh fruits and vegetables, while the DASH diet encourages the same, though it includes lean meat, low-fat dairy, and restricts the intake of sodium, sugar, and fat.

Allergies and Your Hearing

So, it may not seem a natural connection, but your allergies and your hearing aren’t totally unrelated.

The fact is, though we usually take it for granted, our hearing requires an incredibly complicated system to function at a very high level — day in and day out. And yes, allergies can throw sand in the gears.

Allergies usually mean that some part of your body swells. Even if you’re not overly allergic to bees, you’ll have swelling around the sting as the body reacts (and if you have a severe allergic reaction minor swelling is the least of your problems).

With many allergic reactions, there will also be congestion in your chest and nasal cavity. This kind of “clogging up the works” can directly influence your hearing, since this can change the fluid pressure in your inner ear. Your eardrum is calibrated to “normal” pressure and allergy-induced changes will affect the entire system.

Likewise, there are tubes in your middle ear that allow drainage to occur (part of keeping everything calibrated). If those get clogged with fluids produced by an allergic reaction, then things get backed up in the ear canal.

Some allergies will also induce your body to produce more earwax. This just clogs up your ear canal directly. Nothing subtle about that.

Allergic skin reactions can wreak havoc as well, since both your inner and outer ear are, well, covered in skin. If there’s severe swelling in the ear canal the passage is narrowed, which will block sound waves and once again throw off the calibration of the system.

Some things to be aware of if you’re having allergy issues include the urge to scratch inside your ear, bouts of dizziness, and any ringing in your ear. These are all signs that something is amiss.

If there’s a sudden hearing loss, you’ll probably want to have things checked out by a professional.

Sobering Research On Hearing Loss and Dementia

Although the specific reasons are not yet clear, what is observable is that there is a link of some kind between untreated hearing loss and the onset of dementia.

Several long-term studies — including two prominent ones affiliated with Johns Hopkins Medicine — have been carried out over the last decade. They have tracked the cognitive abilities of older people with varying levels of hearing capabilities. There appears to be a clear correlation between hearing loss issues coinciding with an erosion of cognitive health.

Some theories include: limited audiological input robs the brain of needed activity — as if the exercise routine of the brain had been severely reduced — and results in brain tissue loss; that the effort the brain must endure in deciphering garbled sounds over a number of years overwhelms brain function; or that there is some yet undiscovered common pathology that leads to both hearing loss and dementia.

Yet another theory is that hearing loss leads to social isolation, since communicating with other people becomes harder and harder. It has already been established that loneliness is a risk factor for developing cognitive disorders.

This last theory makes it clear that early discovery and intervention regarding hearing loss is vital. Treatments — such as hearing aids — may very well lessen whatever link there is between hearing loss and dementia. It’s very possible that by continuing more “normal” sound input to the brain, hearing aids prevent the deterioration of brain function.

These findings and theories point in one clear direction: that hearing should be routinely tested — starting in middle age as part of annual physical checkups — and issues treated as quickly as possible. It’s clear that hearing loss does the brain no good.

Hearing protection at a music festival

Have Some Summer Fun, But Think Ahead

Summer is full of fun. And one of the great things that happen in the summer is music festivals.

But … festivals can be loud. Some precautions should be taken to ensure the fun doesn’t leave a mark on your hearing.

And this isn’t an “oldies” show phenomena. A quarter of U.S. adults between the ages of 18 to 44 report hearing loss issues. Not to mention the widespread hearing issues reported by musicians over the years.

One obvious precaution is to wear earplugs, especially if you plan on getting close to the stage (and thus closer to the speaker stacks). Many festivals have vendors who sell earplugs on the side, though expect to pay the markup for what are probably lesser-quality products.

For the best earplugs, visit a hearing professional before going to the concert site. If you’re a concert devotee and put yourself in loud music environments on a regular basis, consider getting some high-end ear molds, which a care provider can customize for you. They are discreet, rugged, and offer the best protection.

It also helps to give your ears a sabbatical. For the amount of time you’re exposed to high-decibel music, take the same amount of time to let your ears recover. Wander around the perimeter, see some acoustic acts, and peruse some merchandise. Give your ears a breather.

Remember, hearing loss due to chronic exposure to high-decibel sound is not treatable. There are no miracle cures for hearing loss — no equivalent of joint replacements later in life. Once you lose your hearing, there’s no way to get it back without external devices like hearing aids.