Hearing Loss
Hearing Loss
Fending Off
the Sounds of Silence
Kathy Peck loved head-banging music. A bass player and lead singer in an all-female punk rock band, she always figured the louder the music, the better.
For nearly five years, her group, the Contractions, rehearsed four times a week in a tiny room filled with gigantic speakers and performed onstage in the San Francisco area at least three nights a week without wearing earplugs.
"At punk clubs in those days, somebody would probably have beat you up if you dared to wear earplugs," she says.
But after the band got its big break as the opening act for Duran Duran at the Oakland Coliseum, Peck noticed her hearing was fading fast. "After that show, I had ringing in my ears, and when I tried to talk with friends, I could see their lips move, but I couldn't hear any sound. I was basically deaf for days."
Soon afterward, testing revealed that she had a suffered a 40 percent hearing loss. Depressed, Peck worried about her career and wondered if Father Time was catching up with her, even though she was only in her early thirties.
"I lost confidence, and I didn't feel I was good at what I was doing anymore. I felt like I was aging. Like a lot of other people, I thought hearing loss was something that happened to older people," says Peck, co-founder and executive director of Hearing Education and Awareness for Rockers (HEAR), a San Franciscobased nonprofit organization that encourages high-decibel musicians and fans to turn down the volume and wear earplugs.
But as Peck and many other women are discovering, hearing loss in the thirties and forties is all too common. "Hearing loss is occurring at younger and younger ages and is more prevalent than is generally thought," says J. Gail Neely, M.D., professor and director of otology, neurotology and base of skull surgery at Washington University School of Medicine in St. Louis.
Overall, about 10 million American women have significant hearing impairment, and over 2.5 million of those women are under age 45, according to the American Speech-Language-Hearing Association. In a survey of 2,731 people with hearing impairment, nearly 57 percent said they first noticed the problem before age 40, says Laurel E. Glass, M.D., Ph.D., professor emeritus and former director of the Center on Deafness at the University of California, San Francisco, School of Medicine.
The toll of that hearing loss is enormous, doctors say. It can lead to social isolation, limit your job prospects, complicate your sex life, rob you of your self-esteem and make you feel as if life's parade is passing you by.
The Five-Minute Hearing Test
Suddenly, everyone around you mumbles, mutters or whispers. Could it be that you have a hearing problem? To find out, take this quiz prepared by the American Academy of OtolaryngologyHead and Neck Surgery. Your choices are almost always (A), half the time (H), occasionally (O) and never (N). 1. I have a problem hearing over the phone. 2. I have trouble following conversation when two or more people are talking at the same time. 3. People complain that I turn the TV volume too high. 4. I have to strain to understand conversations. 5. I miss hearing some common sounds, such as the phone or doorbell ringing. 6. I have trouble hearing conversations in a noisy background, such as at a party. 7. I get confused about where sounds come from. 8. I misunderstand some words in a sentence and need to ask people to repeat themselves. 9. I especially have trouble understanding the speech of women and children. 10. I have worked in noisy environments (on assembly lines, with jackhammers, near jet engines and so on). 11. I hear fine--if people just speak clearly. 12. People get annoyed because I misunderstand what they say. 13. I misunderstand what others are saying and make inappropriate responses. 14. I avoid social activities because I cannot hear well and fear I'll reply improperly. To be answered by a family member or friend: 15. Do you think this person has a hearing loss? Scoring Give yourself three points for each time you answered "almost always," two points for every "half the time," one point for every "occasionally" and no points for every "never." 0 to 5. Your hearing is fine. 6 to 9. The academy suggests that you see an ear, nose and throat specialist. 10 and above. The academy strongly recommends that you see an ear, nose and throat specialist. |
Hear Ye, Hear Ye
Before looking at why Kathy Peck and other women have hearing problems, it's important to understand how your ears work. When your best friend tells you the punch line to her latest joke, the sound of her voice enters your ear canal and strikes the eardrum, a cone-shaped elastic membrane stretched across the end of the canal. As the eardrum vibrates, it causes tiny bones in the middle ear to move back and forth. These movements trigger small waves of fluid in the inner ear that ripple through a snail-shaped organ called the cochlea. Inside the cochlea, 30,000 hairlike cells transmit impulses to the auditory nerve, which carries the sounds to the brain. There they are interpreted as the funniest joke you've ever heard, and you laugh.
Some hearing loss is a natural part of aging, says Debra Busacco, Ph.D., audiologist and coordinator of the Lifelong Learning Institute at Gallaudet University in Washington, D.C., the world's only liberal arts university for the deaf. The eardrum stiffens with age, thereby reducing its ability to vibrate. Agerelated changes to the bones in the middle ear, such as the degeneration of joints and calcium deposits in those joints, cause the middle ear system to become stiffer, resulting in less effective transmission of sound. Over time, irreplaceable hair cells in the inner ear are damaged by a combination of aging, noise exposure, medication, decreased blood supply to the ear and infection. And once they're damaged, the auditory nerve becomes less efficient. But most of those changes don't occur until a woman is at least 60 years of age.
If symptoms of hearing loss appear at an earlier age, the cause could be something as simple as excessive earwax or the very rare side effect of a medication. It could also be caused by a shattered eardrum, a head injury, high blood pressure, an ear infection, meningitis or a tumor. Some types of hearing loss run in families, such as otosclerosis, a disease that causes excessive bone deposits in the middle ear and prevents the middle ear from conducting sounds to the inner ear, says John House, M.D., associate clinical professor of otolaryngology at the University of Southern California in Los Angeles.
But the most common cause of hearing loss in adults under age 50 is excessive noise exposure, says Susan Rezen, Ph.D., professor of audiology at Worcester State College in Massachusetts and author of Coping with Hearing Loss. This still is usually a man's problem because of greater exposure to noise on the job and at play. But as women's lives change, the prevalence of noise-induced hearing loss is expected to increase. "The effects of noise exposure are long term," says Dr. Rezen. "They don't show up right away. But when people are continually exposed, their ears wear out faster, and the effects of aging show up earlier."
"There are no continuous loud sounds such as rock concerts or jackhammers in nature. Our ears were designed to be sensitive, so our ancestors could hear a twig snap, which might mean food or danger was nearby. So when you go into a noisy environment, you're putting yourself into an environment that your ears simply weren't designed to handle," says Flash Gordon, M.D., a primary care physician in San Rafael, California, and co-founder of HEAR.
Sudden loud noises close to the ear, such as firecrackers or gunshots, can cause immediate hearing loss. But usually, noise-induced hearing loss happens gradually, over years. In general, the longer you expose yourself to sounds louder than 85 decibels, whether it's a rock concert or a leaf blower, the more likely you are to destroy cilia in the inner ear and damage your hearing, Dr. Rezen says.
How Loud Is Loud?
Decibels are how hearing experts measure sound intensity (sound pressure), beginning with the softest sound a person can hear in a laboratory setting, which is 0 decibels. Using this system, 20 decibels is 10 times more intense than 0, 40 decibels is 100 times more intense, 60 decibels is 1,000 times more intense, and so on.
So how loud is 85 decibels? It's about the same amount of noise as a vacuum cleaner, a blender or a power lawn mower. In contrast, a normal conversation is about 65 decibels. Noise levels at some rock concerts come close to exceeding 140 decibels, a level that can cause rapid and irreparable hearing damage in some sensitive ears. Even symphony orchestras can generate sounds louder than 110 decibels, which can cause ear discomfort and pain in some people.
In fact, just one two-hour rock concert can potentially age a woman's hearing by nearly 2 1/2 years if she doesn't wear ear protection, according to calculations by Daniel Johnson, Ph.D., an engineer who tests hearing protectors for the military at Kirtland Air Force Base in Albuquerque, New Mexico. Based on that, he estimates that after 50 concerts, the same woman could have a decline in hearing similar to a woman 16 years older who hasn't been exposed to high noise levels. In addition, if a 30-year-old woman who doesn't wear earplugs began working eight hours a day near machinery that produced noise averaging 95 decibels, by age 40 she could have the high-frequency hearing loss of a 70-year-old.
Louder Isn't Better
But of course, most of us have gone to loud concerts, stood by passing trains or worked near noisy equipment such as chain saws. So what exactly are those noises doing to your hearing?
Try this the next time you go to a rock concert or another loud event, Dr. Gordon suggests. Before you leave your car, tune the radio to a talk radio station and turn down the volume to a point where you can just barely understand all the words. Then after the concert but before starting your engine, turn on the radio. Chances are the voices that were understandable before the concert won't be then.
That's what doctors call a temporary hearing threshold shift. Basically, it means that the noise has overstimulated the hair cells in your inner ear. As a result, the hair cells aren't functioning as efficiently as they usually do, so sounds have to be louder for you to hear them, Dr. Neely says. Researchers at the University of Manitoba in Manitoba, Winnipeg, for example, tested the hearing of ten women before and after a 21/2-hour rock concert. For most of the women, the threshold of their ability to hear was ten or more decibels higher after the concert than before.
That may not sound like much, but for several hours you'd probably have difficulty hearing rustling leaves or whispered conversation. Fortunately, your hearing would return to normal within 24 hours.
But a temporary threshold shift is a warning sign that your hearing is at risk if you continue to expose yourself to loud sounds. Some people never experience temporary threshold shifts and mistakenly assume that they are immune to the dangers of loud noise, Dr. Neely says. In truth, repeated exposure to loud noises can gradually kill off hair cells and permanently damage your ability to hear, particularly high-frequency sounds such as the consonants sh, ch, t, f, h and s, which are frequently used in conversation.
"If you miss hearing those high-frequency sounds, the remaining part of a word won't make sense to you," Dr. Neely says. "You literally won't know if people around you are talking about fish or tin cans. That can be very confusing and frustrating."
When the Ringing Won't Quit
At 31, Elizabeth Meyer was finding her way in life. She was taking marimba lessons and theater classes and looking forward to a career as a musician. Then the morning after an African music concert in Portland, Oregon, she noticed a ringing in her ears; over the next few weeks, she also developed an intense sensitivity to sound. Soon she could speak on the telephone only if she held a pillow between her ear and the receiver. Before she gave up going to the movies, she was wearing two pairs of earplugs and industrial-strength earmuffs like airport baggage handlers wear. She couldn't travel for more than 15 minutes in a bus because the noise and the ringing in her ears overwhelmed her. "Overnight, I felt like I'd aged 30 years," says Meyer, now 36. "I literally felt like I was 60. It has gotten a bit better, but the first year I spent just trying to stop myself from jumping up and banging my head against the wall every 30 seconds. At first I went through a suicidal period. Finally, I realized that although my condition might not improve, my ability to cope with it certainly would." Meyer is one of the 3.5 million American women who endure chronic tinnitus, an annoying ringing, humming or buzzing in the ears that can be a symptom of everything from excessive earwax to high blood pressure to heart disease. One in three women who has tinnitus, like Meyer, also develops hyperacusis, which is an extreme sensitivity to sounds. Both tinnitus and hyperacusis can also be signs of noise-induced hearing loss caused by damage to the cilia, hair cells in the inner ear that help conduct sound to the auditory nerve in the brain, says Christopher Linstrom, M.D., director of otology and neurotology at the New York Eye and Ear Infirmary in New York City. Hyperacusis, for instance, causes individual hair cells, each of which is normally stimulated only by certain frequencies, to react to the same range of sounds. As a result, more and more hair cells vibrate in unison, and that can make the quietest noises seem loud and jarring. When this damage occurs, sounds that are quite tolerable to many people can be painful to you, says Lt. Col. Richard Danielson, Ph.D., supervisor of audiology in the Army Audiology and Speech Center at Walter Reed Army Medical Center in Washington, D.C. In some cases, tinnitus can be treated with drugs or surgery, particularly if it's caused by excessive fluid in the middle ear, high blood pressure, a partially blocked artery in the neck or allergies. But in most instances, there is no cure for either tinnitus or hyperacusis, Dr. Linstrom says. Once tinnitus or hyperacusis is diagnosed, you should avoid loud noises and wear earplugs to prevent more hearing damage that can make these conditions worse. Masking devices that produce pleasant sounds such as raindrops or ocean waves can help people with tinnitus drown out the ringing, Dr. Linstrom says. Caffeine and nicotine aggravate both conditions, so quit smoking and avoid coffee, tea and chocolate, he says. Some medications such as aspirin, antibiotics and anti-cancer drugs can also cause tinnitus and hearing sensitivity. A hearing aid might help, because the better you hear, the less noticeable the ringing may be, says John House, M.D., associate clinical professor of otolaryngology at the University of Southern California in Los Angeles. If you have questions about these hearing problems, see your physician or write to the American Tinnitus Association, P.O. Box 5, Portland, OR 97207. |
Defending Your Ears
Although most of us will suffer some hearing loss due to aging, you can keep your hearing sharp well into your golden years if you protect your ears from noise now. "Imagine that your hearing is a big barrel of sand," Dr. Gordon says. "Either you can empty it out gradually with a teaspoon, so it will last a long time, or you can use a shovel and run out of it a lot sooner." Here are some ways to prevent hearing loss.
Turn it down. You probably can't do much about traffic noise, jackhammers and many other sources of excessive sound. But you can turn down the volume on your stereo, says Stephen Painton, Ph.D., an audiologist at the University of Oklahoma Health Sciences Center in Oklahoma City. Some sound systems can produce noise equal to the loudest rock concerts. Here's a way to tell if your stereo is too loud. Turn it on, then walk outside your home and close the door. If you can hear the music, it's too loud. The same rule applies to your car radio. And if you use headphones or a personal stereo, the person standing next to you shouldn't be able to hear the sound.
If you have to shout, get out. If you have to raise your voice to be heard by someone standing a foot or two away from you, that's a clear warning that the noise level may be dangerous, and you should get away from it as soon as possible or wear ear protection, Dr. House says.
Keep plugs handy. Stuffing cotton or pieces of shredded paper napkin into your ears does virtually nothing to minimize damage to your hearing. Instead, get in the habit of carrying earplugs with you, Dr. Busacco says. Most earplugs are small and can easily be carried in your purse or pocket. That way, she says, you'll be prepared for unexpected noise, such as an unusually loud movie. The foam rubber types are good because they are inexpensive and available over the counter at most drugstores and they can be quickly rolled up and placed in your ears. Look for the noise reduction rating on the side of the box, Dr. Painton says. This will tell you how many decibels of sound the earplugs will muffle. Buy plugs that have a rating of at least 15. Those plugs will reduce noise by 15 decibels and slash the chances that your hearing will be damaged. If you want better protection, an audiologist can design a pair of custom-made plugs for about $80 that reduce noise by about 35 decibels, Dr. Busacco says.
Take time-outs. The longer you expose yourself to loud sounds without a break, the more likely you are to cause permanent damage to your hearing, even if you're wearing earplugs. So give your ears a 5- or 10-minute break from noise every 30 minutes, Dr. Gordon says. "It's like putting your head underwater for 20 minutes. You can do it if you hold your breath for a minute at a time, then take a 10-second break. But if you'd try to do it in two 10-minute segments, you'd be dead. If you give your ears an occasional break, they can rest and recover from the excessive work that loud noise makes them do."
Spread out the noise. Placing several loud appliances or power tools near each other will compound your noise problem. So if your TV set is in the same room as your dishwasher, for example, you might be tempted to turn up the TV volume excessively when you do a load of dishes. Instead, move the television into a quieter room, says Lt. Col. Richard Danielson, Ph.D., supervisor of audiology in the Army Audiology and Speech Center at Walter Reed Army Medical Center in Washington, D.C.
Swab the deck, not your ears. Attempting to clean wax out of your ears with a cotton swab, matchstick or anything else smaller than the Love Boat does more harm than good, Dr. House says. Earwax is actually good for you. It repels water and helps keep dust away from your sensitive eardrum. Sticking small objects in your ear pushes the wax farther into your ear and can cause infection. "The best thing to do about earwax inside the ear canal is leave it alone," Dr. House says. If it becomes bothersome, see your physician or get an over-the-counter earwax removal kit that contains drops that will soften the wax and allow it to flow naturally out of your ear.
Muzzle your medication. Taking six to eight aspirin a day can cause ringing in your ears and temporary hearing loss, Dr. Gordon says. Antibiotics such as gentamicin (G-Mycin), streptomycin and tobramycin (Nebcin) can also damage your hearing, says Barry E. Hirsch, M.D., a neurotologist at the University of Pittsburgh School of Medicine. If you are taking any drug and develop hearing problems, ask your doctor if the medication could be causing it.
Puffing hurts your ears. Smoking reduces blood flow to the ears and may interfere with the natural healing of small blood vessels that occurs after exposure to loud noise, Dr. House says. In a study of 2,348 workers exposed to noise at an aerospace factory, researchers at the University of Southern California School of Medicine found that smokers had greater hearing loss than nonsmokers. So if you smoke, quit.
Slash the java. Like nicotine, caffeine cuts blood flow to the ears, increasing your chances of hearing loss, Dr. House says. Drink no more than two eight-ounce cups of coffee or tea a day. If possible, drink decaffeinated brews.
Balance your diet. The same fatty and cholesterol-laden foods that are bad for your heart also endanger your ears, according to Dr. House. High blood pressure and atherosclerosis, a buildup of plaque on artery walls, not only cause heart disease but also can reduce blood flow to the ears and gradually strangle your hearing, Dr. House says. So cut the fat with a balanced daily diet that includes at least five servings of fruits and vegetables, six servings of breads and grains and no more than one three-ounce serving of lean red meat, poultry or fish.
Exercise. Walk, run, swim, or do any other aerobic exercise for 20 minutes a day, three times a week, Dr. House suggests. It will stimulate blood circulation, lower your blood pressure and help keep your ears in peak condition.
Making the Best of It
The average person waits five to seven years after first noticing a hearing problem to seek help for it. Those can be years of unnecessary social isolation and frustration, Dr. Busacco says, because the earlier you seek help, the sooner your hearing problem can be diagnosed and treated.
"People are a lot more self-conscious about their hearing than they are about their vision," Dr. Hirsch says. "It's often an issue of vanity. Wearing a hearing aid somehow implies aging, while wearing glasses doesn't."
If you suspect that you have a hearing problem, particularly if you have ringing in your ears or develop a sudden sensitivity to loud noises that didn't bother you in the past, see your doctor or a physician who specializes in diseases of the ear, nose and throat. Some hearing problems such as Ménière's disease, a disorder that causes ringing in the ears and dizziness, can be treated with prescription medication or surgery. Other conditions, such as perforated eardrums and otosclerosis, may be corrected with surgery.
Even if the loss can't be fully corrected, powerful but inconspicuous hearing aids--some small enough to fit inside the ear canal--are available to help you get back in touch with the world. Prices range from about $550 for a basic hearing aid to more than $2,500 for top-of-the-line computerized models. An audiologist, a professional trained to fit hearing aids, can help you choose one that fits your needs.
Here's how to recognize if you have a hearing loss and how to cope with it.
Tune in to your turn signal. Sure, it's annoying when you drive down the road and realize that your turn signal has been on for miles, but it could also be a clue that you have a hearing problem. If you snap on your turn signal and can't hear the accompanying clicking sound in your car, it's time to get your hearing checked by an audiologist or doctor, Dr. Painton says.
Don't be shy about it. If you have difficulty hearing or understanding people, tell them, says Philip Zazove, M.D., assistant professor of family medicine at the University of Michigan Medical School in Ann Arbor who has had profound hearing loss since birth. Simply saying "I don't hear as well as I used to," "Could you repeat that?" and "Talk a little slower" can prevent a lot of misunderstandings, frustration and anger, he says. If necessary, ask the person to repeat herself, or if you have trouble with a key word, have her write it on a piece of paper.
Light up your sex life. Hearing loss can cause havoc in the bedroom. Those whispered sweet nothings you used to enjoy so much when you were making love are often the first casualty. Leave in your hearing aid if there is any possibility of sex, or ask your partner to leave on the light so that you can see well enough to lip-read, Dr. Rezen suggests. Talk about what you want sexually before you go into the bedroom. If necessary, develop your own secret code, such as "Two taps on the back means kiss me." "If you don't plan, you may lose the opportunity altogether," she says.
Find a quiet spot. If you really want to talk to an interesting man at a party, pull him away from the middle of the room and into a secluded corner. Not only is that more intimate, you can concentrate on what he's saying and don't have to compete with laughter, music and other background noise that just makes it that much harder to hear, Dr. Zazove says. At home, consider turning off the television, radio or other noisy appliances before you try to listen to someone.
Laugh it off. A good sense of humor is vital if you have a hearing problem, Dr. Painton says. So what if you misunderstand a word or two and say something inappropriate? Enjoy the moment and join the laughter.
Do your homework. If you're attending an important business meeting or conference, get there early and try to nab a front row seat facing the person who you think will do most of the talking, Dr. Zazove says. If possible, tell the speaker about your hearing loss and ask her to avoid turning away from you. Maintain eye contact with the speaker. Try to get a written summary of the topic or agenda, so you'll be prepared for words or phrases that might come up. That way, if you do miss a few words, you'll have a better chance of filling them in accurately.
