Coping with hearing loss...

Do people seem to be mumbling more than they used to? Are your friends complaining because it takes you forever to answer the phone? Are you asking people to repeat themselves more frequently? Do you find it easier to let your spouse do all the talking at parties because all the noise runs together and prevents you from understanding conversations around you?

If you answer yes to more than one of these questions, you may be one of the approximately 20 million Americans who are considered to be hearing impaired. Age-related hearing loss will ultimately happen to everyone, it just affects some of us earlier than it does others. Ears have a tendency to be like the family car. Sometimes they just don't work, they get damaged, or they simply wear out.

Statistics indicate that, for many people, the loss of hearing begins at about age 55. In medical terminology, age-related hearing loss is called presbycusis -- presby meaning elder and akousis or hearing. Generally, this kind of hearing loss affects both ears; it is permanent because there has been some degeneration of nerve cells; it gradually worsens with age, and is more pronounced for high-pitched sounds.

If one or both of your parents had hearing difficulties relatively early in life, the odds are pretty good that you will experience some hearing impairment by the time your middle 50's roll around. Medical science now has evidence that Mom was right when she said to turn down the stereo; there is a whole generation of people today who have hearing problems that are traceable to teen years spent with the volume permanently set on "max."

How the Equipment Works...

The human ear is an amazing mechanism, but not as efficient as those belonging to some of our friends in the animal kingdom. Some foxes, for example, have the ability to direct their outer ear to detect even ants moving underground. That would be dandy if ants happen to be a source of survival, but most humans would settle for hearing the news on TV, or a grandchild's laughter.

To refresh what most of us learned in junior high school health class, the ear has three basic components: the outer ear, middle ear and inner ear. The outer ear consists of the skin and cartilage that hangs on both sides of your head and the ear canal, which extends about an inch inside the head. This canal not only protects the delicate inner parts of the ear, but actually amplifies the resonance of certain pitches necessary for understanding speech.

The middle ear consists of the eardrum, the ossicles (tiny bones nicknamed the hammer, anvil and stirrup), and the Eustachian tube. The eardrum is highly sensitive to vibration which it passes along to the ossicles; they, in turn, compress it; focusing all the vibration onto the tiny footplate of the stirrup. Because sound is nothing more than a vibration in the air, the body's internal amplifier needs air provided by the Eustachian tube. It has one open end in the middle ear and the other end in the back of the throat, and provides a way to equalize pressure.

The inner ear consists of the snail-like cochlea, the semicircular canals and the endings of the auditory nerve. The intensive vibration of the stirrup on the oval window that connects the middle and inner ear creates a wave in the fluid filling of the cochlea, setting in motion its tiny hairlike projections, which then contact the nerve endings. The nerve carries the signal to the brain for interpretation.

With all this delicate machinery, it is easy to see how something might go wrong along the way. Sometimes it is as simple as an accumulation of wax in the ear canal, which may only get packed deeper when you try to clean it out. In other cases, a perforated eardrum can result from an injury or an illness and cause temporary hearing loss. The fragile inner ear is subject to infection by a variety of viruses including mumps and measles and any illness accompanied by a very high fever.

In a conductive hearing loss, the outer or middle ear does not conduct sound as well as it should, primarily causing a loss of sensitivity for hearing soft sounds. When the problem is in the inner ear, stemming from disease, injury or age (where the transmitter is operating but the brain isn't picking up the signal), this is misleadingly referred to as "nerve deafness." With this sensorineural hearing loss, there is a reduced sensitivity to soft sounds as well as difficulty in clearly distinguishing one sound from another.

There's something wrong with your hearing, not with you...

It is a real mystery why people hardly think twice about correcting their eyesight with glasses, but find it difficult or impossible to admit they don't hear as well as they used to. Hearing loss is not a sign of senility and it certainly doesn't mean that your life is over.

Psychologists who have worked with hearing impaired patients do point out, however, that there are often many vocational, social and emotional aspects that require special attention. They need to be dealt with not only by the person experiencing the loss, but by family and friends, as well. There is a process very much like grieving that many hard-of-hearing people go through; a process that may require understanding and quite often, a great deal of patience.

Denial may be a natural initial reaction, but it is sometimes carried to extremes. ("I can hear anything I want to hear, thank you.") Projection is the second emotional safety valve that allows all the blame to be placed on someone else. ("Why do young people mumble all the time?") The next step is anger, usually misdirected, at the person in closest proximity. ("Maybe I can't hear so well, but I can still think for myself!")


Depression may come on the heels of anger, frequently made worse by embarrassment, and may even result in self-imposed exile or a personality change. There may be a very real reason for the depression; when subtle background sounds -- like birds chirping or the wind in the trees -- are no longer heard, there is often a profound sense of sadness. The ability to hear helps warn of impending danger; so the loss of hearing can also produce a sense of insecurity and vulnerability.

The final stage is acceptance, when the depression lifts and the person is ready to get on with living again. This usually leads to contacting a physician for a hearing examination, which may result in a recommendation for a hearing aid. A hearing aid is not a cure-all. it will never restore all of a person's hearing ability. With a good emotional adjustment and proper use, however, a hearing aid can often make it easier to cope.

Options and Choices...

If you suspect a hearing loss, you may want to schedule an appointment with your family practitioner or an ear specialist (otolaryngologist or otologist). After a basic examination, your physician may refer you to an audiologist. This professional is trained in the non-medical aspects of hearing impairment, and can help evaluate the extent of the loss and provide screening, therapy, counseling and, if a hearing aid is recommended, suggestions as to what type would best suit your needs.

There are four common treatments: medication, which may include antibiotics in cases of infections causing conductive hearing loss; aural habilitation, which involves training to help a person maximize their remaining hearing ability; surgery to correct the outer ear, middle ear bones and eardrum problems to relieve pressure; and hearing aids to help increase and control sound sensitivity and expand the range of tones heard.

It may be an understatement to say that a hearing loss requires some adjustments. There are likely to be some changes in your life; some easier to cope with than others. Try to recognize your emotional triggers, admit your problem to those around you, and seek professional assistance at the first indication your hearing is failing.

It might be your hearing loss -- and it will affect others around you -- but don't allow it to harm your relationships with friends and family or force you into isolation. There's help available...all you have to do is ask for it.

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