Hearing Loss Help  

by Neil Bauman, Ph.D.

A lady asked:

Do you know what degree of hearing loss would qualify a person for Social Security Disability? Unaided I have approximately 80% loss in my left ear and aproximately 50% loss in my right. I have hearing aids but can’t wear them all day.

There is no set degree of hearing loss that makes you eligible for Social Security Disability (SSD) here in the USA. Each application is decided on a case by case basis. What is required is that you must have a “functional limitation” that prevents you from working for a living.

Since you have some residual hearing and wear hearing aids that help you–even though you don’t wear them all the time (neither do I)–and since there are many other assistive devices that can also help you to effectively communicate, it is highly unlikely you would meet the requirements of a functional limitation that prevents you from working.

Hearing loss alone shouldn’t prevent you from working. In fact, there are many jobs you can do that do not require much hearing. These occupations range all the way from entry level jobs such as dish washing, stocking shelves and janitorial work to working on an assembly line, to entering data (keyboarding) or bookkeeping, to writing or editing books and articles, to coding complex computer programs. In addition, there are many skilled trades such as sewing or cabinetmaking that do not require good hearing. When you really look, the list is almost endless.

To be sure, hearing loss does make it harder (maybe even much harder), but not impossible, to function on the job. I well know what that is like as my hearing has been worse than yours all my life. What I did was choose occupations that I both liked and where my poor hearing would not totally block me.

Instead of withdrawing from the workforce, look at the many job possibilities open to you as a hard of hearing person. As one wise person said:

“Success comes in cans.
Failure comes in can’ts.”

What you really need is a “can do” attitude that you take with you to your job. So, tomorrow morning, instead of lamenting your poor hearing, take a “can” of success with you. It will make all the difference.

by Neil Bauman, Ph.D.

A concerned mother wrote:

I was just exploring your website for information regarding enalapril and healing loss. My son is on Enalapril and a Baby Aspirin each day. He is 3 years old and had a hearing screening at school yesterday. He passed with flying colors on the right and had no response to the test on the left. I am very concerned that there is a link between the ototoxicity of his medications and his hearing loss. Can you advise me about his situation?

I can’t speak specifically to your son’s situation. However, I can tell you that Enalapril can cause hearing loss, tinnitus, ataxia, dizziness and/or vertigo in some people. However, I don’t know how the Enalapril would affect a young child as opposed to an adult.

Also, Aspirin can (and does) cause hearing loss and tinnitus in people. Fortunately, typically, but not always, hearing returns and tinnitus goes away when you stop taking the Aspirin.

I find it a bit strange that one ear is “perfect” and the other one is “dead.” You would think that drugs would affect both ears more or less equally–although I know of a number of cases where only one ear was affected for whatever reason.

Therefore, although it is possible that these drugs are the culprits, with such limited information, I have no way of knowing for sure. At the same time, there is the possibility that neither of these drugs caused the problem and you need to look for an unrelated cause.

For example, have you had your son tested to see if he has enlarged vestibular aqueducts–Large Vestibular Aqueduct Syndrome (LVAS). I know of hundreds of kids with this condition. Interesting enough, a number of them have hearing loss in only one ear. Furthermore, often it isn’t detected until they are tested as was your son. It is at this point that the doctors look further to try to find a cause and discover the LVAS. This is just one of the things you might want his doctors to check out.

You can learn more about LVAS by reading my article, Large Vestibular Aqueduct Syndrome.

by Neil Bauman, Ph.D.

Carolyn asked:

How in the world do I get a sensible hearing test when I have so much internal noise in my ears? My tinnitus sounds just like the “beeps” I’m supposed to be hearing

You have a valid concern. A number of people have asked me the same question. During pure tone testing, the fear is that your tinnitus will mask the faint pure-tone “beeps” especially when they are at the same frequency.

I have the same problem. Fortunately, there are a couple of solutions that work for me. They should work for you also.

Many audiometers now can produce 2 or 3 different “kinds” of tones. However, most people are only familiar with the standard single pure tone “beeps.” Before the test, ask your audiologist what other sounds her audiometer can produce besides these simple “beeps.”

The best one I’ve found is a warble sound. Warble tones are very distinctive. You won’t mix up warble tones with your tinnitus or other phantom sounds–at least I never have. I wish all audiometers had a warble tone option.

If the audiometer doesn’t have a warble tone, the next best solution is the double beep sound. Instead of a single “beep,” you hear a “beep-beep” and by listening for the break between the two beeps, you can more easily separate the audiometer’s sound from your tinnitus or other phantom sounds. This works for me too. However, the warble is still much easier to detect.

Ask for one of these options and you will feel more confident that the pure tone testing produced valid results in spite of your tinnitus.

by Neil Bauman, Ph.D.

A working woman explained:

I have just recently been fitted with a BTE Oticon Syncro hearing aid for one ear only. My question is that if I obtain a Single Music Link and assuming it will work not only with an M3 player, radio, CD/Walkman player, but also with a VOR micro cassette recorder, how do I use it at the same time using a headphone for my other ear?

I’ve been having big trouble listening/hearing my bosses dictations (using the VOR micro cassette recorder) and thought that the Single Music-Link may be a solution for me.

Yes, this could be an ingenious solution to your problem. The single Music Link will work with these devices as it is wired with a standard 1/8″ (3.5 mm) stereo plug. (Incidentally, both stereo channels are wired together so you won’t miss any sound on either stereo channel.)

I suggest you get a 1/8″ stereo Y adapter from Radio Shack (part #274-879; $5.99) and plug it into your stereo devices–eg MP3 player, cassette recorder, etc, and plug the single Music-Link into one jack of the “Y” and the headphones into the other one.

Now you will be able to hear via one headphone/ear bud in your good ear, and via the t-coil in your hearing aid in your bad ear.

Another solution, if your headphones are dynamic ones (meaning they are miniature loud speakers with voice coils in them) is to place the headphone over your hearing aid, switch it to t-coil mode and listen that way. You won’t get any feedback because the hearing aid microphone is switched off in t-coil mode.

by Neil Bauman, Ph.D.

A lady wrote:

At certain times, the sound in my left ear will suddenly surge to such a level that it is intolerable. This happens often at the end of a meal. Also, when I made a trip this summer, it happened in the plane on every leg of the trip.

When sound levels suddenly change when eating or flying, often the cause is your Eustachian tubes not properly regulating the air pressure in your middle ears.

One of the functions of your Eustachian tubes is to keep the air pressure in your middle ear (an air-filled cavity) at the same pressure as the outside air pressure. Normally, your Eustachian tubes are closed, but whenever you swallow or yawn, your Eustachian tubes open momentarily to equalize the air pressure.

However, if your Eustachian tubes are not working properly for some reason, or if they get clogged up, for example, from a cold or virus, when you swallow or yawn, the mucous and “gunk” in them prevents the air from freely flowing through them. The result is that either you have lower or high pressure in your middle ears than the outside atmosphere.

If your middle ear has reduced air pressure inside it, then the ear drum is sucked in more than usual. Thus, any sound vibrating it would really shake the middle ear bones since they are now much closer to the eardrum than usual. The result is much louder sounds than normal.

By the same token, if there was increased air pressure in the middle ear, the ear drum would be slightly pushed out. Thus, it would not make contact as good a contact with the middle ear bones as it normally would. The result is reduced hearing.

You often notice this latter condition when you are flying (taking off) or going up a hill. Sounds get fainter and fainter until you swallow or yawn and let the air pressure equalize. When you do this, suddenly the sounds return to normal. The change in volume can be considerable.

For example, when I am flying, if I deliberately don’t yawn or swallow, as the plane ascends enough pressure can build up in my middle ears so I can’t even hear the sound of the jets any more. Swallowing brings the sound back with a bang!

The good news is that whenever you swallow or yawn and your Eustachian tubes finally clear themselves, your hearing should return to your normal levels.

by Neil Bauman, Ph.D.

A lady wrote:

I have had hearing problems since I was in my 20s. I have had surgery for otosclerosis 3 times in my left ear and 2 in the right.

Another lady responded:

I have been diagnosed with otosclerosis. My left ear is worse than the right. Until now, nobody ever mentioned that this surgery might not be permanent. If the bone is just going to grow back, what is the advantage of the surgery? I can still hear somewhat–should I just wait until my hearing is completely gone before pursuing it?

Let me explain a bit about otosclerosis. There are two basic kinds of otosclerosis. If it just affects your middle ear—basically spongy bone overgrows the stapes (stirrup) and fixes it to the oval window so it can’t vibrate freely–you have the more common kind of otosclerosis. This kind gives you a conductive loss. This is also the kind of otosclerosis that surgery can fix.

If the spongy bone growth invades the cochlea, you not only have a conductive loss, you also end up with a sensorineural hearing loss. Cochlear otosclerosis can not be fixed by surgery like the middle ear variety can.

Unfortunately, as you have discovered, this surgery isn’t always a permanent fix. This is because often the spongy bone continues to overgrow the stapes and consequently eventually you need the operation all over again.

In some people, this occurs quite rapidly. In others it takes a long time. I think a lot depends on what stage you are in your life. In women, otosclerosis often flares up at puberty, pregnancy and menopause. So for example, if you had a stapedectomy to fix your otosclerosis, and then got pregnant, you might undo it all in short order. However, if you had the surgery after menopause, you might have good results for the rest of your life.

by Neil Bauman, Ph.D.

A mother wrote:

My son’s genetecist recently concluded that he has Pendred’s Syndrome. I’m a little sketchy on how they came to that conclusion. When I mentioned that because of the results of his CT scan, he was diagnosed with LVAS, she didn’t know much about it. I’m wondering what, if any, correlation exists between them.

I read on-line the following, “The SLC26A4 gene encodes an anion transporter known as pendrin and is the gene mutant in Pendred syndrome (PDS; 274600), DFNB4 (600791), and enlarged vestibular aqueduct syndrome (EVA; 603545).” If a mutation on that particular gene is for Pendred and/or LVAS, how do they know that you have Pendred and not just LVAS?

Good question. I am not a geneticist, but this is my understanding on the subject.

There are three conditions that all result from the mutation of the same SLC26A4 gene. Thus in one sense, they are all just different manifestations of the same thing.

If the mutation of the SLC26A4 gene results in developmental abnormalities in the cochlea, a sensorineural hearing loss and thyroid problems (goiter), then they call it Pendred syndrome.

If the mutation of the SLC26A4 gene results in an enlarged vestibular aqueduct and sensorineural hearing loss and/or balance problems, they call it Large Vestibular Aqueduct syndrome.

If the mutation of the SLC26A4 gene results in non-syndromic sensorineural hearing loss (and goiter and LVAS are not noticeable) then they call it Sensorineural Non-syndromic Recessive Deafness. (Sometimes a goiter later develops and then they say, “Oh, it must have been Pendreds after all.”)

So for all practical purposes, these three are really one condition having several manifestations.

Look at it this way. In all cases there is a sensorineural hearing loss.

If, in addition, one of the manifestations is an enlarged vestibular aqueduct, then the diagnosis is LVAS.

Or, if, in addition, one of the manifestations is thyroid problems, then the diagnosis is Pendreds.

Or, if neither an enlarged vestibular aqueduct nor thyroid problems are evident, then the diagnosis is sensorineural non-syndromic recessive deafness.

However, a person could have both a thyroid problem and LVAS. Some doctors may simply diagnose this as Pendred syndrome, while others may mention that the person has LVAS.

Maybe it would be easier to understand if we lump all the above together and call it “SLC26A4 Gene Mutation Syndrome” and explain that this syndrome includes sensorineural hearing loss and may also include thyroid problems (goiter) and/or enlarged vestibular aqueducts.

by Neil Bauman, Ph.D.

A Dutch firm has just unveiled their latest invention–Varibel eyeglass hearing aids. The hype says they:

offer older people the chance to stay active longer – free from the aesthetically unpleasing and technologically limited traditional hearing aids.

The release goes on to say,

The Varibel cannot be compared to traditional hearing aids. In each leg of the eyeglass frame there is a row of four tiny, interconnected microphones, which selectively intensify the sounds that come from the front, while dampening the surrounding noise. The result is a directional sensitivity of +8.2 dB.

Let’s look at this supposed invention a bit closer. First, eyeglass hearing aids have come and gone. They became popular 45 years ago–way back in the 1960s. In fact, I still have my old pair of eyeglass hearing aids I purchased in 1961. These new Varibel eyeglass hearing aids actually look very similar to my old ones, so what’s new about them?

They claim that these new eyeglass hearing aids are aesthetically pleasing. If you call having plain frames with thick gawky legs “aesthetically pleasing” then these are for you.

In my opinion, wearing modern glasses and modern hearing aids are much less noticeable than the pictures showing these Varibel hearing aids.

To their credit, these hearing aids are supposed to have a great innovation–4 microphones on each leg of the eyeglass frames thus giving them very good directional sound.

However, before you rush out and purchase a pair, remember that many BTE hearing aids also have multiple microphones on them. About 3 years ago, I tried on a pair of Seimens Triano hearing aids. Each of them had 3 microphones–and boy were they directional! I was totally impressed! So even this is not unique. You do not need to get eyeglass hearing aids in order to have good directionality.

Furthermore, eyeglass hearing aids fell out of favor in the 1970s for a good reason. When you take your glasses off, you also have to take your hearing aids off. For example, one lady remembered, “Every time I went to the eye doctor, I would have to take off my glasses and my hearing aids. Thus I could neither lipread nor hear during the eye appointments.”

Even worse is if either the hearing aid or the glasses break, you lose both your eyes and both your ears at the same, leaving you deaf and blind to whatever degree your hearing and vision are defective. And you remain thus until they are sent away and repaired, in some cases days or weeks later. If you wear two traditional hearing aids and one breaks, you can wear the one while the other is fixed. Not so, if they are both on the same pair of glasses!

Also, if you have two or more pairs of glasses–unless you want to pay for two or more sets of hearing aids you have to decide which pair of glasses have the hearing aids in them. For example, say you had reading/computer glasses and driving glasses as I do, if I only had the hearing aids on one pair, I’d have to decide whether I want to be deaf when driving or when reading.

At first glance, these Varibel devices may look like a nice invention, but they are just not as practical as having separate glasses and hearing aids. So unless you have a compelling reason to get these new eyeglass hearing aids, I recommend you get glasses you like for your eyes, and separate hearing aids you like for your ears!

If you want to see what these Varibel eyeglass hearing aids look like, click on the following link (http://www.varibel.nl), then click on “De hooroplossing” on the left and scroll down for some pictures. Sorry the whole website is in Dutch.

by Neil Bauman, Ph.D.

A man explained:

I have used Tegretol (Carbamazepine) for the past 10 years. I believe that it has caused loss of hearing at the high frequencies in my left ear. I also suffer from mild to moderate tinnitus, and more recently, fullness in that ear.

My question is, “If I were to stop taking the medication would that possibly reverse the loss of hearing and resultant tinnitus or will this likely be a permanent loss? Also, does hearing loss get progressively worse as a result of being on long term Tegretol?” My dosage is 1200mg/day.

The reason for taking this is that I was diagnosed with a brain tumour in my front right lobe 10 years ago. I am not sure that the Tegretol is helping me anymore and may be damaging my hearing. What do you think?

You have raised a number of interesting issues. First off, very often the three symptoms you are experiencing–hearing loss, tinnitus and a feeling of fullness in your ear–go together.

Typically the hearing loss is the primary problem. Unfortunately, tinnitus very often accompanies hearing loss–and sometimes even seems to precede it. In actual fact, I think that the hearing loss sneaks up on you over a period of time, starting at the very high frequencies where you don’t even notice it. However, your brain can tell this difference and the result is tinnitus–typically pitched at the frequency of your hearing loss.

In addition, when some hearing loss occurs reasonably suddenly, often you experience a blocked sensation in that ear. This is because your brain thinks your ear is blocked or else you’d be hearing properly in it, wouldn’t you? The result is that it generates this blocked feeling, often otherwise described as a feeling of fullness, or ear stuffiness.

You wonder if there is any connection with your hearing loss and taking the Tegretol. Good question. However, before you jump in and blame the Tegretol, take a minute to consider any other contributing factors that might have caused this hearing loss.

For example, is this high frequency hearing loss one of the effects of aging? Is it the result of exposing your ears to loud sounds over the years? This could be as simple a thing as driving your car with your window open. This lets a lot of road noise and truck noise assault that ear. Thus you could expect your left ear to have a greater resulting hearing loss than your right ear.

Once you have considered other factors, you need to consider why you suspect the Tegretol of causing your hearing loss.

To be sure, Tegretol (Carbamazepine) is indeed ototoxic to some degree. It can cause things such as hearing loss, hyperacusis (where normal sounds are now too loud), tinnitus (ringing in the ear) and auditory hallucinations (hearing various phantom sounds).

In addition, it can cause balance problems such as ataxia (staggering gait), dizziness, nystagmus (eyes jerking horizontally) and vertigo (feeling of motion such as the room spinning when it isn’t) in some people.

Unfortunately, very little is known about the long term effects of most drugs on our ears, including Tegretol. When studies are done, they are conducted for only a few weeks or months at the most. Thus the long term effects (such as your 10-year episode) are largely unknown until people like yourself raise the question.

It is hard to know whether your hearing loss and tinnitus will be permanent or not. Not much is known about the ototoxicity of this drug. However, one person experienced temporary hearing loss for about 3 weeks after taking a massive overdose of Carbamazepine (36,000 mg). So from this you could conclude that the hearing loss might be temporary.

However, length of time is also a factor. The above case was a one-time dose. You have taken this drug continuously for 10 years. Thus, personally, I wouldn’t be surprised if your dose over the past 10 years has had a slow and insidious effect on your hearing that is just now becoming noticeable.

Tegretol is an anti-convulsant drug and is commonly used to prevent seizures. If you don’t get seizures any more, I’d wonder whether you still need to take this drug–especially if you have good reasons to suspect it is damaging your ears.

Of course, if the Tegretol is doing its job, you won’t be getting seizures. Thus, the only way you could tell if you really need it now or not is to stop taking it (under your doctor’s supervision of course), and see if any seizures return. If you don’t get any more seizures, why risk possible further ear damage by continuing to take this drug? And who knows, maybe your hearing will return and the tinnitus fade away.

by Neil Bauman, Ph.D.

A man asked:

Is there any difference between how our left and right ears hear and process sounds? I understand the process is different on the left and right side. Can you explain this?

Having two properly-functioning ears greatly improves our listening enjoyment and gives us more balanced hearing, especially when listening to music, or in small group situations. This is because our brains process different information from each of our ears. If we only have one properly-functioning ear, our brains only give us part of the message.

Our brains consist of two halves or hemispheres. The left side of our brain is the logical or the technical side. It gives us discrete pieces of information. The right side of our brain is the aesthetic side. It gives us our appreciation of beauty and our ability to recognize images and patterns of sound.

God wired our brains so that the sounds our right ears hear go mainly to the left side of our brains. There our brains interpret what a person is saying. The sounds our left ears hear go mainly to the right side of our brains. There our brains interpret how the person speaking means it. The two sides of our brains have many interconnecting links so they rapidly “talk” back and forth to each other as they are processing this information.

To be sure, some of the sound impulses from each ear travel to that same side of our brains. However most of the signals cross over to the other side of our brains. This extra information helps us hear and understand better. Thus we need both our ears to completely understand all sounds, speech and music.

For example, take the words “I love you.” Three simple words with a myriad of shades of meanings. Our right ear (and our left brain) would hear and interpret the actual words and analyze the context. Our left ear (and our right brain) would determine how we understand this message–whether sincere, sarcastic or casual.

When listening to music, we “hear” the sounds of the individual instruments of the orchestra in our right ear and “listen” to the blended beauty of the music itself with our left ear.

Therefore, only having one ear detracts from our ability to hear, understand and appreciate sound.

If you are hard of hearing, this is another reason why you need to wear hearing aids in both ears.