Hearing Loss Help  

by Neil Bauman, Ph.D.

A young lady explained:

I have been noticing for about 12 months now that I am really finding it hard to hear in bars, restaurants and noisy environments. Because of this, I yell when I am talking to those around me because I think the people I’m talking to can’t hear me. This then means I strain my vocal chords and the next morning can barely talk and it takes hours to warm up my voice. Also, my voice is gradually getting huskier.

At first I thought it was voice nodules so I went to an ENT and he checked everything and said ‘no, you’re fine—just stop yelling’ and left it at that.

It has gotten considerably worse in the last 6 months and I have finally realized that I am yelling because I can’t hear the people around me, and when I talk normally it sounds to me like I am whispering. (My sister actually said ‘Stop yelling! We can hear you fine. Can’t you hear us fine?’ If I was old I would understand, but I am only 26!

Is there anything I can do to stop this getting worse? Does this mean I have some loss of hearing? I work in the events industry. Could the loud show music that I am often exposed to be the reason for this? If yes, will continuing to work with loud music make this worse?

I would really appreciate any advice you can give me, I need some treatment but I’m not sure what I need at the moment!

I think you are beginning to realize that you must have a hearing loss, although you don’t want to believe it is true.

The truth is, you do indeed have a significant hearing loss, especially in the higher frequencies. When you get a hearing test, your audiogram will very likely show a significant hearing loss around 4,000 Hz. We call this a “noise notch”.

One of the first signs of hearing loss is that you can’t understand people when you are in noisy situations such as the bars and restaurants you mention.

Another sign is that you often speak (yell) louder than those around you because you don’t hear your voice as loud as you used to.

We are used to hearing our voices at a certain level—thus as we lose our hearing, we tend to talk louder so we can still hear our voices at the old level. The result, to those around us, is we sound like we are yelling.

I’m surprised that your ENT was so ignorant of hearing loss that he didn’t immediately suspect a hearing loss and had your hearing tested.

Although you are only 26, you have “old” ears. You have already damaged them from all the loud noise you have been around (and/or perhaps other factors such as taking ototoxic drugs).

In order to stop your hearing loss from getting worse, there are two things you need to do. First, avoid noisy places as much as possible. If the average sound level is above 80 dB or so, it is too loud and will eventually damage your ears.

Second, if you have to be in loud environments, wear ear protectors such as the foam ear plugs that you can get at almost any drugstore. These will work fine as long as they have a dB rating of 25 to 30 dB.

You need to see an audiologist and ask for a “complete audiological evaluation”. Your audiologist will then be able to tell you exactly what your degree of hearing loss is—and what you can do about it.

In quiet situations you will find that wearing hearing aids will really help you understand speech better. In noisy situations, take your hearing aids off and put in the ear protectors.

You need to start doing this now. Your voice box will love you for it—not to mention your ears, and also those around you to whom you’ve been “yelling”.

by Neil Bauman, Ph.D.

A high school teen wrote:

Thank you for taking the time to answer 10 questions which I hope will enrich my knowledge on the subject of hearing loss in teenagers. I would love to learn some new information to not only better my understanding on the topic, but to better the lives of my peers and allow them to live more hearing-friendly lives. Here are my questions:

Question 1: In words that any teenager could understand, what are the risk factors that are most likely to cause hearing loss at a young age?

By far the most common risk to hearing is exposing your ears to loud sounds, especially for extended periods of time. The louder the sound and the longer you listen to it, the greater the risk of resulting hearing loss and tinnitus (ringing or other sounds in your ears). Keeping all sounds below 80 dB (decibels) will eliminate this risk.

A second risk factor is hearing loss resulting from middle ear infections. Ear infections are quite common from birth up through elementary school, but ear infections at any age can cause hearing loss. Fortunately, hearing loss from ear infections in often temporary and hearing comes back when the “gunk” (to use a fancy medical term) drains out of your middle ears via your Eustachian tubes in the back of your throat. However, if the doctor prescribes an antibiotic to kill the infection, the antibiotic can itself may cause hearing loss. (See below).

A third risk factor is taking one of the many drugs that can damage your ears. These are called ototoxic drugs. There are hundreds of these ototoxic drugs. Some can cause hearing loss within a few days, while others require taking the drug for extended periods over several to many years. The end result is  the same—hearing loss, tinnitus and/or balance problems.

Those are 3 of the main risk factors for young people. Of course there are many others such as infectious diseases (measles, mumps, chickenpox, etc), viruses, genetics (I was born with a severe hereditary hearing loss), trauma to your ears, etc.

Question 2: How frequently do you hear about teenagers with some degree of hearing loss?

The statistics reveal that about 1 in 5 teens has a significant hearing loss (19%). That means a LOT of school age young people have some hearing loss whether they realize it or not. Since hearing loss typically begins in the very high frequencies, people typically aren’t aware they have a hearing loss until it works its way down into the speech frequencies. By that time the person has a significant hearing loss that makes it hard for them to understand speech, particularly in noisy situations.

Question 3: In your opinion, what is the most common type of hearing loss in teenagers?

There are two common kinds of hearing loss—conductive and sensorineural.

A conductive loss is a mechanical loss in the middle ear. Such losses are often temporary or can be treated medically. A typical cause is gunk (fluid) in your middle ears caused by a middle ear infection. This is probably the most common kind of hearing loss in young children.

The second kind of hearing loss is a sensorineural hearing loss. This is an inner ear hearing loss. A common cause in teens is exposing their ears to loud sounds. About 90% of adults with hearing loss have a sensorineural hearing loss.

Question 4: What kind of research is being done to try and find a cure for hearing loss?

The all time best “cure” for hearing loss is prevention of hearing loss in the first place. Don’t expose your ears to loud sounds, especially for extended periods of time.

One line of current research is looking at anti-oxidants and other things that can help prevent hearing loss after being exposed to loud sounds—such as soldiers are exposed to (gunfire, explosions, etc.)

Another line of research is finding the genes responsible for various genetic hearing losses. Once doctors know which genes are responsible, they want to see if they can find a way to alter the genetic mutations to prevent such hearing losses in the future.

Yet another line of research is delving into the secrets to regenerating hair cells in the inner ear. If this proves successful, some degree of hearing may be restored. Quite a bit of effort is being poured into this line of research and researchers are optimistic they will have results within the next 20 years or so.

Question 5: What kinds of activities/hobbies do teens participate in that are most damaging to their hearing?

Loud noisy situations are the main culprits. This can range from loud music concerts, listening to iPods/MP3 players at high volumes, attending loud sports venues (crowded stadiums, race car tracks, etc), using loud recreational vehicles (motorcycles and ATVs), using firearms without wearing ear plugs, etc.

Question 6: Tinnitus is usually a common warning symptom of hearing loss. Is this treatable?

Tinnitus may be a sign of hearing loss or impending hearing loss, or it can be a stand-alone condition. About 70% of the people with hearing loss have tinnitus associated with it.

There are a number of ways to treat tinnitus—none of which work for everyone. Most people with tinnitus are never able to eliminate it completely. Rather, they learn techniques to reduce the volume and intrusiveness of their tinnitus so that it doesn’t bother them. This is called becoming “habituated” to your tinnitus.

Question 7: Many people believe that iPods and MP3 players are dangerous to people’s hearing. What is your opinion on this?

Without a doubt, this is true IF you crank the volume way up. Some of these devices can put out 110 dB of sound. That is much too loud for hearing health. However, if you listen to these devices at volumes such that the music peaks are always below 80 dB, then there is no problem with them damaging your hearing. At least that is the current thinking. A good rule of thumb is to listen to your music at the same volume as you hear people talking.

Incidentally, having your ears exposed to sustained sounds at 80 dB all the time is not the best either. Our ears (and our brains) like respite from noise. It is best to not expose your ears to sustained sounds for long periods for your general well-being. Silence at times is good.

Question 8: How would having hearing loss affect a teenager’s daily life?

Hearing loss affects your daily life in many different ways—too numerous to mention here. However, here are four significant ways.

First, you feel left out when you can’t hear the chit-chat around you, so you tend to withdraw from your friends and family. This can lead to depression and other psychological problems. Also, when you can’t hear others, they tend to leave you out, and this makes you feel unwanted and worthless. Loneliness and poor feelings of self-worth are real problems with hard of hearing people of any age.

Second, you have much more difficulty in school maintaining good grades since you miss a lot of what the teacher says and most classroom discussion.

Third, you have much more difficulty making and maintaining good relationships with the opposite sex. Dating can be a real “minefield” when you can’t hear well.

Fourth, you have difficulty understanding the radio, TV, telephone and movies so you tend to avoid those activities. This leaves a big hole in your social development.

Question 9: For a teenager with hearing loss, what would be the best treatment for their condition?

If you have a conductive loss, then seeing an ear specialist (ENT or otologist) is a good first step. Often an ear specialist can help fix the loss since conductive losses are really just mechanical problems in the middle ear and often can be successfully treated medically or surgically.

However, if you have a sensorineural hearing loss, there is typically nothing medically that can be done at this time (apart from getting a cochlear implant if you have little to no hearing left). In this case, the best “treatment” is to have a complete audiological evaluation by an audiologist to determine exactly your type and degree of hearing loss. Then, get, and wear, properly-fitted hearing aids if your audiologists recommends them, and do the following things.

A. Use assistive devices when your hearing aids don’t help you much such as in noisy situations, or where you are at a significant distance from the speaker. Assistive devices include personal amplifiers, FM systems, loop systems, etc. (Incidentally, you can listen to most assistive devices with ear buds if you are not wearing hearing aids.)

B. Learn to speechread (lip read). Speechreading together with your residual hearing can really make a difference. I used my speechreading skills all through school and college. It was critical to my success.

C. Finally, learn and use the many, many coping strategies that help you hear better. These include such simple things as get close, have the light on the speaker’s face, cut out background noise, speak face to face, and so on.

Question 10: What is your advice to every teenager to protect their hearing on a day to day basis?

Turn the sound down! Don’t become addicted to loud sound in the first place. Don’t listen to iPods/MP3 players at volumes more than 80 dB. Either avoid loud venues, or wear properly-rated ear protectors when in noisy environments. You can get good foam ear protectors at almost any drug store for a few bucks. Get ones rated at 25 or 30 dB of protection. Just doing these things can help prevent most noise-induced hearing loss in teens.

Thank you for taking time out of your busy day to help me further my education, understand my condition, and also educate my peers about protecting something that most people take for granted. You have my gratitude for sharing your wealth of knowledge and your time.

You’re welcome. I wish more teens were as interested as you in protecting their precious hearing, because once it is gone, it is gone! Thus, the time to learn good hearing conservation habits is right now before it is too late.

by Neil Bauman, Ph.D. with Bob Eldridge

Bob Eldridge has been a teacher for many years. He is also hard of hearing. Here is how he warns his students about protecting their ears from hearing loss.

As a hearing impaired teacher I make it my business, when I introduce myself to new students, to talk about hearing loss.

I ask them if they like to listen to their I-pods with the volume turned up loud. I share with my students that as a kid I liked to listen to music loud. As a teen I got one of the first transistor radios with headphones. I outfitted my cars with pumped up sound systems. When I played with a live band, I did not protect my ears from microphone feedback and loud noises.

Then I tell them that about 5 years ago, I started not being able to understand what my students were saying. I tell them about going to the doctor and being sent to a practitioner who fitted me for hearing aids. I take out my hearing aids and show them. I tell them that hearing aids help but are not replacements for natural hearing.

Usually there is a ventilator fan running in the classroom and I ask them to notice the fan noise. They do and are amazed that their brains tend to block out that noise. I tell them with hearing aids, my brain can no longer block out the fan noise. (I do have a setting to reduce it.) Then I ask them, “Do you think I told you all of this so that I could show off my hearing aids?”

“No, Mr. E”, comes the reply ‘You don’t want us to make the same mistakes you did.’ And they are absolutely right.

by Neil Bauman, Ph.D.

If you had to guess, what percentage of children between the ages of 6 and 19 years of age would you think have noise-induced hearing loss? (Note: this is not hearing loss from causes such as middle ear infections, heredity, etc., but just noise-induced hearing loss.)

According to the Centers for Disease Control and Prevention the answer is 12.5%. This means that approximately 5,200,000 kids in the USA have permanent noise-induced hearing loss (1). It’s shocking to realize that on the average, 1 in every 8 children you meet each day has a significant hearing loss just from listening to sounds that are too loud.

There are two areas of concern.

First, it’s about time parents take an active interest in what their kids are listening to and at what volume. Safe sound levels are a maximum of 80 dB if they are going to listen for any length of time.

Second, teachers need to be aware that at the very minimum 1 out of every 8 of their students have trouble hearing them. Yet I hear so many teachers say they don’t know of any students in their classrooms that have hearing losses.

Now you know. They are there—3 or 4 in the average classroom— in every classroom in the nation. Add to these, the many other children, especially in the lower grades, with hearing loss from ear infections, allergies, etc. One study showed that on any given day, 15% of the children in elementary schools have a significant hearing loss. Consequently, ALL teachers need to practice good hearing-loss coping strategies so their hard of hearing student’s can hear them.

(1) “As Teens Plug In, Parents Fret—Worries are justified, say hearing loss experts who urge prevention” by Kathleen Doheny, HealthDay Reporter, US News & World Report. October 8, 2009.

by Neil Bauman, Ph.D.

A veteran asked:

I have a hearing loss now. In my earlier years after finishing High School I joined the Navy. I spent most of my 4 years in the Navy in an engine room aboard a ship. After the Navy, I spent most of my working life in situations that did not expose me to any excessive noise. I am now in my senior years, and for the last 15 years have noticed a hearing problem. Could the years in the engine room be a possible cause for my hearing loss?

Look at it this way—your years in the engine room probably caused some hearing loss back then, but probably not enough that you or anyone noticed, but it “used up your reserve” so to speak so that when other contributing factors began affecting your hearing, it didn’t take much to make the hearing loss obvious.

There are lots of likely contributing factors besides your navy stint. Here are a few of the more common ones.

1. The loud sounds your ears are exposed to in daily life. For example, traffic, sirens, horns honking, loud music at parties and receptions, lawnmowers, chainsaws, snowmobiles, motorcycles, shooting guns, and so on over time all take their toll on your ears.

2. All the drugs and medications you have taken over the years (assuming you have). There are hundreds of drugs that can cause hearing loss. As you get older, typically you take more and more drugs. Their combined effect can result in increasing hearing loss.

3. Simply getting older negatively affects our ears and hearing.

4. The cumulative effects of our lifestyles affects hearing. For example, when our arteries get clogged up, less oxygen gets to our inner ears and the result is loss of some hearing acuity.

5. Smoking and drinking can, and do, cause hearing loss in some people.

These are just 5 possible factors—but you can see that a little bit of hearing loss here from one cause, and a bit there from another cause, added up over a lifetime results in major hearing loss. No doubt, your initial hearing loss began in the navy, but your hearing loss continued throughout your life from other causes. Now that you are a senior, you really notice how bad your hearing has gotten. It’s not fair to place the blame solely on any one factor because that is not how things typically work in real life.

by Neil Bauman, Ph.D.

Did you know that loud music can blow out your lungs? It’s true. I recently came across a scary news item entitled “Loud music lung collapse warning” (1). It explains the cases of 4 young men that literally blew their lungs apart from being too close to big loudspeakers when they were playing loud music.

One man was driving around in his boom box car—with a 1,000 watt “bass box”. Another man was standing next to a loudspeaker in a club. A third man was standing near several large loudspeakers while attending a pop concert. The fourth man blew out his lungs, not just once, but several times, while attending heavy metal concerts. (Talk about a slow learner!) These are just a few of the many people that have damaged their lungs from being too close to loudspeakers.

These four men suffered what is called a “pneumothorax” or “collapsed lung” in lay terms. A pneumothorax is when air gets into the space between the lungs and the membrane that covers them when breaks occur in the lung walls. Doctors think that the intense pulses of low-frequency, high-energy sound causes the lungs to rupture.

Since these loud sound waves are bursting people’s lungs, imagine the damage they are doing to the sensitive structures in their ears. These people are foolishly sentencing themselves to a lifetime of unrelenting tinnitus, and ever-increasing hearing loss.

Unfortunately, they don’t seem to care because they are clueless, or think they are invincible.

Don’t be like them. As a minimum, when in places where loud music is played, keep well back from the big loudspeakers and wear ear protectors. It’s that important to your physical and aural health!

(1) Loud music lung collapse warning. BBC News. August 31, 2004.

 by Neil Bauman, Ph.D.

A man wrote:

I have extreme sensitivity in my hearing and some distortion as well. My ears buzz slightly to my own voice and others that have a deep tone in their voice. I believe this was sound-induced from my iPod and loud video gaming with head phones. My hearing is good except most everything with a high frequency hurts my ears and causes me distress. I have had this for a month and a half. Do you think it is permanent?

I think your extreme sensitivity to high frequency sounds will slowly go away if you protect your ears from louder sounds from now on. It may never completely go away, but it should be a lot better given enough time.

Very often exposing your ears to loud sounds results in damage to your ears such that you now perceive some sounds as being much too loud—in your case, the high-frequency sounds. This is called hyperacusis.

The problem can result from just one loud sound, but the “fix” often takes several months. It is generally a slow process. Think of it like a sprain—you get it in one sudden wrench—but healing takes weeks or months—slowly getting better. However, if during this time, if you wrench it again, you have to start all over again.

Your ears are the same way. That is why you must be so careful not to expose your ears to those damaging levels of sound again. Wear ear protectors in such situations if you can’t turn the sound down.

At the same time, don’t overprotect your ears by wearing ear protectors all the time, or you can make the situation even worse. I can’t emphasize this enough. Your ears need adequate sounds reaching them all the time to keep your hyperacusis under control—just not too loud.

by Neil Bauman, Ph.D.

According to an animal study at the University of Michigan, “a combination of high doses of vitamins A, C and E and magnesium, taken one hour before noise exposure and continued as a once-daily treatment for five days, was very effective at preventing permanent noise-induced hearing loss.” (1)

Here’s why researchers think this works. They feel that one of the major factors causing hearing loss from loud noise is excessive free radical activity. “Scientists have learned that noise-induced hearing loss occurs, in part, because cell mitochondria in the inner ear churn out damaging free radicals in response to loud sounds.”

Think of these free radicals as tiny enemy bullets. If they fatally damage a cell, it goes into a process called apotosis—in which the cell systematically shuts itself down and dies. If those cells are the hair cells in your inner ears, then you lose hearing when those hair cells die. Thus, it is important to zap the free radicals before they do their dastardly deeds.

The anti-oxidant vitamins are the “good guys”. They act as tiny missiles that shoot down the free radical bullets before they can cause any damage.

In addition to the vitamins A, C and E, your body makes a powerful antioxidant called glutathione. (This above study didn’t include glutathione, but it should have.) You see, “glutathione is considered the most powerful natural antioxidant there is. Your body makes this antioxidant naturally from compounds such as N-acetyl-cysteine and D-methionine which in turn are made from three amino acids-cysteine, glycine and glutamic acid. When your ears need extra help, taking N-acetyl-cysteine and D-methionine helps your body quickly make more glutathione.” (2)

“According to the researchers, pre-treatment [with vitamins A, C and E and magnesium] presumably reduced the free radicals that form during and after noise exposure, and noise-induced constriction of blood flow to the inner ear, and may have also reduced neural excitotoxicity, or the damage to auditory neurons that can occur due to over-stimulation. The post- noise nutrient doses apparently “scavenged” free radicals that continue to form long after this noise exposure ends.” (1)

That magnesium helps our ears is nothing new. Back in 2005 I wrote, “In addition, researchers now know that the mineral magnesium plays an important part in hearing. Scientists have found that a magnesium deficiency increases susceptibility to noise damage. One of the things that happens is the lack of magnesium causes the tiny blood vessels in your ears to constrict, thus depriving them of an adequate supply of oxygen. At the same time, loud noise depletes your ears of magnesium—so loud noise actually causes a double-whammy. There is evidence that high doses of magnesium taken soon after a sudden hearing loss can sometimes help restore hearing.” (2)

The University of Michigan has applied for patents covering the use of this combination of vitamins and minerals. However, you don’t have to take their patented formulation if you don’t want to. Just make sure you are taking adequate daily doses of vitamins A, C and E, and magnesium supplements, and you will get essentially the same protection.

You can get all of the above in almost any good health food store for a fraction of what you will likely have to pay for the patented formulations. Furthermore, when you get your own supplements, you can tailor the amounts you take of each supplement to fit your own body chemistry and lifestyle.

___________
 

After having said all this, don’t be stupid and deliberately expose your ears to loud sounds thinking that you can always zap the free radicals with the various things named above. These nutrients help, but they don’t do a perfect job. You will likely still experience some degree of ear damage.

Thus, If you are around noisy machinery, use loud lawnmowers and leaf blowers, ride noisy recreational vehicles such as motorcycles and snowmobiles, go to loud sports venues or loud concerts, in addition to taking your vitamins and glutathione, etc., Wear ear protectors. The little foam ones available at most drugstores for a few bucks go a long ways towards protecting your ears from the results of excessive noise.

(1) “Nutrients might prevent hearing loss in war zones, concert halls & workplaces, new animal study suggests” by Anne Reuter, 2007. University of Michigan Health System.

(2) “Loud Music and Hearing Loss” by Neil Bauman, 2005.

by Neil Bauman, Ph.D.

A recent report out of Norway (September 11, 2008) revealed a shocking statistic. “One in six children are affected by kindergarten noise.” One in four employees suffer permanent hearing loss for the same reason.

Figures published by the pre-school teacher’s union and work safety authorities indicate that stress, headaches, tinnitus, learning difficulties and at worst, impaired hearing can affect children in noisy kindergartens, according to daily newspaper Dagbladet.

According to a Labor Inspection Authority report from 2005, 75 percent of kindergarten employees are exposed to harmful levels of noise at work. This means that the kids are also exposed to these same harmful sound levels.

Things are no better over here. Many kindergartens are noisy places. I know. My younger daughter works in one. But this does not have to be. She told me the remarkable difference in noise levels in Montessori schools she has also taught in. Maybe the kindergartens should learn how the Montessori schools control excessive racket and do the same. Reducing this harmful racket will benefit both the kids and the staff.

Aftenposten English Web Desk / NTB

by Neil Bauman, Ph.D.

A lady wrote:

 I have an iPod. Music on the iPod sounds very good to me. The other day I downloaded many tunes from the iTune Store and was excited about being able to listen to all the oldies from the 50′s. I did a lot of listening with ear buds that day. The next day I listened to my down loaded tunes and I was disappointed. Everything had an extra edge to it; hard to describe but sort of like static and raspy. Real speech sounded that way to me as well. My ears felt like they had weights in them. I had more ringing in the ears than usual, the aids felt like ear plugs and I took them out. Ordinarily I don’t feel them in my ears at all. This condition went on for about a week and I was very discouraged. What is going on? Does listening to music with headphones or ear buds for too long bring this on?

You are right—too much of a good thing ends up being a bad thing, especially if you are listening to the music at louder volumes. Sustained louder sounds such as you would experience when listening to music with the volume up causes noise-induced hearing loss (NIHL).

In fact you describe 3 of thee classic symptoms of noise-induced hearing loss.

First, you have the “plugged up” feeling. You describe it as your ears feeling “like they had weights in them” and “my hearing aids felt like ear plugs”. This muffled hearing is a sign that you have had the volume too loud for too long. You are now experiencing some degree of temporary hearing loss—what doctors call a temporary threshold shift. This makes everything sound muffled, or as though you are hearing through a fog. The more often you expose your ears to loud sounds, the longer this threshold shift will last, until finally you will be left with further permanent hearing loss.

Second, you have increased tinnitus. As you say, “I had more ringing in my ears than usual.” Any sounds that cause your ears to ring (or your existing ringing to get louder) indicates that you are exposing your ears to damaging levels of sound. This tinnitus is your first warning that the sound is too loud—so you need to immediately turn the volume down and/or give your ears a rest.

Third, you have distorted hearing, which you describe as “everything had an extra edge to it; hard to describe but sort of like static and raspy”.

The good news is that if you give your ears a rest from all loud sounds, often your hearing will go back to normal and the ringing and distortion will disappear too. In this case, it took your ears a whole week. That is quite long. Often it only takes minutes to a few hours. As I said, the more often your ears are exposed to loud sounds, the longer it takes them to recover. I’d be very careful in the future, because one day if you keep on listening to music at that volume and for extended periods, these symptoms will never go away—and you do not want that!