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Daily Checkup: Many Americans are suffering from hearing los

The Director of Otologic Research at the New York Eye and Ear Infirmary at Mount Sinai, Dr. Ana (Hae-ok) Kim treats patients for hearing loss, balance problems, and anything ear-related.  Andrew Lichtenstein

The Director of Otologic Research at the New York Eye and Ear Infirmary at Mount Sinai, Dr. Ana (Hae-ok) Kim treats patients for hearing loss, balance problems, and anything ear-related.  

The Specialist

The Director of Otologic Research at the New York Eye and Ear Infirmary at Mount Sinai, Dr. Ana (Hae-ok) Kim treats patients for hearing loss, balance problems, and anything ear-related. She sees about 50 patients a week for hearing loss.

WHO’S AT RISK

It’s easy to take hearing for granted, but doctors now estimate that up to 15% of Americans under the age of 70 have some degree of hearing loss due to exposure to harmful noise. “Hearing loss falls into one of two categories, depending on whether it’s caused by nerve damage or a structural injury, like a perforated ear drum or damage to the tiny hearing bones in the middle ear,” says Kim. “Most hearing loss is due to nerve damage, which is due to a combination of genetics, noise exposure, and the natural nerve loss that comes with aging.”

Hearing loss affects both men and women of all ages. “All ethnic groups are affected by the hearing loss associated with aging, though certain diseases can be more prevalent in one group than another,” says Kim. “For people under the age of 65, hearing loss is often associated with exposure to hazardous noise levels at work or leisure — for instance, listening to loud music through headphones or at a concert.”

No one is immune to hearing loss, but some groups are at particular risk. “The primary risk factors are noise exposure, genetics, and a history of ear infections,” says Kim. “Certain occupational noise exposure or lifestyles can also put you at risk, including being in the military, riding motorcycles, or working in construction.”

Sound is measured in units called decibels; sounds under 75 decibels are considered relatively safe, while repeated exposure to decibels at or above 85 puts you at risk of hearing loss. “The National Institute for Occupational Safety and Health guideline recommends that the maximum level our ears can be exposed to is 85 decibels for eight hours straight,” says Kim. “Repeated exposure can lead to cumulative damage.”

One of the most devastating things about hearing loss is that it interferes with the ability to communicate. “Patients often realize that they’re not hearing as well as they used to; they’ll say, ‘I’m asking people to repeat themselves, and they’re getting annoyed,’” says Kim. “One of the reasons that it’s so important to treat hearing loss is that it can really make people feel cut off and isolated.”

Doctors use a test called an audiogram to measure how well a patient’s ear can hear at normal conversational frequencies. “The human ear can hear frequencies from 20 to 20,000 hertz, and normal conversation takes place between 500 hertz and 3,000 hertz,” says Kim. “For people with mild to moderate hearing loss, we have to crank up the volume to 50 decibels for them to hear what would be a normal conversation; moderate to severe hearing loss requires cranking volume from 50 to 70 decibels, and anything beyond 90 is profoundly deaf.”

SIGNS AND SYMPTOMS

Patients tend to describe hearing problems in one of two ways. “A lot of the time, patients will come in and say something like, ‘My wife complains that I don’t respond when she’s talking to me,’ or ‘I’m having difficulty hearing conversations in restaurants,’” says Kim. “Another group comes in and says, ‘I have a ringing noise in my ears, or ‘My ears feel clogged,’ but when you look in the ear, there’s no ear wax or infection.” For some people, hearing problems fluctuate, and for others, they can be accompanied by balance problems.

TRADITIONAL TREATMENT

The first step toward treatment is getting a proper diagnosis. “We use a series of exams to check hearing: a physical examination of the ear itself, a tuning fork test that helps us figure out what kind of hearing loss you might have, and an audiogram,” says Kim. “If you do need an audiogram, you want it to be done correctly, in a sound proof booth, and by an audiologist who knows what they are doing.”

The treatment options will depend on the cause of the hearing loss. “If there’s an infection, it should be treated, and if there’s a hole in the eardrum, it can be surgically repaired,” says Kim. “For patients with a wide range of hearing loss due to nerve damage, hearing aids can be quite helpful.”

For those unable to wear hearing aids, there’s a technology called bone-anchored hearing aids (BAHA), which relies on your skull bone to help your hearing.

For those unable to wear hearing aids, there’s a technology called bone-anchored hearing aids (BAHA), which relies on your skull bone to help your hearing. “For people with moderate to severe hearing loss, there’s also the option of middle ear implants,” says Kim. “For people with profound hearing loss, cochlear implants remain their only option.”

We can all take common-sense measures to prevent hearing loss in the first place. “Don’t put anything in your ear that can provoke infection, and stay away from the speakers at nightclubs or concerts,” says Kim. “Lots of summer activities from mowing the lawn to fireworks can be very loud — give your ears a break by wearing ear plugs, or stepping outside the noisy area now and then.” Get your hearing checked once a year so any hearing loss doesn’t sneak up on you.

RESEARCH BREAKTHROUGHS

Gene therapy options for hearing loss are now entering clinical trials. “For people who are profoundly deaf, there is a phase-1 clinical trial to regenerate the cochlea’s hair cells and possibly restore hearing,” says Kim. “This therapy has been tested in animals, and is just now being tested to check that it is safe for people too.”

QUESTIONS FOR YOUR DOCTOR

Because some systemic diseases like lupus and diabetes are linked to hearing loss, if you have a complex medical history or family history, ask, “Should I have my hearing screened?” Even if you don’t have hearing loss, the screening will give you and your doctor a sense of your baseline hearing range. Elderly patients especially should ask, “Am I at increased risk of hearing loss?” and “What can I do to preserve my hearing?” And if you are having trouble hearing, ask “What are my options?” “Hearing loss is a quality of life issue — if you can’t hear, the tendency is to become secluded and antisocial,” says Kim. “But now that we have so many better treatments and even tiny hearing aids that no one can see, you don’t have to live with debilitating hearing loss.”

WHAT YOU CAN DO

Get informed.

NIH runs a superb site on noise-induced hearing loss (nidcd.nih.gov/health/hearing/Pages/noise.aspx), and the Department of Labor shares tips on how to protect your hearing on the job (osha.gov/SLTC/noisehearingconservation). The Eye and Ear Infirmary at Mount Sinai (nyee.edu/) hosts information on ear health in general as well as hearing loss.

Get screened.

Kim recommends an annual hearing screening, which can diagnose any hearing loss or establish a baseline number for your healthy hearing.

Protect your ears.

Don’t put anything in your ear that can provoke infection-yes, that includes q-tips. If you do use ear buds, crank the volume down to 50 or 60 decibels maximum, which is usually about half the full volume possible. If you work in a loud environment or like loud activities like riding a motorcycle or going to the shooting range, find the right ear plugs to protect your ears.

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