Hearing can be one of life’s greatest pleasures. Whether it’s an evening at the symphony with your spouse, a dinner party with your oldest friends, or a tea party with your granddaughter, you stand to miss out on a lot if your hearing is impaired. Indeed, accurate hearing is essential to full participation in every aspect of life: social, occupational, familial…even personal. If you think you may have a hearing loss, you are in good company. The sad fact is about 1 in every 10 Americans struggle with their hearing, according to the National Institute on Deafness and Other Communication Disorders (NIDCD). That’s 34 million persons in the U.S. suffering from hearing loss right now. As sobering as that sounds, there is good news. The technology available to help people overcome hearing loss is more advanced than ever, and our procedures for identifying areas of loss and fitting instruments to compensate for the loss are more accurate than ever before.
Types of Hearing Loss
There two main types of hearing loss: Conductive and Sensorineural. They both have to do with a failure to transfer sound along the path from the outer ear to the brain’s hearing centers.
Conductive Hearing Loss
In the case of Conductive hearing loss, the transmission of sound through the outer and/or middle ear is limited because of disease or disorder. The most common treatments are medical and surgical for this type of loss, but in some cases hearing aids can be effective alternatives.
Sensorineural Hearing Loss
Failure to fully or accurately transmit sound through the inner ear (cochlea) or along the neural pathways is called Sensorineural hearing loss. Usually the cause of this failure is damage to the interior workings of the cochlea. Sound vibrations are transmitted through the middle ear and into the cochlea, where they pass over and stimulate minute hair cells. When damaged, these hair cells cannot accurately convert sound vibrations into the neuro-electrical impulses that travel through the auditory nerve to the brain. The result is a reduction in perception and interpretation of the hearing impulses. This decrease in hearing sensitivity is typically treated by carefully targeting sound amplification with hearing instruments to compensate for damaged hair cells.
Causes of sensorineural hearing loss can be congenital (present at birth) or acquired (after birth). Congenital causes might include: infections, prematurity, hereditary factors, or birth trauma. Acquired causes include: overexposure to noise, ear infections, head injury, disease (like meningitis or encephalitis), or a negative side effect of some drugs.
Degree of Hearing Loss
The degree of hearing loss is determined by a comprehensive hearing evaluation. A hearing evaluation will determine the softest levels you can hear sounds of different pitches. These levels are called your thresholds, and are measured in an intensity scale called “decibels hearing level” or dB HL. Normal hearing is defined as thresholds for all sounds within the 0 dB HL to 25 dB HL range. Degrees of hearing loss are defined as follows:
Mild Hearing Loss:
Thresholds in the 26 dB–40 dB range. People with a mild hearing loss have difficulty hearing and understanding soft sounds and soft speech. Hearing aids are recommended when mild hearing loss cannot be medically treated. A wide range of styles, including some that are nearly invisible when worn, is available. New, open ear hearing aid models offer benefits for people with mild and moderate high-frequency hearing loss.
Moderate Hearing Loss:
Thresholds in the 41 dB–70 dB range. With a moderate loss, conversations can be difficult to follow, especially in noisy environments. People with moderate hearing loss often perceive that other people are mumbling, because their hearing loss prevents them from hearing speech clearly. Even in quiet environments, people with moderate hearing loss find it hard to have a conversation in a group of people, or if the person speaking has their back turned or has a soft voice. They may often rely on visual cues or lip reading to help fill in what they don’t hear, without even realizing it. Hearing aids are recommended for moderate hearing loss that cannot be medically treated. A wide range of styles is available.
Severe Hearing Loss:
Thresholds in the 71 dB–90 dB range. People with severe hearing loss cannot hear soft or moderate sounds, birds singing, or conversational speech. They require the person speaking to them to use a very loud voice in order to hear speech at all. In addition, when volume is increased, words or sounds may sound unclear and distorted. Profound Hearing Loss: Thresholds greater than 90 dB. Profound hearing loss is sometimes referred to as “deafness”. People with profound hearing loss can typically only hear very loud environmental sounds. In almost all cases of severe and profound hearing loss, hearing aids or cochlear implants are recommended.
Signs & Symptoms
While the causes, types, and degrees of hearing loss vary, the symptoms of hearing loss are essentially the same. People with hearing loss typically find that the answer is “yes” to the following questions below.
• Do I hear but have a difficult time understanding?
• I hear sounds, but have trouble distinguishing words.
• I frequently have to ask people to repeat themselves.
• I have difficulty understanding conversations in restaurants and meetings.
• My hearing keeps me from enjoying good times with friends and family.
• I’m embarrassed by my hearing difficulties.
• I have to turn up the volume when watching the TV.
• I have particular trouble hearing the voices of women and children.
• I have trouble hearing at movies, concerts, church and in group conversation.
Effects of Untreated Hearing Loss
Chances are, if you’re reading about hearing loss, you’ve already been dealing with it for some time. Studies show, in fact, that people with progressive hearing loss wait an average of 5-15 years before seeking treatment (1). During those years, some undesirable things happen.
The biggest problem with allowing hearing loss to go untreated may be a condition known as Auditory Deprivation (2). When the neurons that carry "hearing" signals to the brain experience prolonged lack of stimulation because of damage to the hair cells, they degenerate (similar to how an unused muscle, or your ability to play an unpracticed musical instrument would degenerate). This leaves dead regions where certain sound frequencies can no longer be interpreted. Even if these areas are stimulated again through noise amplification, the brain may no longer be able to interpret the noise. The result is a chronic decrease in speech understanding. In other words, "use it or lose it" applies to hearing too.
From a lifestyle point of view, hearing loss can create many negative effects, both on the individual with loss, and his or her family, friends, or work associates. Individuals with hearing loss are more likely to experience:
• Tension, irritation, or frustration at communication difficulties
• Feelings of inadequacy in everyday interactions
• Fear of being ridiculed, pitied, or appearing less intelligent
• Feelings of being prematurely old, handicapped, or abnormal
• Tendency to avoid social gatherings, outdoor activities, even personal interactions
• Embarrassment at having to ask for repetitions or at not understanding conversation
• Physical fatigue from straining to hear
• Personal safety risks
The effects of hearing loss on the friends, family, and associates of an individual with loss might include:
• Relationship problems from misunderstandings. Someone with hearing loss may answer a question inappropriately or not at all, or may incorrectly hear requests, comments, or instruction leading to undesired action or inaction
• Significant others may be required to interpret for the individual with hearing loss causing stressful logistical and conversational difficulties
• Feelings of rejection or misunderstanding because of communication difficulties
• Feelings of guilt arising from not including an individual with hearing loss in conversation or activities
• Feelings of resentment at not being able to enjoy certain activities because of reclusive behavior of an individual with hearing loss
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