Do you have trouble hearing when you’re in a crowd? Do you find yourself frequently asking people to repeat themselves? You’re not alone.
Hearing loss is a significant problem for 25 percent of people over age 65, and for almost half of those over 80.
Hearing loss has many causes, but the type that shows up in later years is almost always due to degeneration of the sensory nerve cells in the inner ear.
In the normal ear, sound waves proceed through the outer and middle ear and then tickle tiny hairs that are attached to nerve cells in the cochlea of the inner ear.
With this type of hearing loss — sensorineural — the hairs and nerve cells are unable to collect the vibrations and transmit sound messages to the brain.
Sensorineural hearing loss can be hereditary, but it most often occurs in a person with no family history of hearing problems.
The best answer to the “why” question isn’t a very elucidating one: It’s due to simple wear and tear.
It starts early
Some loss of hearing acuity can be demonstrated in almost all persons by age 50, but it’s usually too insufficient to cause trouble.
As the years go by, however, it becomes increasingly more likely that degeneration of the nerve cells will cause significant hearing symptoms.
Other factors may be causal or contributive. Loud occupational or recreational noise is harmful to the nerve cells in the inner ear, and with prolonged exposure, hearing loss is likely.
These days the wise worker wears ear protection in noisy environments. Unwise kids who like their music at 100 decibels or more are fodder for tomorrow’s hearing aid manufacturers.
Some drugs have the potential to damage the ear’s nerve cells. The list of problem drugs isn’t long, but includes life-saving agents in the antibiotic and diuretic (water pill) groups. Aspirin and quinine can also cause hearing trouble at high doses.
Voices lost amid noise
Not all nerve cells are affected equally in sensorineural hearing loss.
Those that detect high frequency sound wavelengths are most prone to damage. And that isn’t a good thing.
High-frequency sounds are the ones that enable discrimination of speech sounds, especially consonants.
What’s left are words that sound like they’re made up of all vowels (A-E-I-O-U). Speakers sound mumbly. Words are heard, but not understood.
In the early stages of hearing loss, discrimination of the spoken words is more a problem than the volume of the speaker.
Nerve cells in normal ears have sufficient power to detect and separate specific conversations — even when there’s a lot of background noise.
But a nerve-damaged ear is overwhelmed by background noise and separation is impaired.
An early symptom of sensorineural hearing loss is trouble hearing conversation in the presence of background noise.
Conversation in noisy places is lost, and the impaired person is likely to avoid such environments.
Don’t opt for denial
It’s common for an older person to tolerate and adapt to hearing loss rather than seek professional help.
But the toleration and adaptations typically lead to yet more problems. A hearing-impaired person may stop attending movies and plays, avoid dining out with friends, sit mute in groups or avoid initiating conversation.
At its worst, the resulting progressive social isolation can lead to depression and even confusion.
The absence of pain or acute distress, along with the insidious progression of the hearing loss, makes the afflicted person under-aware of the severity of the problem and its social consequences.
Too often a spouse, friend or family member has to use a baseball-bat approach to convince their loved one to seek help.
Sound is one of the riches of life. Missing out on sound is missing out on life.
Only about one in five people with hearing loss use a hearing aid: Cost, embarrassment, misinformation and procrastination are the common reasons.
Like all technologic devices, the performance of hearing aids has advanced dramatically over recent years. Yes, they’re costly.
But they’re absolutely worth the investment.
Dr. Michael Spilane, now retired, spent more than four decades practicing and teaching geriatric medicine in St. Paul. Send comments or questions to firstname.lastname@example.org.