Living with Hearing Loss

Although most hearing loss is permanent and cannot be reversed, it can be successfully addressed and managed to improve quality of life. In fact, hearing technologies have advanced dramatically in recent years, and they continue to improve. At the same time, a growing body of evidence underscores the importance of addressing hearing loss early due to its potential link to other health concerns, including cognitive decline and dementia, and its impact on quality of life.

Signs of hearing loss

Most acquired hearing loss comes on gradually—which means that people with hearing loss who have not gotten a hearing test may not fully realize the extent of their hearing loss or the impact it’s having on their lives.

Common signs of hearing loss include:

The frequent need to ask people to repeat themselves
Having trouble following conversations when several people are involved
The need to keep the volume on the television and radio turned up
Trouble hearing in noisy environments and/or hearing children and women with higher-pitched voices
Ringing in the ears
Feeling tired and stressed from straining to follow the conversation
Frequently feeling as though people are mumbling

The chance that someone will develop a hearing loss increases if there’s:

A family history of hearing loss
A history of noise exposure—that is, for instance, a noisy workplace, frequent loud concerts, or isolated incidents of excessively loud or explosive sounds
A history of taking medicines known to cause damage to the hearing system (ototoxic drugs)
A health condition linked to hearing loss, such as diabetes and cardiovascular disease

Return to top

The importance of getting a hearing evaluation

About one in four U.S. adults who report excellent to good hearing already has hearing loss—which means, getting a professional hearing exam not only helps identify existing hearing loss, but also provides a baseline for measuring any future loss.

It’s important for anyone who believes they may have a hearing loss to see an otolaryngologist (ear, nose, and throat specialist—ENT) or an audiologist to get a proper diagnosis and appropriate treatment. Hearing aid specialists also can provide basic hearing tests.

Although procedures may vary somewhat from state to state and among practices, a basic hearing evaluation is likely to involve three steps:

A review of the individual’s hearing and general health, including family history
A visual examination of the ear canal with an otoscope—a special magnifying light used for this purpose
Hearing testing, which may include:
- A tone test during which the individual wears headphones and listens for short tones of different volumes and pitch that are played into the right and left ears separately
- A pressure test, which uses air pressure to determine the flexibility of the eardrum and tiny bones in the middle ear
- A speech test, which involves listening to spoken words at different volumes, and repeating them

Return to top

Addressing hearing loss matters

Addressing hearing loss has been shown to improve quality of life. And as researchers learn more about the link between hearing loss and other health issues—including cognitive function—many experts encourage people to learn the status of their hearing and to address hearing loss early.

Although there is no actual cure for most sensorineural hearing loss at this time, there are hearing technologies and assistive devices that can help people hear better in their day-to-day lives.

Return to top

Hearing aids

Hearing aids have advanced tremendously over the past several years in terms of functionality, design, and comfort. They can provide benefit to many people with hearing loss by amplifying the sounds they have trouble hearing. With technology progressing so quickly, it’s important for anyone with hearing loss to let go of old assumptions about hearing aids of years gone by and to educate themselves on current options and technologies.

Today, hearing aids function like mini-computers and can be programmed to the specific hearing needs of the individual. Using modern technologies and algorithms, many hearing aids analyze the sound environment at any given moment, amplifying appropriately to the needs of the listener.

Useful features of modern hearing aids that people might want to discuss with a hearing care professional include:

Feedback cancellation technologies, which help to eliminate any squealing or whistling.
Noise-reduction technologies, which can help the wearer better discern what they need to hear by filtering out background noise. Some scan the listening environment and adapt to it automatically. Others “geo-tag” favorite locations, storing the sound information of that locale; so when the user is at a favorite coffee shop, for example, the hearing aids adjust themselves accordingly.
Directional microphones, which help the wearer better focus in on the person they want to hear. Also, advanced directional microphone technologies are designed to enable the listener to hear from all directions—side and back included—when the situation warrants.
Wireless technologies (e.g., Bluetooth), which allow for streaming to smartphones, laptops, conference-room speakerphones, TVs, home entertainment systems, and other devices. Some hearing aids with such connectivity let the user control the volume and other sound settings with a smartphone app.
Automatic sound control, which analyzes the sound and automatically adjusts the volume when streaming.
Sound therapy, which can be useful to people troubled by tinnitus.
Telecoils, which work with hearing loops at public venues so the sound source—at a play or church, for instance—streams directly into the listener’s hearing aid. They also work with telecoil-compatible telephones. This technology helps filter out background noise.
Wind noise reduction, which helps on breezy days.
Remote controls, which let wearers adjust hearing aid features without the need to touch the hearing aid.
Rechargeable batteries, which can make maintenance easier.
Waterproof hearing aids, which swimmers and people who want to shower in them find convenient.
Reminders, which is a lifestyle convenience that some hearing aids come with that can be used for appointments and to prompt people to take their medications on time.
Complementary devices—such as wireless mini-microphones clipped to the speaker’s lapel, worn around their neck, or placed on a conference room table—can work in conjunction with hearing aids to provide an additional sound boost for given situations.

People with hearing loss also can choose style options—that is, how they want to wear their hearing aids. There are several choices, which range from the traditional behind-the-ear (BTE) hearing aid (although many new BTE designs are sleeker and barely visible), to hearing aids that fit partly in the ear canal, to hearing aids that are molded to sit completely in the ear canal. How visible each of these styles are depends on the person’s physical features.

Licensed hearing care professionals can advise people of the full range of styles and what is most appropriate for their hearing and lifestyle needs.

Maximizing benefit through education and aural rehabilitation

Purchasing a hearing aid from a hearing care professional frequently includes post-fitting orientation and counseling. These services help ensure that the individual’s hearing aid is programmed and adjusted appropriately so it works optimally for their needs. But taking a comprehensive approach to addressing hearing loss through aural rehabilitation helps to even further maximize the benefits that hearing aids can offer.

Usually, it takes people time to adjust to processing sounds they haven’t heard for a long time—often it’s been years. Essentially, the brain is relearning to hear these sounds. While the hearing care provider can work with the individual through this progression by adjusting the hearing aids as needed, aural rehabilitation goes even further and includes additional approaches to easing the transition. Aspects of aural rehabilitation can include working on listening skills; learning to use visual cues to enhance understanding of spoken conversation; strategies for navigating certain listening environments, such as where to position oneself at restaurants, parties, and places of worship; tips for communicating in noisy environments; and more. Sometimes hearing care providers will offer group hearing aid orientation, which provides the added benefit of peer support.

Including family in the rehabilitation process tends to bring better outcomes, as well. When loved ones learn to use clear speech by talking at appropriate speeds and volumes, it helps people tremendously as they adjust to hearing aids and the new world of sound.

For more information on aural rehabilitation, visit the Hearing Loss Association of America (HLAA).

Return to top

Cochlear implants

A cochlear implant is a sophisticated electronic medical device that can help people with severe-to-profound sensorineural hearing loss or those who are profoundly deaf to understand speech. Cochlear implants do not restore normal hearing. And they’re not hearing aids. In fact, they work in an entirely different way.

Hearing aids amplify sound for people with damaged hearing. Cochlear implants do not. Instead, they bypass the damaged cochlea—essentially doing the work for it—and stimulate the auditory nerve directly through the application of electrical current. The brain then receives the signals and interprets them as sound.

Cochlear implants have several components. The implant itself is internal and placed in the inner ear, also called the cochlea. The external part is hooked over and worn behind the ear, although some of its parts can be worn in a pocket or carrying garment, such as a belt pouch. The internal portion contains a magnet to keep the external portion properly aligned.

The external portion of a cochlear implant includes a microphone(s), a sound or speech processor, and a transmitter that together work to capture sound and convert it into digital code that is then transmitted through the skin to the internal implant. The implanted portion includes a receiver that picks up the code and changes it to electrical impulses. These impulses stimulate the auditory nerve, which, in turn, delivers them to the brain, where they’re interpreted and actual hearing occurs.

Because cochlear implants are not a one-for-one replacement for normal hearing, it takes time to adjust to them and learn, or relearn, how to process sound. Auditory rehabilitation helps people with cochlear implants relearn and better develop listening and language skills. This typically involves speech-language pathologists and audiologists.

As with hearing aids, many people with cochlear implants have them in both ears (bilateral), which many experts say provides greater benefit in distinguishing speech in noise and the direction of sound. Individuals who have more residual hearing in one ear than another may use a hearing aid in one ear and a cochlear implant in the other.

Candidacy for a cochlear implant and follow-up

According to the NIDCD, roughly 58,000 adults and 38,000 children in the United States have received cochlear implants as of December 2012.

The criteria for candidacy for a cochlear implant has broadened over the years, in part due to ongoing research. When the U.S. Food and Drug Administration (FDA) approves new devices, it sets general candidacy requirements, including age. But the evaluation and decision making processes involve a team of medical specialists, including a surgeon with expertise in cochlear implantation.

In the past, candidates for cochlear implants included both children and adults who were either deaf or had severe-to-profound hearing loss and didn’t get adequate benefit from hearing aids.

According to the American Cochlear Implant (ACI) Alliance:

In general, if someone wearing appropriately fit hearing aids cannot understand speech without seeing the speaker’s face, they should be evaluated for a cochlear implant.
Cochlear implant candidacy guidelines have changed to include children and adults with more residual hearing as well as other anatomic, health, and learning issues that would have been considered “absolute” or “relative” contraindications in the past.
An assessment of any child with a severe-to-profound hearing loss should be made as early as possible, as outcomes with a cochlear implant are significantly better in children who receive an implant at the earliest possible age.

Anyone who wishes to determine if they’re a candidate needs to arrange for an evaluation at a center specializing in cochlear implants. The ACI Alliance provides useful information on where to go for an evaluation and on the cochlear implant process. An ENT or an audiologist also can provide a referral to a cochlear implant center for an evaluation.

The evaluation for a cochlear implant typically includes a medical exam, imaging studies, audiological testing, and psychological testing, along with counseling so there is a clear understanding of the follow-up commitment involved. Counseling also helps ensure realistic expectations regarding the performance of the cochlear implant. It’s important to note that functional benefit to hearing ability from a cochlear implant varies from person to person. Because cochlear implants can help people with a range of hearing loss, the individual’s experience depends on the degree of hearing loss, how long the person has been without their hearing, speaking ability, and rehabilitation training.

People who receive cochlear implants are not fitted with the external component until about four to six weeks after the surgery, when the audiologist activates the implant and begins programming it to the individual’s specific hearing needs. There are subsequent appointments over several months for adjustments and fine-tuning, as well as for rehabilitation therapy and training.

AHRF has long supported research aimed at enhancing the benefits of cochlear implants. The Foundation has funded more than a dozen studies on different aspects of cochlear implantation, investing over $300,000 in seed grants.

While cochlear implants can help people with certain degrees of sensorineural hearing loss, there are other implantable devices to address conductive hearing loss, when there are mechanical issues with the ear. HLAA provides a brief overview of these devices.

Return to top

Other assistive listening devices

Oftentimes, people with hearing loss find that other assistive listening devices can be helpful. These include amplifiers for the telephone, devices that flash lights when the telephone rings, devices that vibrate when the doorbell sounds, flashing smoke alarms, television amplifiers, and more. HLAA provides useful information on these types of devices.

PSAPs—personal sound amplifiers are another product sold directly to consumers that people sometimes mistake for hearing aids. PSAPs, however, are not hearing aids and are not designed to treat hearing loss. Hearing aids are medical devices, regulated by the FDA; they are programmed by a hearing care professional to address the specific hearing needs of the individual and zero in on specific frequencies. The actual sound processing in a PSAP may vary from a general increase in volume to more sophisticated processing. Experts recommend that consumers who choose to use PSAPs watch the decibel levels on these devices to ensure that they are not over-amplifying to dangerously loud levels.

It’s important for people with hearing loss to understand that actual hearing aids are medical devices specifically designed to address hearing loss and are cleared by the FDA. Currently, they’re only sold by hearing care professionals and are custom-fitted and programmed to address the specific needs of the individual. Oftentimes, aural rehabilitation training is involved to help the person adjust to the hearing aids and more easily transition back to hearing and processing sounds they may not have been able to hear for many years.

In the next few years, over-the-counter (OTC) hearing aids will become available as a result of the Over-the-Counter Hearing Aid Act of 2017, which was signed into law in August 2017. This law requires the FDA to create and regulate a new category of OTC hearing aids for consumers with perceived mild-to-moderate hearing loss. The FDA was given three years to do this.

Return to top

Protect your hearing

We live in modern societies and, by and large, noise is all around us. Whether we work in large cities and are constantly exposed to the din of traffic, operate loud machinery on rural farms, or visit suburban coffee shops filled with the whir of blenders competing with the backdrop of music, sound envelopes us.

Quite simply, the greatest threat to most people’s hearing is noise. Yet, while noise-induced hearing loss is the most common type of hearing loss, it’s also the most preventable. And there are simple, everyday practices that people can follow to protect their hearing.

First and foremost, people can limit their time in noisy environments.
When noisy environments cannot be avoided, it’s important to use appropriate hearing protection.
Alternating time in the noisy setting with periods away from it, in quiet, also can help give the ears a rest.
Many people find that carrying earplugs with them helps for unanticipated situations.
Custom ear protection, purchased from a hearing care professional, is a good way to ensure a snug fit for enhanced hearing protection.
Another strategy, for when a loud noise comes as a surprise, is for people to plug their ears with their fingers and quickly move away from the source of noise.
It’s also important to keep the volume down when using headphones, ear buds, or using a cell phone.

Both volume and duration of exposure impact the degree of damage that noise can have on hearing—so keeping both to a minimum is important for protecting one’s ears.

It’s a Noisy Planet provides useful information and tools for educating children about the importance of protecting their hearing.

Return to top