Why can't I hear?

Early signs of hearing loss can be subtle. Can you hear people but not always understand what they are saying? This is a common symptom of hearing loss. Why? In 90% of all cases, hearing loss occurs when the delicate hair cells in the inner ear are damaged or not functioning properly. This means the brain does not receive all the sounds and frequencies it needs to understand speech. 

Usually this affects the high frequency sounds. The consonant sounds like F, S, and TH become difficult to hear and women’s and children’s voices sound softer and garbled. Imagine removing all the high keys on a piano and asking someone to play a well-known melody. Even with only six or seven keys missing, the melody might be difficult to recognize. People with hearing loss experience a similar variation of the soundtrack of their lives every day. 

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Recognizing the need for a hearing aid can be tricky

Because most hearing losses develop gradually, it is common not to recognize it. Gradually the sound of chirping birds or rustling leaves disappear without even noticing it. Many people do not become aware of the problem until it starts to affect speech recognition and communication. 

Hearing loss is not uncommon

More than 500 million people worldwide experience some degree of hearing loss. You might be one of them. If you are, a hearing aid may help you regain your hearing so you can live the life you are used to. 

Types of hearing loss

Hearing loss can be caused by many different circumstances and can occur at any age. There are three basic types of hearing loss:

Conductive hearing loss
Conductive hearing loss is a decrease in sound due to problems located in either the middle ear or the outer ear. This type of hearing loss is often treatable with the right type of intervention such as medicine or surgery. The conductive hearing loss can have several causes. Among them are ear infections which tend to cause fluid in the middle ear, wax in the ear canal or a perforation of the eardrum. 

Sensorineural hearing loss
Sensorineural hearing loss is a problem related to the inner ear and/or the nerve pathways between the inner ear and the brain. Along the most common causes of sensorineural hearing loss are:

1. Aging
2. Infection
3. Excessive exposure to noise
4. Meningitis
5. Certain genetic disorders
6. Meniere’s disease
7. Viruses

The sensorineural hearing loss is not correctable and is treated with hearing aids.

Mixed hearing loss
The mixed hearing loss is the occurrence of both a conductive hearing loss and a sensorineural hearing loss at the same time. Thus, the inner ear and nerve paths are damaged as well as a blockage in either the middle ear or the outer ear. While the conductive hearing loss can usually be corrected, the sensorineural problem is permanent and hearing aids are usually prescribed. 

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Sooner is better

The sooner you take steps to manage your hearing loss, the easier your process will be. The ability to hear resides in our brain; the longer it is deprived of sounds, the harder it is to teach it to hear those sounds again. Wearing hearing aids can prevent or reduce this negative impact.

Getting treatment can improve your quality of life dramatically:

  • Greater self-confidence
  • Closer relationships with loved ones
  • Improved outlook on life

Modern hearing aids are almost invisible

Today’s hearing aids are as small, comfortable and attractive as they are powerful and they have limited impact on your appearance. In fact, most people will not even notice you are wearing one. Not being able to hear is actually more visible than wearing a hearing aid.

Treating hearing loss with a hearing aid

A hearing care specialist can identify the type of hearing loss you or your loved one has.  They will also measure the degree of your hearing loss and discuss treatment options. And if hearing aids are part of that treatment, they will introduce you to the styles and technologies that best fit your unique situation.  

Wearing a hearing aid means rediscovering the pleasure of gathering with friends and family, feeling more confident at work, and enjoying movies, music and TV programs. A hearing aid means living with all of your five senses again.

Choosing a professional

Finding a good hearing healthcare professional is an important first step in managing hearing loss. He/she will help you find the right hearing aid for you, make sure it is programmed properly and help you adjust to your new hearing aids.

Tinnitus – symptoms and causes

Typically, tinnitus is a buzzing or ringing in the ears, but it is as individual as you are. Tinnitus can occur with or without a hearing loss.  Even without a hearing loss, the technologies found in today’s hearing aids and hearing aid apps can be very helpful in treating tinnitus.

They don't have to miss out on a thing

Most children with hearing loss benefit from amplification

Friends and Family

Do you have a loved one with hearing loss? Learn how you can support them in their hearing loss journey.

Selecting a Hearing aid

Wondering which hearing aid is right for you? We explain the different styles, features and what to consider when choosing a hearing aid.

Prior to starting your exam, your hearing healthcare professional will ask you questions about your general health, lifestyle, and the reasons why you are seeking an evaluation.  
These might include:

  •   Are you still working?
  •   What activities do you like to do?
  •   Do you often go to noisy places such as restaurants?
  •   Do you regularly use a cell phone?
  •   Is there anything you cannot do because of suspected hearing loss?

Next, he or she will examine your ear canal using an otoscope to look for physical clues about your hearing health.   
Then you will be asked to listen to a series of tones while wearing earphones to evaluate your hearing at different frequency and volume levels. This hearing test determines the softest level at which you can hear different frequencies.

Step by step:

  1. You will be placed in a sound-treated room with a set of headphones placed over your ears
  2. Those headphones are connected to an audiometer, which is calibrated to measure your hearing with precision.
  3. The audiometer sends tones at various frequencies to one ear at a time.
  4. As the sounds are being played, you will signal by raising your hand or by pressing a button when you hear the tone. You might hear the same tone more than once, but do not worry, that is part of the test and helps ensure accurate results.
  5. During the test, the hearing healthcare professional will plot points on a graph, called an audiogram, and later use that to explain your hearing.
  6. Your evaluation may include other subtests such as speed audiometry. In that test, your hearing healthcare professional will read lists of words to you through the headphones and you will be asked to repeat what you hear. Do not worry if you miss any of the words. Just do the best you can. A bone conduction test may also be performed using vibrating tuning forks placed in contact with the head. By bypassing the external and middle ear, bone conduction tests can help distinguish problems in the inner ear.
  7.  After the hearing test, your hearing healthcare professional will share your audiogram with you and discuss their findings.
Should you need a hearing aid, your hearing healthcare professional will work with you to determine the model that best suits your lifestyle.

If you suspect you have hearing loss, it is a great idea to have a hearing exam. Audiologists, ENTs and hearing aid specialists can all provide audiometric evaluations and fit you with the proper aid.

  • An audiologist is a person with a college degree in audiology, either a Masters degree or a doctorate. In addition to treating hearing loss,  they are trained to treat disorders like tinnitus and balance issues.

  • A hearing aid specialist is an individual who is licensed by the state to test for hearing loss and fit hearing aids.

  • An ENT, also called an Otolaryngologist, is a medical doctor that specializes in diseases of the ear, nose and throat. 

To determine the type of hearing loss you have, what might be causing it, and the best way to treat it, your hearing healthcare professional will likely give you a full hearing test and evaluation, including a visual representation of your hearing, called an audiogram. This audiogram demonstrates which sound frequencies you can hear and at what volume. 

The audiogram reads in frequency, sometimes called “pitch”, across the horizontal axis, and in decibels, or loudness, down the vertical axis. The frequencies are low on the left side and then gradually climb to higher pitches on the right side.  The decibel scale goes from very soft at the top to very loud at the bottom. 0 db does not mean there is no sound, it simply represents the softest sound a person with normal hearing would be able to detect at least 50% of the time. 

The softest sounds you hear at each pitch make up your hearing threshold and those thresholds are marked on your audiogram. Typically, the parts of the test given to you through headphones are called "air" thresholds because the sound must travel through the air of the ear canal to be heard. An O is used for the right ear and an X is used for the left ear to represent your air thresholds.

A bone-conduction vibrator is usually used to test for thresholds as well. A < symbol is used for the right ear and a > symbol is used for the left ear. A bone-conduction vibrator is a device that gently rests on the bone behind the ear and is held in place by a small metal band stretching over the top of the head. This device transmits sound vibrations through the bones and tissues and fluids within the skull directly to the cochlea (the hearing organ of the inner ear). This process allows the examiner to bypass your outside and middle ear areas and test the sensitivity of your inner ear directly.

By combining the results of these two tests, your hearing healthcare professional can determine the type of hearing loss, how well you hear low, medium and high pitches, and which part of the ear is causing the loss.

Hearing aids generally range in price from several hundred to several thousand dollars depending on their type, style and features. While price should not be the primary deciding factor in selecting a hearing aid, it will understandably come into play. There are a number of things to consider when determining the cost of your hearing instruments.  

At this time Medicare does not cover the cost of a hearing aid. However, because Medicare laws are continually changing, it is always a good idea to double check coverage details before making any medically-related decisions. Do not forget to check with your insurance provider too. They may cover part of the cost depending on the terms of your policy.

Some nonprofit organizations provide financial assistance for hearing aids. Contact the National Institute on Deafness and Other Communication Disorders (NIDCD) Information Clearinghouse with questions about organizations that offer financial assistance for hearing aids.

A warranty usually covers loss or damage of your hearing aids as well as repairs for a specific period of time. Ask your hearing healthcare professional for full warranty details before you make a purchase.

Modern hearing aids typically last 3-6 years but in some cases can last longer with proper care and maintenance.  

Our ears are naturally designed to work together to perceive sound. This binaural hearing helps us understand speech more clearly, locate sounds and hear better in noisy environments. Consequently, when patients have hearing loss in both ears, two hearing aids are recommended.   

Your decision on the style of hearing aid and the features built into it often comes down to the lifestyle you live and the environments you are in most often.  Someone who lives a quieter lifestyle and mainly deals with one-on-one conversations will not need as many features as someone who finds themselves frequently in busy restaurants or sporting events. 

Determining your lifestyle
The chart below shows different lifestyle scenarios. Which of these situations do you fall into? Do you find yourself in Quiet, Moderate or Challenging environments most often? How important are each of these activities to your greater well-being? If you fall into the Moderate category most often but do go to Concerts/Sporting Events, how often do you find yourself at those and how important are they? If you have season tickets to the baseball game, finding a device suitable for the Challenging environment is probably important to you.

Making your selection

Sharing this lifestyle information with your hearing healthcare professional will help them recommend the technology features especially suitable for the listening environment you find yourself in the most.

The time it takes to adjust to your hearing aids generally depends on the severity of your hearing loss and the length of time your brain has been deprived of sound. Some people adjust quickly. Others may need time for their brains get used to sounds and stimuli they have not receive in a while. This can be overwhelming at first, but do not worry ― it is normal. With practice and patience you will soon be comfortable hearing the world around you again.

Speeding up your adjustment period
Here are some suggestions to help you through the adjustment period as quickly and easily as possible: 

  • Talk with someone whose voice you know well. This will help you understand certain words and phrases faster. Remember that communicating is a combination of listening and visual clues. Pay attention to facial expressions and gestures as well as the words.
  • As you gain confidence, begin wearing your hearing aid in a wider variety of environments like work or at social occasions. Practice selecting specific sounds and voices; focus your attention on them.
  • In public places, sit as close to the speaker as possible. In cafes or restaurants, try to sit with your back to the main source of noise. Also avoid sitting near an open window or on a sidewalk if possible.
  • With your new hearing aid on, sit between 6 and 12 feet away from the TV and set the volume to what others consider to be a normal level. Then adjust your distance to the TV so that you can hear comfortably. Follow this same process when listening to a radio or other device.

Be patient
It is not unusual for the adjustment process to take several weeks as your brain learns to balance and reprioritize sounds. And while hearing aids should never hurt, they can be slightly tender as they adjust to the device sitting on or in the ear. If you have any concerns about what you are feeling or the length of time it is taking to adjust, contact your hearing healthcare professional for a follow up visit.

Proper care and cleaning of your hearing aid will keep it in tiptop shape and prevent the need for many common repairs. Your new devices likely came with care instructions. Always follow those since each hearing aid has slightly different requirements. 

In general there are three places that need to be cleaned on any hearing instrument:

With the exception of a dead battery, wax building up in the receiver is the most common cause of hearing aid failure. Gentle cleaning with the brush that came with your hearing aid should be done daily to help prevent build up. This area of your hearing instrument is very delicate so be sure to talk to your hearing healthcare professional with specific directions.

The surface of the hearing aid is called the shell. Buildup can cause the hearing aid to not fit properly, be uncomfortable or even stop working. To clean the shell, use a dry tissue or soft cloth to gently wipe the surface clean. If there is a particularly stubborn area, slightly dampening the cloth can help.

The microphone is another delicate area of your hearing aid. Use the brush provided with your hearing aid to gently sweep away any debris. Make sure you point the microphone port towards the floor when cleaning so no loose debris falls into it.

In addition to proper maintenance, it is important to keep your hearing instruments in a safe, dry place when not in use. Keep them in their case is the best option and will protect them from dirt and damage. It is also important to leave repairs to an expert. The technology inside your hearing aid is very sensitive and could be ruined with improper handling.

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Here are some additional recommendations to keep your hearing aids in excellent shape:

  • Keep hearing aids away from heat and moisture. For example, leaving them in sun or in the car, placing them in or near a microwave or conventional oven, or using a hair dryer on them could cause damage
  • Clean hearing aids as instructed daily
  • Avoid using hairspray or other hair care products while wearing hearing aids
  • Turn off hearing aids when they are not in use
  • Replace dead batteries immediately
  • Keep aids and replacement batteries away from children and pets
  Visit your hearing healthcare professional on a regular basis to have your hearing aids inspected and adjusted.