Hearing Loss: Causes and Use of Hearing Aids
Guest: Dr. Ted Meyer – Otolaryngology/Head & Neck Surgery, MUSC
Host: Dr. Linda Austin – Psychiatrist, MUSC
Dr. Linda Austin: I’m Dr. Linda Austin. I’m interviewing, today, Dr. Ted Meyer, who is Assistant Professor of Otolaryngology, which is Ear, Nose, and Throat, here at MUSC. Dr. Meyer, surely one of the most common health problems in the world is deafness. How common is that in the United States?
Dr. Ted Meyer: Hearing loss in and of itself affects at least 50 million people, if not more. It ranges from a mild hearing loss to a severe to profound hearing loss. Typically, people with severe to profound hearing loss have what’s termed deafness.
Dr. Linda Austin: Most people understand, I think, somewhat, that there are different kinds of deafness. What are some of the more common causes of deafness as people age?
Dr. Ted Meyer: Hearing loss can be broken down into a conductive hearing loss, which is a difficulty of transmission of sound through the system, and a sensory neural hearing loss; damage to the inner ear, or damage to the auditory pathway. Both are actually quite common. As we age, sensory neural hearing loss is extremely common. It is caused by the aging process itself, metabolic disorders, toxins, medications, high blood pressure; these sorts of things. Conductive hearing loss can be caused from things as common as a cerumen impaction, or wax in the ear, to a hole in the eardrum, to fluid in the ear, to ear infections, to cholestiatoma.
Dr. Linda Austin: And cholestiatoma is?
Dr. Ted Meyer: Cholestiatoma is result of eustachian tube disease, where the eardrum, instead of being held out in its normal position, gets pulled back into the middle ear. And, when the skin of the eardrum is pulled back into the middle ear, or even to the mastoid, it doesn’t migrate out properly. Patients are then prone to infections. The skin collects there. The skin, then, degrades the ossicles, or the bones of the middle ear; the hammer, the anvil, and the stirrup. Cholestiatoma, in very bad cases, can erode into the brain. It can erode into the inner ear. It can cause a facial paralysis.
Dr. Linda Austin: Hmm, a lot of bad stuff. Let’s walk through the process of the typical American, let’s say, who has hearing loss. What should that person do to get that evaluated?
Dr. Ted Meyer: A person with hearing loss can see an audiologist, which is a professional trained to test patients with hearing loss. They are normally referred by a physician to an audiologist. As an otolaryngologist, we see a lot of patients with hearing loss referred by their primary care provider. And then we have audiologists available on our staff to test hearing for us.
Dr. Linda Austin: And then, can the audiologist determine something about whether it is the sensory neural, or nerve, loss, versus a conduction difficulty?
Dr. Ted Meyer: Yes. Through a battery of hearing tests, you can tell whether it’s a conductive or a sensory neural hearing loss quite accurately.
Dr. Linda Austin: So, what’s step two, then, of the evaluation?
Dr. Ted Meyer: When a person comes in for a hearing test, they normally start with a pure tone audiogram, or a pure tone hearing test; raise your hand when you hear the beep. We all remember doing that when we were in grade school, usually in the school library. That gives us an audiogram, or how much hearing loss you have at various frequencies; low tones versus high tones. Then the audiologist will perform speech testing on the patient to see how well they do with common words. And different types of audiograms can be obtained to differentiate between conductive and sensory neural hearing loss.
Dr. Linda Austin: Then, what happens?
Dr. Ted Meyer: I take this information and help the patient to determine how much hearing loss they have; hopefully determine what the cause of the hearing loss is, and then discuss potential treatment options. Potential treatment options may be doing nothing at all, to surgery for various forms of hearing loss, to wearing hearing aids. Hearing aids are beneficial for patients with conductive loss, and sensory neural hearing loss. Even patients with minimal hearing can gain great benefit from hearing aids. But sometimes patients have too much hearing loss for hearing aids to be of much help.
One other thing that’s important is that if there are differences between the two ears, those differences need to be worked up. Sometimes this means further hearing tests; or sometimes this means a CAT scan, or an MRI scan to search for a cause of hearing loss.
Dr. Linda Austin: Because it may not be quite so simple as just the aging process?
Dr. Ted Meyer: Right. It may be that a tumor is causing hearing loss. It may that a patient has Meniere’s disease, or otosclerosis, or something else causing their hearing loss.
Dr. Linda Austin: So, for this podcast, let’s talk about the simplest case scenario. Let’s imagine that a patient is a candidate for a hearing aid. Why is that people complain about their hearing aids so often?
Dr. Ted Meyer: It’s a good question. If a patient is reluctant to have a hearing aid, it can be for many reasons, including what seems to be the most common, for me: hearing aids make you look old. Or at least that’s the perception. Every week, I will have several patients who are 80 years old, or older, who’ve worn glasses for 50 or 60 years, and don’t want a hearing aid, even though they’re having a great deal of difficulty with communication, because they’re concerned that the hearing aid will make them look old.
In jest, I will often take their glasses away and say, what if I had you go through life without your glasses? And then they inevitably say, well, then I can’t see; I need my glasses. And, every once in awhile you’re able to convince somebody that they’re having just as much trouble hearing as they are seeing, and that they should consider hearing aids. But there are a lot of reasons why people don’t like hearing aids.
Hearing aids do amplify everything. They can’t, specifically, just amplify speech and get rid of background noise, no matter what the commercials on television would have us believe. But technology has improved greatly with hearing aids. Some hearing aids are digital. You can filter the signals appropriately to increase the clarity. And, actually, most patients do gain a lot of benefit from the hearing aids, if they give them a chance.
Dr. Linda Austin: If a person wants to get good information about what is good value in a hearing aid; I know they can be very expensive, and I’m sure there are plenty of people who might feel that it’s okay for them to be expensive, but want to get their money’s worth, and don’t know how to evaluate that, what would you suggest?
Dr. Ted Meyer: Hearing aids can range in price from around $500, up to $5,000, for a single hearing aid. So, a pair of hearing aids can get to be quite expensive. There’s a lot of technology that goes into the hearing aids, so there’s a good reason why they cost what they do. The benefit is subjective, but we can measure objectively how patients will do with a hearing aid. We can have them trial a pair of hearing aids in the clinic and measure their benefit with a hearing aid, compared to without, in various speech tests. And the patients can actually see what sort of benefit they can obtain.
Dr. Linda Austin: So, they should talk with their doctors about that?
Dr. Ted Meyer: Yes. They should talk with their doctors, and see an audiologist.
Dr. Linda Austin: Well, in another podcast, I want to go into some of the subtypes a little bit more, and also talk about cochlear implants, which, I understand, you’re an expert in. But let’s pause again.
Dr. Ted Meyer: Thank you.
Dr. Linda Austin: Thanks.
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