“I hear just fine!”

“I hear just fine!”  That is what a lot of times we hear from patients who were politely asked (i.e. forced) by family members to come and get their hearing checked.  Most of us might not necessarily be aware of decreased hearing acuity ourselves, but our loved ones can often point out difficulties in communication as they need to talk louder or repeat themselves frequently.

A slow and gradual decline in our hearing acuity is part of life.  As we all grow through the aging process, some of the receptor cells within our ears that pick up sounds deteriorate.  This usually happens in the higher frequencies first, and it slowly progresses to involve the lower frequencies as well.  This process is called presbycusis.  For most patients, they cannot discern high-pitch voices and sounds first.  Therefore, they might experience problem with deciphering spoken words, which happen to be at the higher frequency, versus background noise, which happens to be at the lower frequency that is still maintained intact.  A hearing test is the only way to properly detect presbycusis.

If presbycusis is in fact detected, there is not a good amount of medical therapy that could be offered to relieve the situation.  At the moment, we do not have any medical therapy to reverse the process, nor is there any surgery to overcome it.  The best way that we can remedy the situation is to get hearing aids.

Many patients are otherwise averse to the idea of getting a hearing aid.  I would tend to agree with most that a hearing aid is not ideal.  However, this is the only treatment that we can offer, and without it, the condition can actually worsen.  Most recent medical science points that in patients who have lost some degree of hearing due to deterioration of the hearing cells within our ears, the lack of signal going to the brain can lead to secondary loss and shrinkage of the size of the brain.  Therefore, the loss is not only in the ear, but also results in loss of brains function and more early-onset dementia symptoms.

There are a few candid points that I usually review with patients considering getting a hearing aid.

  1. A hearing aid is, by definition, a mechanical sound.  Our original hearing is biologic, and has a much more organic sound.  However, trying to synthesize voices or noises into machinery, we can never match the quality of our own hearing.  Some patients complain of a brassy quality to the sounds of the hearing aid.  It is important to invest in a better quality hearing aid, and also to make sure that the fitting of the hearing aid is perfect to reduce echo and other such acoustic issues
  2. A hearing aid sits in or around ear and gives us the sounds that we are missing.  Therefore, some patients complain of local irritation where the hearing aid is sitting.  A perfect fit is very important for avoiding these friction issues.  Patients also need to be more cognizant that having a hearing aid within the ear on a regular basis might further build up earwax issues.  Therefore, I recommend for patients who wear hearing aids to be seen every six months for preventive cleaning of earwax.
  3. Some patients also complain that the hearing aid is way too loud and the whole thing is just not right.  I usually use the following example to explain to them why actually the hearing aid is not loud at all.  Have you ever gone to see a movie during a matinee show?  Before you walk into the movie theatre, the sun is out, and everything is bright.  Once you come out of the movie theatre after having been there for two hours, all of a sudden the sun is way too bright and almost blinding.  People usually have a reaction when they transition from extreme darkness to the light.  Although this is the same exact sunlight that was there before you went into the movies, coming out of that relative darkness is very uncomfortable.  The same thing goes for our hearing.  As we slowly lose our hearing acuity, most patients live in a relative silence not hearing every single sound that is going on around us.  Sometimes, the silence is rather comforting and soothing.  Once we are fitted with a hearing aid, all those sounds that for the past few years we have not noticed, are reintroduced back into our system.  This is not a distortion of the sounds, but rather a restoration of whatever sounds we actually did use to hear before we lost our hearing to begin with.  This relative coming out of the silence zone could be uncomfortable for some patients at times.  However, once you learn to adjust the volume of the hearing aid and also learn to live again with all the sounds that are around us just a way you did when you are much younger, nature can actually be quite enjoyable in its full perception.
  4. Of course, there is also the issue of cost.  Most commercial insurances do not pay for hearing aids at all, and a small amount may partially cover the cost of a most basic hearing aid.  The hearing aids come in various different configuration shapes, size, and costs.  Many patients have questions about the differences between the different models.  Once again, I use an example to clarify my point.  Buying a hearing aid is rather similar to buying a car.  If you are in the market for new car, you can get a basic Chevrolet or you can get a nice Cadillac, or you can really splurge for a Lamborghini.  Those are all cars and they will easily take you from your home to your work and to the supermarket and back home.  However, based on your finances and the level of investment that you would like to make, you get what you pay for.  I recommend for patients to fully review with their audiologist all the different models available, and to consider their price range accordingly.

If you or your family members are having problem with hearing, it is best to start with a visit to the doctor’s office to check for wax or other issues.  Once that is done, a hearing test could be done to assess for the degree of loss.


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Posted in: Ears

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