The first step in treating hearing loss is an accurate diagnosis - finding out exactly what's causing the hearing loss. When a specific cause is found, treatment options can include:
- Treating the underlying disease, such as hypothyroidism, if a disease is found.
- A hearing aid to provide amplification of sound (for most people with sensorineural hearing loss, amplification is the best or only option)
- Surgery for mechanical causes such as chronic ear infections
Hearing aids are never as good as perfect hearing. However, there have been dramatic improvements in technology. In general, it is possible to find a very satisfactory, appropriate hearing aid as long as there is some residual hearing (not total deafness).
Reputable hearing aid dealers, audiologists, speech and hearing centers, and some ear doctor offices dispense hearing aids. Any reputable hearing aid dispenser offers a 30-day return period, during which the hearing aid can be brought back for refund if the user finds it unsatisfactory.
Need To Know:
Selecting a proper hearing aid requires skilled evaluation and testing with numerous devices and electronic adjustments. Door-to-door salespeople do not ordinarily have the capabilities to perform such testing and should generally be avoided.
Hearing aids vary greatly in style and cost. Some fit almost entirely within the ear and are nearly invisible. A larger hearing aid that fits behind the ear may be necessary. Occasionally, for extremely severe hearing losses, traditional "body aids" with a wire are still used, but these are required for only a very small number of people.
Selecting a hearing aid is a very personal process, and it is essential that any potential hearing aid user have the opportunity to listen to a variety of instruments adjusted expertly before making a selection. Expensive, fancy digital hearing aids are now available. For many people, they really do offer substantially improved sound quality, and digital programming options that make it easier to hear with noise.
Hearing aids can be worn on one or both ears depending upon the hearing loss. There are even CROS (contralateral routing of signals) aids for total deafness in one ear, in which a microphone is placed on the deaf side and transmits sounds by radio signals to the good side. This is a great convenience for many people who have to function in meeting rooms. It is also extremely helpful when driving. For example, a person driving with a deaf right ear has trouble hearing a passenger, especially if the driver's window is open.
A cochlear implant is a device that restores hearing to people with very severe or profound deafness. Cochlear implants have been used since the late 1960s.
A cochlear implant is a safe electronic device that is implanted beneath the skin and into the inner ear (in rare cases, the device can actually be implanted directly into the brain). Once the outer skin has healed, an external device is placed on the skin over the implanted device and turned on.
Cochlear implants allow totally deaf people to hear common sounds such has a telephone, doorbell, car horn, and spoken voice.
- In almost all people, understanding of speech is possible and lip reading is improved dramatically by the ability to hear the rhythms and the stops in normal speech.
- Most people are able to talk on the telephone with modern cochlear implants.
Until very recently, cochlear implants were approved for use only in people with profound (total or near-total) deafness. However, in 1995, the FDA approved expanded indications to include people with severe hearing loss as well. This change came about after an eight-year study that showed people with cochlear implant get better hearing than with traditional hearing aids.
Ear surgery is extremely common, and it is generally safe and effective when performed by an expert surgeon. Certain operations are particularly common:
Myringotomyand tube placement involves making a small incision in the eardrum, suctioning fluid out of the middle ear, and placing a ventilating tube within the eardrum. In children, the procedure requires general anesthesia. In adults, it can be done as an office procedure and ordinarily takes only a few minutes. After tubes have been placed, they generally fall out by themselves in 3 to 12 months. Most physicians agree that is important to keep the ears dry (avoid water) while the tubes are in.
- Stapes surgery is performed under local anesthesia. Like all ear surgery, it requires the use of an operating microscope. The eardrum is moved aside, and the immobile stapes bone (the stirrup) is either mobilized or replaced with an artificial bone (usually made out of Teflon and stainless steel). As with all ear surgery, there are potential risks including worse hearing loss,
tinnitus, dizziness, facial paralysis (extremely rare), bleeding, infection, and others. However, the overall success rate of stapes surgery is in the range of 97% or 98%, and many people prefer surgical restoration of hearing to wearing hearing aids.
- Tympanoplasty and Mastoid surgery usually involves general anesthesia (although it can be performed under local anesthesia when necessary). An incision is usually made behind the ear. The mastoid bone (a bone in the skull, behind the ear) is removed using high-speed drills, and any disease is eliminated from the mastoid. In traditional mastoid surgery, the ear canal is removed and a cavity created. Cavities often necessitate cleaning (one to four times per year by a physician), and many people with mastoid cavities cannot get water in them without causing infection. It is possible to do mastoid surgery leaving the ear canal intact. The ear drum is reconstructed and following such procedures, hearing can often be restored to normal, and people can shower, swim, and perform other activities without restriction.
- Translabyrinthine surgery (surgery through the inner ear) is performed to remove acoustic neuromas. This approach involves removal of the mastoid bone in order to enter the brain cavity. However, it always results in total loss of hearing. In most cases, the tumor has caused a significant hearing loss, and the roots of the tumor are embedded in the hearing nerve. This approach has many advantages, including minimizing trauma to the brain and preservation of the facial nerve, which lies near these tumors and is subject to swelling and temporary weakness. Occasionally some permanent weakness results.
- Middle Fossa and Retrosigmoid surgery removes smaller tumors and in some cases hearing may be preserved. The middle fossa approach goes above the ear and the retrosigmoid approach goes behind it. The risks are essentially the same as for translabyrinthine surgery in properly selected cases. As with translabyrinthine surgery, the facial nerve lies adjacent to the tumors and is subject to swelling and temporary weakness. Occasionally some permanent weakness results.
What Can I Do To Protect My Hearing?
Preventive medicine is always the best medicine. Here are some simple steps you can take to protect your hearing:
- Wear ear protectors when mowing the lawn or using a power saw.
- Pieces of cotton or paper towel (or spent bullet casings) stuffed in the ears are generally inadequate.
- With personal portable music systems, if the person standing next to you can tell what you are listening to through earphones, the music is probably too loud and should be turned down.
- Have your blood pressure checked regularly, and take medication to keep high blood pressure under control.
- Maintain healthy eating and exercise habits, and have regular physical exams.
- If you have a family history of hearing loss, you should have regular hearing tests so that problems can be recognized and addressed early.
Like so many other things, we rarely appreciate the value of hearing until it is lost. Through sensible preventive measures, many potential causes of hearing loss can be eliminated. When hearing loss occurs, its progression can sometimes be prevented or slowed. In every case, early diagnosis and treatment will minimize the psychological and social trauma so common in people with hearing impairment.
Hearing experts are constantly working to learn more about the conditions we don't yet understand. Even for patients who can't be cured today, there is always hope for tomorrow.