One-third of Americans older than age 60-and half of those older than 75-have some degree of hearing loss. Although a number of factors can contribute to the risk of hearing impairment (including hereditary factors), the most common cause is simply age-and the cumulative effect of years of exposure to noise.

The good news: Cochlear implants and recent advances in hearing aids now make it possible for people who have severe or profound hearing loss to significantly improve their ability to hear conversation and other sounds.

Basics: Sound is picked up by the ear and transmitted to the brain through a complex pathway. Sound vibrations are collected by the outer ear, pass through the ear canal and cause the eardrum to vibrate. This, in turn, causes the vibration of three small middle eat bones. These bones ultimately connect to an opening in the cochlea, the part of the eat that turns the vibration of sound into nerve impulses. These impulses then travel through the auditory nerve to eventually reach the brain.

As Hearing Starts To Fade

The first thing people usually notice is difficulty hearing what other people are saying...

Mild hearing loss. It's difficult to hear other people in a noisy environment like a restaurant or at a party.

Moderate hearing loss. Normal conversation becomes hard to hear even in a quiet room, and virtually impossible in a noisy room.

Severe hearing loss. People can hear only shouted conversations.

Profound hearing loss. The final stage before deafness, where even shouted words often go unheard.

When To See The Doctor

You should see a doctor immediately if you experience sudden hearing loss-especially if the loss occurs in one ear only. This could be a sign of idiopathic sensorineural hearing loss. Nobody knows why it occurs, but doctors have found that treating patients using steroids promptly-ideally within the first 72 hours after the onset of symptoms-can restore hearing to normal or near-normal levels.

Caution: If steroid treatment doesn't start within two weeks, the hearing loss can be permanent.

Gradual, age-related hearing damage typically occurs in both ears and is not a medical emergency. if you're experiencing noticeable hearing loss, however, you should still be checked as soon as possible by an otolaryngologist (ear, nose and throat specialist) who can determine exactly how much hearing loss has occurred...look for underlying medical problems that might contribute to the hearing loss.. .and prescribe treatment-including a hearing aid, if necessary.

Schedule an appointment with an otolaryngologist if you...

Notice that it's harder to hear when you are on the telephone.

Have trouble hearing conversation if there's background noise.

Often ask people to repeat themselves.

Hear a persistent ringing, humming or buzzing sound in your ears (a condition known as tinnitus).

Notice changes in balance associated with a change in your hearing-balance and hearing are both functions of the ear.

Your Checkup

Your otolaryngologist will take a full history of your symptoms and any factors that might put you at risk for hearing loss. An audiogram will be obtained to test how well you hear sounds over a wide range of frequencies.

The audiogram gives the single best picture of how well your auditory nerve and the rest of your sound-conducting system are functioning. It will show if your hearing follows a pattern consistent with age-related hearing loss or noise exposure, or indicates that there is some other condition, such as an inner ear disturbance or something that is preventing the proper movement of one or more of the three bones of the middle ear.

Expect an ear, head and neck exam, which will help check for underlying conditions that may be causing or related to your hearing loss. Potential causes of bearing loss include...

Ear infections, with the acute and chronic effects of such infections.

Holes in the eardrum.

Otosclerosis, a condition in which a bone in the middle ear becomes fixed in place and may need to be replaced or freed with surgery.

Autoimmune diseases, such as lupus and rheumatoid arthritis.

Meniere's disease, an inner ear ailment marked by symptoms such as dizziness and fluctuating hearing loss.

Selecting A Hearing Aid

Once your doctor has determined the nature and degree of your hearing loss, the next step is to discuss different treatment options. The majority of people who have a hearing loss can be treated using hearing aids, but depending on the nature of your problem, you may require medical or surgical therapy.

Today's hearing aids are complex devices that can be customized to your own hearing profile, amplifying certain frequencies and not others. When properly prescribed and fitted, they can significantly improve the hearing abilities of most people who have a hearing loss.

Your level of hearing loss will dictate what type of hearing aid you should have. It is critically important to get a comfortable, well-designed, custom-molded hearing aid, not a one-size-fits all model. Both analog and digital models (some of which are programmable for multiple environments) are available. With programmable models, you can boost different frequencies to hear best when you're talking in a crowded restaurant or when you're talking on the phone.

Cost: Can vary from $600 to $3,000. Some insurance plans cover the cost of hearing aids, others subsidize the cost.

Each individual type of hearing aid serves different needs. After you've settled on a model, your otolaryngologist will take a mold of your ear, fit the device, tune it to complement your existing hearing and show you how to care for it.

More than 90% of the people who get fitted with a hearing aid find that it helps restore hearing function.

After getting your hearing aid, it is important to follow up with your hearing professional, especially your audiologist, to ensure that the device continues to suit your needs and that you continue to use it properly. Because the standard hearing aid sits in the ear canal, it can keep ear wax from naturally making its way out of the ear, and you may require periodic removal of the wax.

Cochlear Implantation

For some causes of profound hearing loss, a possible treatment is cochlear implantation. This procedure is used in both adults and children and is a great benefit to some people. Every patient must be carefully evaluated on a case-by-case basis, since not everyone will benefit from such a device.

A cochlear implant is made up of three parts: (1) a small microphone that picks up sounds around the user. These sounds are then transmitted to (2) a speech processor, worn on the belt or carried in the user's pocket, which converts the sound into electrical signals that are then transmitted to (3) an electrical receiver (that has been surgically implanted under the skin behind the user's ear) that has an electrode going into the cochlea. The signals from the electrode are ultimately picked up by the auditory nerve and ascend along the complex pathways to the brain. The user "hears" sound once the device is activated and programmed to best suit that person. The quality and intelligibility of the sound varies from person to person.

Cost: Approximately $60,000, including post operative training. Insurance coverage varies.

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