Ten Ways to Recognize Hearing Loss:
More than 28 million Americans are deaf or hard of hearing and 30 million more are exposed to dangerous levels of noise. Levels of hearing impairment vary from a mild but important loss of sensitivity, to a total loss of hearing. The largest group of Americans suffering from hearing loss is the elderly. Age-related hearing loss affects 30 to 35 percent of the U.S. population between the ages of 65 and 75 years, and 40 percent of the population over the age of 75. The most common cause of hearing loss in children is otitis media, a disorder that affects predominantly infants and young children. A substantial number of hearing impairments are caused by environmental factors such as noise, drugs, and toxins. Many acquired sensorineural hearing losses may result from a genetic predisposition. Important progress has been made during the last decade in understanding the auditory system.
The following questions will help you determine if you need to have your hearing evaluated by a medical professional:
1. Do you have a problem hearing over the telephone? Yes or No
2. Do you have trouble following the conversation when two or more people are talking at the same time? Yes or No
3. Do people complain that you turn the TV volume up too high? Yes or No
4. Do you have to strain to understand conversation? Yes or No
5. Do you have trouble hearing in a noisy background? Yes or No
6. Do you find yourself asking people to repeat themselves? Yes or No
7. Do many people you talk to see to mumble (or not speak clearly)?
8. Do you misunderstand what others are saying and respond inappropriately? Yes or No
9. Do you have trouble understanding the speech of women and children?
10. Do people get annoyed because you misunderstand what they say? Yes or No
If you answered "yes" to three or more of these questions, you may want to see an otolaryngologist (an ear, nose, and throat specialist) or an audiologist for a hearing evaluation.
What is the importance of noise induced hearing loss?
The industrial and technological revolution may have propelled society to higher levels of achievement. At the same time, however, this progress has also made the world a noisier place in which to live. In fact, noise pollution is a growing health hazard and is everywhere. Car alarms, leaf blowers, gunshots, boom boxes, and traffic congestion fill our cities with decibels (the measure of sound intensity). Even escaping to the country may not provide a quiet refuge. Thus, farmers are at high risk for exposure to noise from their farm machinery.
What's more, potentially harmful noise is not necessarily unpleasant or unwanted. For example, the music at a concert or the pounding of a jackhammer on the street can be equally damaging to the inner ear. The reason for this is that any sounds (acoustic energies) delivered with equal intensity, regardless of their source, are equally dangerous. Eventually, continued or repeated exposures to high intensity sound can cause acoustic trauma to the ear. This trauma can result in hearing loss, ringing in the ears (tinnitus), and occasional dizziness (vertigo), and nonauditory effects, such as increases in heart rate and blood pressure.
One-third of the 30 million Americans with hearing loss have an impairment that is at least partially attributed to excessive noise exposure. Noise remains the most common preventable cause of irreversible sensorineural (involving the ear's sensory nerve) hearing loss.
What are acoustic trauma and noise induced hearing loss?
Acoustic trauma occurs when any excessive sound energy strikes the inner ear. If it is brief, the noise may cause a reversible, temporary auditory fatigue, technically known as a temporary threshold shift. For example, after a loud rock concert, it is common to experience hearing dullness and ringing for several hours. In this situation, if symptoms persist beyond several days, oral steroids (cortisone-type medications) may help the inner ear recover. If the noise is loud enough and the duration of exposure long enough, however, it may cause a permanent threshold shift. This condition is called noise induced hearing loss, and has no cure and is irreversible.
Hearing loss produced by a sudden and very loud noise (blast injury) is called acute acoustic trauma. If the sound is loud enough, it can cause the eardrum to rupture or the person to have a complete loss of hearing. Sometimes, particularly if the sudden loss is total and combined with dizziness, immediate surgical exploration of the ear may be necessary. In this circumstance, the ear surgeon may need to locate and patch a hole (perilymphatic fistula) between the inner ear fluid space and the middle ear space.
How can a person tell if a noisy situation is dangerous to their hearing?
People may differ in their sensitivity to noise. Nevertheless, as a general rule, noise is probably damaging to the hearing if the noise:
- Makes it necessary to shout to be heard over the background noise
- Causes ear pain
- Makes the ears ring
- Causes a loss of hearing for several hours or more after exposure to the noise
In contrast to popular belief, there is no truth to the idea that a person is able to "toughen up" the ears by frequent exposure to loud noise. In reality, cumulative noise in the past has probably damaged the ears to such a degree that a person doesn't hear the noise as much. Unfortunately, no treatment is available for noise induced hearing loss once the damage has occurred.
How loud can a sound get before it affects hearing?
Many experts agree that continual exposure to more than 85 decibels (dB) may be dangerous to the ears. As already mentioned, the decibel is a measure of the intensity of sound. The faintest sound the human ear can detect is labeled 0 dB, whereas the noise at a rocket pad during launch approaches 180 dB. A quite whisper is approximately 30 dB, normal conversation is 60 dB, and a lawnmower is 90 dB. Decibels are measured logarithmically, which means that the sound energy of noise increases by units of 10. Therefore, a dB increase of a sound from 20 to 30 dB is an increase of 10 times, and a db increase of a sound from 20 to 40 dB is an increase of 100 times (10 times 10).
Do the duration and closeness of exposure to loud noise relate to hearing damage?
There is a direct correlation between the duration of exposure to a loud noise and the damage to hearing. This means that the longer the exposure, the more the damage. Furthermore, the closer one is to the source of the intense noise, the more damaging it is. For example, a gunshot produces a noise that could damage the ears of anyone in close hearing range. Large bore guns and artillery are the worst because they are the loudest. But even a cap gun or a firecracker can damage the hearing if the explosion is close to the ears. Accordingly, anyone who uses firearms must wear hearing protection.
Studies have shown an alarming increase in hearing loss in children and young adults. Evidence suggests that loud music along with increased use of portable CD players with earphones may be responsible for this increase. Here, the problem is the long duration and close exposure to the loud music.
What factors increase a person's susceptibility to noise induced hearing loss?
The following factors have been associated with an increased susceptibility to noise induced hearing loss:
- Blue eyes
- Light skin
- Family history of hearing loss
- Diabetes mellitus
- Meniere disease
- Iron deficiency
- Vitamin A deficiency
- Older age
- Atherosclerosis (hardening of the arteries)
- Smoking tobacco
How else can noise affect a person?
After exposure to noise, tinnitus, which is a ringing or another sound in the ears, occurs commonly. The tinnitus is a sign that inner ear damage or nerve destruction has occurred. Initially the tinnitus will just be temporary, lasting only several hours. As more cumulative exposure and damage occur, the tinnitus will last longer until eventually it will become permanent.
· Loud noise will also cause some people to have anxiety and irritability, an increase in heart rate and blood pressure, or an increase in stomach acid. In addition, very loud noise can reduce efficiency in performing difficult tasks by diverting attention from the job.
What are the regulations regarding on-the-job exposure to noise?
Habitual exposure to noise above 85dB will cause a gradual hearing loss in a significant number of individuals. Moreover, noise greater than 85dB will accelerate this damage. Accordingly, the Occupational Safety and Health Administration (OSHA) has imposed regulations nationwide regarding on-the-job exposure to noise. For unprotected ears, the allowed exposure time decreases by one half for each 5 dB increase in the average noise level. For instance, exposure is limited to 8 hours at 90 dB, 4 hr at 95 dB, and 2 hr at 100 dB. The highest permissible noise exposure for the unprotected ear is 115 dB for 15 minutes per day. Any noise above 140 dB is not permitted.
· OSHA, in its Hearing Conservation Amendment of 1983, required the institution of a hearing conservation program in noisy workplaces. Such a program must include a yearly hearing test for workers exposed to an average of 85 dB or more of noise during their 8-hour workday. It turns out that approximately 25% of the American industrial workforce is exposed to this much noise.
· Ideally, noisy machinery and work places should be designed to be quieter and/or the workers' time in the noise should be reduced. The cost of reducing noise exposure in these ways, however, is often prohibitive. As an alternative, individual hearing protectors are required when noise averages more than 90 dB during an 8-hour day.
· When noise measurements indicate that hearing protectors are needed, the employer must offer at least one type of earplug and one type of earmuff without cost to employees. If the yearly hearing test reveals a hearing loss of 10 dB or more in the higher sound frequencies (pitch) in either ear, the worker must be informed. (The higher frequencies of sound are the most sensitive to noise damage.) Also, the worker must wear hearing protectors when noise averages more then 85 dB for an 8-hour day. Greater losses of hearing or the possibility of ear disease necessitates referral to an ear doctor (otolaryngologist).
How effective are hearing protection devices?
Hearing protection devices decrease the intensity of sound that reaches the eardrum. They come in two forms: earplugs and earmuffs.
Earplugs: Earplugs are small inserts that fit into the outer ear canal. To be effective they must totally block the ear canal with an airtight seal. They are available in a variety of shapes and sizes to fit individual ear canals and can be custom made. For people who have trouble keeping them in their ears, they can be fitted to a headband.
Earmuffs: Earmuffs fit over the entire outer ear to form an air seal. They are held in place by an adjustable band. Earmuffs must be snugly sealed so the entire circumference of the ear canal is blocked.
· Properly fitted earplugs or muffs reduce noise by 15 to 30 dB of sound. The better earplugs and earmuffs are approximately equally effective in sound reduction. However, earplugs are better protection against low frequency noise (such as noise from a jackhammer), and earmuffs are better protection against high frequency noise, (such as noise from an airplane taking off). For high frequency sounds, think of the high-pitched treble keys of the piano, whereas for low frequency sounds, think of the low- or deep-pitched bass keys of the piano.
· Simultaneous use of earplugs and muffs usually adds 10 to 15 dB more protection than either used along. Combined use should be considered when the noise exceeds 105 dB. It is important to understand that ordinary cotton balls or tissue paper wads stuffed into the ear canals are very poor protectors since they only reduce noise by approximately 7 dB.
· Excessive noise exposure may occur at live rock concerts as well as in more intimate venues for music whenever amplification is utilized. The damage to hearing from music is every bit as permanent as that incurred by other means. As a matter of fact, special high-fidelity earplugs have been developed specifically for such situations and are being utilized by musicians and professional sound engineers. These earplugs are specially designed to eliminate the so-called plugged (occluded) ear effect and to maintain an even reduction of sound across the frequency range. Otherwise, when the ear is plugged, the plugged ear effect makes one's voice sound more bass, or deeper, and louder. Try it by occluding your ear(s) (gently) with your finger, and speak. You'll hear the plugged ear effect.
How Do I Choose the Hearing Aid that’s Right for Me?
Choosing a hearing aid is an important decision, but it doesn’t have to be a difficult decision. Look for the highest quality aid available, and don’t forget to ask about the service, which is so important to being satisfied with your product.
Styles of Hearing Aids
Wide selection of sizes available
These six sizes are divided into three styles: Behind-the-Ear, Comfort and Cosmetic.
Many Styles – All Advanced Technology
| | Behind-The-Ear (BTE) |
| | Open Fit Behind-The-Ear (BTE)/Receiver in the Canal (RIC) BTE |
| | Comfort Styles |
| | Cosmetic Styles |
What are the common problems with hearing protectors?
Studies have shown that one-half of the workers wearing hearing protectors receive only one-half or less of the noise reduction potential of their protectors. This diminished protection occurs because these devices either are not worn continuously while exposed to noise or they do not fit properly.
· As previously mentioned, a hearing protector can give an average of 30 dB noise reduction if worn continuously during an 8-hour workday. If taken off for just one hour while exposed to noise, however, such a protector would provide only an average of 9 dB of protection during the 8 hours. This substantial reduction in protection occurs because with the logarithmic scale used to measure decibels, a 10-times increase in noise energy occurs for each 10 dB increase in sound. Thus, during the hour with unprotected ears, the worker is exposed to 1,000 times more sound energy than if earplugs or muffs had been worn. (For the 30 dB, 10 x 10 x 10 = 1000 times more noise.)
· In addition, noise exposure is cumulative. So, the noise at home or at play must be counted in the total exposure during any one day. A maximum allowable on-the-job exposure followed by further exposure at home to a noisy lawnmower or loud music will definitely exceed the safe daily limit.
· Even if earplugs and/or earmuffs are worn continuously while exposed to noise, they do little good if there is an incomplete air seal between the hearing protector and the skin. As mentioned above, when using ordinary hearing protectors, it is common to hear one's voice as louder and deeper. This plugged ear effect can actually be taken as a useful sign that the hearing protectors are properly positioned.
Do hearing protectors prevent a person from communicating with others?
The answer is no, at least for people with normal hearing. In fact, just as sunglasses help vision in very bright light, hearing protectors enhance speech understanding in very noisy places. Even in a quiet setting, a normal-hearing person wearing hearing protectors should be able to understand a regular conversation.
· Hearing protectors do slightly reduce the ability of those with damaged hearing or poor comprehension of language to understand normal conversation. Nevertheless, it is essential that persons with impaired hearing wear earplugs or earmuffs to prevent further inner ear damage from noise.
· It has been argued that hearing protectors might reduce a worker's ability to hear the noises that signify an improperly functioning machine. Most workers, however, readily adjust to the quieter sounds and can still detect such problems.
How can someone tell if their hearing is already damaged, and what can be done about it?
Hearing loss usually develops over a period of several years. Since the hearing loss is painless and gradual, many people may not notice it. What someone may notice is tinnitus, which is a ringing or another sound in the ear. The tinnitus could be the result of long-term exposure to noise that has damaged the hearing nerve. Or, a person may have trouble understanding what people are saying or may hear everyone as mumbling. Such hearing difficulties are especially apt to occur when one is trying to hear in a noisy place such as in a crowd or at a party. These difficulties could be the beginning of high-frequency hearing loss.
· A typical hearing test (audiogram) of a person with noise induced hearing loss will initially show only a high frequency loss at 4000 Hz. (Hertz or Hz is the measure of sound frequency or pitch. Four thousand Hz is high frequency, while 250 or 500 Hz would be low frequency). With continued noise exposure and hearing loss, the audiogram will show a broader loss to include lower (deeper) frequencies.
· Noise induced hearing loss will almost always affect both ears equally, but in some situations, especially with firearm usage, it may be worse in one ear than in the other. For example, firing a rifle tends to injure the ear opposite the side of the trigger finger due to the shadow (blocking the sound) effect of the shooter's head.
· If a person has any of these symptoms that suggest hearing loss, he or she should consult a physician with special training in ear and hearing disorders (an otolaryngologist or otologist). This type of doctor can diagnose hearing problems and recommend the best way to manage them.
Portions of the above information has been adapted from the American Academy of Otolaryngology-Head and Neck Surgery, Inc, Alexandria, VA leaflet on noise induced hearing loss.
Hearing Loss Prevention Tips:
Every day we experience sound in our environment such as the television, radio, washing machine, automobiles, buses and trucks. But when an individual is exposed to harmful sounds-sounds that are too loud or loud sounds over a long time-sensitive structures of the inner ear can be damaged causing Noise-Induced Hearing Loss (NIHL).
NIHL is serious. Some 30 million people are at risk in the workplace, in recreational settings, and at home. In fact, it is the most common work-related disease. Already, 10 million Americans have permanently damaged their hearing.
Riddle: What is painless, odorless, tasteless, invisible, and toxic?
The following tips may help save you or your childs hearing. Share these tips with your family so they too will be aware of the dangers of NIHL.
- Noise-induced hearing loss is preventable.
- There are three things to consider about noise: How loud. How long. How close.
- Workplace noises contribute to noise-induced hearing loss.
- An extreme noise like a firecracker, experienced at close range, can damage hearing permanently in an instant.
- Repeated exposure to engines and machines like motorcycles or chain saws can erode hearing more slowly. The result is the same: irreversible hearing loss.
- Be aware of damaging noise.
- Be prepared to protect your hearing. Carry earplugs or other protection.
- Help your kids understand how hearing works and how it can be damaged.
- If you are standing next to a person wearing a personal radio with earphones . . . and you can hear the lyrics to the song . . . damage.
- If your kids are watching you cut wood with a power saw to build a bookshelf in your basement and you're not wearing protection . . . you are all experiencing damage.
- If your teenager is doing lawn work for the summer, using a gasoline engine and not wearing hearing protection, hour after hour, it's doing damage.
- If anyone in your family uses a firearm for recreational shooting, and does not use hearing protection . . . damage.
Know which noises can cause damage and wear ear plugs when you are involved in a loud activity:
NIHL (Noise-Induced Hearing Loss) can be caused by a one-time exposure to loud sound as well as by repeated exposure to sounds at various loudness levels over an extended period of time. The loudness of sound is measured in units called decibels.
- Regular exposure of 110 decibels (and higher) for more than one minute risks permanent hearing loss.
- No more than 15 minutes of unprotected exposure of 100 decibels is recommended.
- Prolonged exposure to any noise above 90 decibels can cause gradual hearing loss!
- Rock concerts and firecrackers are 140 decibels!
- Loud bass in cars (when other cars can feel the vibration and hear the noise) and snowmobiles are 120 decibels!
- A chainsaw is 110 decibels
- Wood shop is 100 decibels
- Lawn mowers and motorcycles are 90 decibels
- City traffic noise is 80 decibels
- Normal conversation is 60 decibels
- Refrigerator humming is 40 decibels
Answer to riddle: What is painless, odorless, tasteless, invisible, and toxic? Noise-induced hearing loss.
For additional information, please visit the MedicineNet.com Hearing Center.
Source: National Institute on Deafness and Other Communication Disorders (www.nidcd.nih.gov)
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How to Choose a Doctor:
Medical Author: Melissa Stoppler, M.D.
Medical Editor: Barbara K. Hecht, Ph.D.
Choosing a new physician can be a difficult task, especially if you have moved and are living in a new community. Asking for recommendations from coworkers, neighbors, and friends is a good way to start, but ultimately you will have to decide which physician is best suited to your individual needs and situation.
Your insurance plan may restrict your choices to a group of plan-approved physicians or offer financial incentives to use plan-affiliated doctors. Always check the terms of your insurance coverage to find out whether your plan will cover visits to the physician you are considering. If he or she does not participate in your health plan, how much will you pay out-of-pocket for visits to this provider? If you have changed jobs and must decide among different health plans offered by your employer, you may want to make your choice of doctor first and then choose the health plan that covers visits to this physician.
You will also need to decide what type of physician you are looking for. Do you need a primary health care provider (a doctor who will manage your overall care and refer you to specialists when necessary)? Or do you need a specialist in a particular area?
Most practicing physicians in the U.S. both primary care physicians physicians (a doctor you would see for routine ailments such as a cold, the flu, and regular checkups) and specialists (doctors who focus on one area whom you would see, for example, for a colonoscopy, rheumatoid arthritis, IBS , multiple sclerosis, cancer, or other specific conditions) are board certified, meaning that they have completed residency training in a specific field following graduation from medical school and have passed a competency examination in that field. Primary care providers may be board certified in different areas such as, for instance, Family Medicine or Internal Medicine.
It is also possible to find out whether a physician is in good standing with state licensing agencies through a Web site run by administrators of several state medical licensure boards. The Web site Administrators In Medicine can provide information about disciplinary actions taken or criminal charges filed against physicians in many states.
Finally, you may have additional concerns when choosing a physician. These concerns should reflect your own needs and priorities The following questions can help you to define further what is most important for you:
1. Where is the practice located? Will it be easy for you to get there? Is it accessible by public transportation? Is there ample parking?
2. Which hospital(s) does the doctor use? Are you comfortable with the possibility of being treated at one of these institutions should the need arise?
3. Where are routine x-rays and laboratory studies performed? Can these be done in-office, or will you have to go to an outside laboratory?
4. How long must you wait for an appointment after you call? Can you be seen on the same day if you have an urgent need?
5. Is the office staff friendly and courteous?
6. If you call with a question about your care, does a doctor or nurse return your call promptly?
7. Who covers for the physician when he/she is away? Whom should you call if you have a problem after-hours? If the doctor works in a group, are you comfortable with being seen by one of the practice partners?
8. Does the physician frequently refer patients to specialists or does he/she prefer to manage the majority of your care themselves?
9. Does the office process insurance claims, or must you pay up-front for services and file the claims yourself?
If you still aren't sure about your choice, ask if you can make an “interview” appointment to speak with the physician about your concerns. You may have to pay a co-payment or other fee for this service, but it can be a valuable way to gather information when making your decision.
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