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Recognizing and Responding to the Signs of Progressive Hearing Loss


Some of the most heartwarming events we can attend are family celebrations that span the generations. At these gatherings, there's always plenty of noise and laughter, with children everywhere. But perhaps you notice Grandma or Grandpa sitting quietly on the sidelines, not engaged in the conversations, looking left out.

Is Grandma depressed? Is Grandpa, who is well past 80, getting senile? The answer to those questions may be no. The real problem, in some cases, may be major hearing loss. They're not reacting to anyone because they simply can't hear what anyone is saying.

More than 20 million Americans suffer similarly. About one-third of adults between 65 and 75, and up to one-half of those 75 and older have significant hearing loss. (Hearing loss disproportionately affects the elderly, but it is not uncommon in younger people.)

For those who hear normally, it is difficult to imagine the negative impact that even mild to moderate hearing loss can have on someone's life. It can get so difficult to communicate with others that personal relationships are strained, problems arise at work and it becomes impossible to enjoy even simple activities, such as watching television or seeing a movie. In some instances, hearing loss can impose real danger--for example, when fire alarms or smoke detectors cannot be heard.

Nevertheless, hearing loss remains one of the most under-recognized and under-treated medical conditions in the United States. Experts estimate that about 80% of men and women with significant loss are not receiving proper treatment. All too often, this occurs because treatment options are too expensive or are deemed cosmetically unacceptable.

But many people fail to get the treatment they need because they don't even realize a problem exists. They lose their hearing so gradually that they're not aware that it's slipping away. They make unconscious accommodations for their declining hearing--by turning up the television volume or staying away from noisy places like restaurants. Though these strategies may work for a while, they usually fail as hearing loss becomes more severe.

The treatment for hearing loss, of course, depends on the cause. In some cases, medications or surgery may correct the underlying problem and produce a dramatic improvement. Much more commonly, hearing aids are prescribed to boost the level of sound that ultimately reaches the internal part of the ear.

Hearing aid technology has advanced greatly in the last decade, and many models of hearing aids can now be programmed to accommodate the specific hearing level and needs of each user. Some aids, for example, can be programmed to boost the volume of only the frequency ranges where hearing loss has occurred. These high-tech features, however, are expensive. A modern programmable aid that uses digital technology can cost upward of $2,000. (A "conventional" aid costs $600 to $1,000.) Unfortunately, most medical insurance--including Medicare--does not cover the cost of hearing aids, which keeps many people from getting the treatment.

Other devices have been developed to help in situations where communication may be difficult even with a hearing aid. To facilitate telephone conversation, for example, handsets with built-in amplifiers are available at a reasonable cost. And television viewing can now be pleasant for everyone in the room, thanks to wireless systems that use light or radio waves to transmit the TV sound to a headset, allowing the television itself to operate at normal volume. (Many movie theaters employ this same type of listening system and offer receivers to patrons who need them.) Even the most expensive hearing aids do not restore hearing to "normal," so good listening skills are essential. The following simple techniques can improve anyone's ability to function.

* Always face the person you are addressing, and stay focused on what is being said.

* Let people know that you have hearing loss. Ask them to speak clearly and at a reasonable rate and volume. If necessary, ask them to slow down, speak up, or repeat or rephrase what they said.

When in a group, request that only one person speak at a time. Also remember that communication is particularly difficult when there is a lot of background noise such as from television, the stereo or even a household appliance. Seek out relatively quiet places for your conversations, and you'll get more out of them.


Early Warning Signs of Auditory Impairment

To see if you have early warning signs of hearing loss, ask yourself the following questions. (If you suspect family members or friends may have significant hearing loss, share this questionnaire with them as well.)

1. Do you have a problem hearing on the telephone?

2. Do you have trouble hearing when there is background noise?

3. Is it hard for you to follow a conversation when two or more people talk at once?

4. Do you have to strain to understand a conversation?

5. Do many people you talk to seem to mumble or not speak clearly?

6. Do you misunderstand what others are saying and respond inappropriately?

7. Do you often ask people to repeat themselves?

8. Do you have trouble understanding the speech of women and children?

9. Do people complain that you turn the television volume up too loud?

If you answered yes to two or more of these questions, you should consult with a physician who specializes in the diagnosis and treatment of hearing disorders (an otolaryngologist or otologist--often referred to as a "head and neck doctor").

You should also have a formal hearing test by an audiologist.


Dr. Jonathan Fielding is the director of public health and the health officer for the Los Angeles County Department of Health Services. Dr. Valerie Ulene is a specialist in preventive medicine practicing in Los Angeles. Send questions to our Their column appears the second and fourth Mondays of the month.

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