Issue Date: July 13, 2003
Here's to ears
Turn down the stereo, go easy with cotton swabs, and read my sound advice to save your hearing.
Next time you are out, drop by a sporting goods store and buy earplugs. Next Saturday morning, wear them. You'll find that everything you do becomes more difficult when you can't hear. Simple conversations are a strain. Listening to the radio is out; watching TV is a chore. Even sensing movement in your house is difficult: You don't hear doors closing, oven timers dinging or air conditioners turning on.
OUR AMAZING EARS
Say someone drops a glass on the kitchen floor. It shatters, sending sound waves in all directions. Some waves enter your ear's external canal and strike the eardrum, causing it to move. The eardrum is connected to the body's three smallest bones (the hammer, anvil and stirrup), creating a "chain" to the inner ear's entrance. As the eardrum moves, the chain vibrates. It sends impulses into the inner ear, where a fluid-filled chamber (cochlea) filled with tiny fibers (hair cells) turns the vibration into an electrical signal. A nerve carries this signal to the brain, where it's interpreted as a distinct sound -- all in a split second. Amazing, isn't it?
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Welcome to auditory isolation. Fortunately, though, hearing loss is preventable for many people.
To brush up on the biology of normal hearing, take a look at the box (right). Then come back here, because I really want you to understand how to keep things from going wrong.
There are two basic types of loss:
Conductive loss. This means sounds are not being "conducted" or getting through to the inner ear (where the interpretation of sound occurs).
Sensorineural hearing loss. Sound makes it all the way through to the inner ear, but once it's there, the signal is dampened or misinterpreted because of damage to tiny fibers in the inner ear, the hearing nerve or the brain itself. People with this type of loss often have tinnitus, a ringing/buzzing sound that occurs intermittently or constantly. For many, this is worse than hearing loss!
A physician or audiologist can distinguish between the types of losses by looking at your history and performing specific exams. A hearing test (audiogram) can confirm a diagnosis.
For conductive hearing loss, the treatment may be as simple as removing wax from the ear canal, or as complicated as surgery for otosclerosis (surgery on the bones in the middle ear). For sensorineural losses, treatment can range from using a digital hearing aid (which works extremely well in select patients) to cochlear implants for people with specific inner ear problems.
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Take my S-O-U-N-D advice
Do yourself a favor: Use this strategy to remember things that can cause ear problems. The tips spell out s-o-u-n-d:
Sensory overload. As a rule, if you have to raise your voice above the background noise for others to hear you, then you need to either get away from the sound source or protect your ears with plugs or headphones. Baby boomers grew up listening to loud rock 'n' roll, and many are paying for it now. Some of us served in the military or grew up shooting guns without ear protection and ended up with the same loss. Motors, machines, munitions and music: Their damage is permanent.
Old age. By age 55, 20% of people have hearing loss. By 65, 33% are affected. The good news is that age-related hearing loss typically doesn't lead to complete deafness.
Undiagnosed tumors or under-treated infections. People with hearing loss in one ear may have an acoustic neuroma, a benign tumor that affects the hearing nerve. It tends to grow slowly but eventually can lead to complete hearing loss and other problems. The treatment is surgery. Many suffer from chronic ear infections, including middle-ear infections, mumps, measles, scarlet fever and meningitis. All of those can lead to hearing loss and should be addressed with a physician.
Non-functioning ear canal or bones. Anything that blocks the ear canal impedes sound flow. I often see patients who aggressively clean their ears with cotton swabs, believing they're removing wax, when they're actually packing it deeper into the ear canal like a cannon plunger! (It's OK to use swabs lightly; if you tend to build up wax, see your doctor for tips.) Sometimes, the middle ear has "hardening" of the bones (otosclerosis) or extra fluid (from allergies or infections).
Damage from drugs, trauma or pressure. Certain antibiotics, drugs for malaria, heart anti-arrhythmics and even aspirin can have toxic effects on hearing. Trauma can damage hearing, too. A hole poked in the eardrum, fractures to the skull, noise trauma (gunfire, fireworks) and pressure trauma (underwater diving or pressurized airplane cabins) all can damage our sound systems.
Remember the earplugs I asked you to buy? Start wearing them when you need to -- mowing the lawn, target shooting, playing video games, watching loud movies, using power tools -- to save your hearing.
Tedd Mitchell, M.D., directs the Wellness Program at the world-renowned Cooper Clinic in Dallas.
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