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How We Hear

Step 1:  Sound waves enter your outer ear and travel down the ear canal to the eardrum.

Step 2: The eardrum vibrates when the sound wave hits it and passes the vibrations on to the three tiny bones in the middle ear (malleus, incus, stapes). These bones, the ossicles, amplify the sound wave before it reaches the cochlea.

Step 3: The vibrations from the ossicles create a wave in the fluid of the cochlea which bends tiny hair cells that, in turn, release neurochemical signals to the auditory nerve.

Step 4: The auditory nerve transmits the signals to the brain, where they are translated into a sound that you can understand.

About Hearing Loss

When describing a hearing loss, there are three main attributes to consider: type of hearing loss, degree of hearing loss, and configuration of the hearing loss.

Types of Hearing Loss

The type of hearing loss is categorized by which part of the auditory system is damaged.

If sound is not conducted through the outer or middle ear efficiently, then it is a called a conductive hearing loss. The problem may lie in the ear canal, eardrum, or ossicles, from either obstruction or damage, resulting in a reduction of the sound level. This type of hearing loss can be corrected through medicine, surgery, bone-anchored hearing aids, or traditional hearing aids.

If there is damage to the cochlea in the inner ear or to the auditory nerve, then it is considered a sensorineural hearing loss. When damage occurs in this portion of the auditory system, it not only causes a reduction in hearing level, but can also effect the clarity of speech. This type of hearing loss is permanent and cannot be corrected medicinally or surgically, but rather with hearing aids or cochlear implants.

Sometimes a conductive hearing loss and a sensorineural hearing loss may be present in the same person at the same time. When this occurs, it is considered a mixed hearing loss, because it is a combination of damage in both the outer or middle ear (conductive hearing loss) and the cochlea or auditory nerve (sensorineural hearing loss).

Degrees of Hearing Loss

The degree of hearing loss refers to the severity of the loss. The amount of hearing loss that may be present is ranked into one of five categories:

  1. Normal
    • Able to hear speech frequencies down to 20 dB HL or better
  2. Mild
    • Able to hear between 21 and 39 dB HL
    • Causes difficulty hearing clearly in noisy situations
  3. Moderate
    • Able to hear between 40 and 69 dB HL
    • Causes difficulty hearing speech without a hearing aid
  4. Severe
    • Able to hear between 70 and 89 dB HL
    • Requires a powerful hearing aid or a cochlear implant
  5. Profound
    • Cannot hear better than 90 dB HL
    • Will likely rely on lip-reading, sign language, or cochlear implant

Configuration of the Hearing Loss

The configuration, or shape, of the hearing loss utilizes other descriptors to create a clear picture of the hearing loss. For example, it describes which frequencies are affected; high frequency loss, low frequency loss, or flat loss (in which all frequencies have the same amount of hearing loss).

Other common terms used:

  • Bilateral– both ears are affected
  • Unilateral– only one ear is affected
  • Symmetrical– the degree and shape of hearing loss is the same in each ear
  • Asymmetrical– the degree and/or shape of hearing loss is different for each ear
  • Fluctuating– hearing loss changes; may improve or worsen from time to time
  • Stable– hearing loss remains the same year after year
  • Progressive– hearing loss becomes increasingly worse slowly over time
  • Sudden– rapid onset of hearing loss, either at once or over several days

Causes of Hearing Loss

For Conductive Hearing Loss

  • Malformation of ear canal or middle ear structures
  • Fluid in the middle ear space
  • Middle ear infection, aka otitis media
  • Allergies
  • Eustachian tube dysfunction
  • Perforated eardrum
  • Benign tumors, such as a cholesteatoma
  • Impacted earwax
  • Outer ear infection, such as swimmer’s ear
  • Foreign body in the ear
  • Otosclerosis
  • Ossicular discontinuity

For Sensorineural Hearing Loss

  • Exposure to loud noise
  • Presbycusis, or aging
  • Viral infection
  • Autoimmune inner ear disease
  • Head trauma
  • Genetic
  • Malformation of the inner ear or cochlea
  • Meniere’s Disease
  • Acoustic neuroma, benign tumor
  • Ototoxic medications

Communication Strategies

When speaking to someone with hearing loss:

  • Make sure you have the person’s attention before you start speaking
  • Turn your face towards them and do not cover your mouth so they can easily see your lip movements and facial expressions
  • Find a place to talk that has good lighting and is away from noise and distractions
  • Speak clearly, not too slowly, using normal lip movements
  • Make sure what you are saying is being understood
  • If someone doesn’t understand what you’ve said, try saying it in a different way
  • Keep your voice down: it may be uncomfortable for a hearing aid user if you shout
  • Don’t lean in to the ear because they need to be able to see your face
  • If in a group, don’t all talk at once
  • Don’t say “Never mind, it doesn’t matter” because to the person who cannot hear you, everything you are saying matters

About Tinnitus

Tinnitus is the perception of sound in the absence of any external sound applied to the ear. The phantom noises may sound like a ringing, buzzing, roaring, clicking, hissing, or music and may be present in one ear or both ears. It can vary in volume and pitch and may change from time to time. Tinnitus may be present all the time, or it may come and go. Very often tinnitus is accompanied by hearing loss.

Approximately one in every 10 Americans will experience tinnitus at some point in their life. There are many causes of tinnitus, and the more common ones include:

  • Noise exposure
  • The natural aging process
  • Certain medications
  • Earwax blockage
  • Head injury
  • Various ear disease such as Meniere’s Disease

People react very differently to their tinnitus; some find it bothersome, some ignore it, and other become very distressed. Depending on the volume, some people report their tinnitus makes it hard to understand what people are saying, find it difficult to concentrate, and have trouble getting to sleep. Other complications may include fatigue, stress, memory problems, depression, anxiety and irritability.

The type of treatment used depends on the underlying cause of the tinnitus. If tinnitus, is due to a health condition, treating that condition should reduce or eliminate the noise. Examples of this include earwax removal for a wax impaction or changing a certain medication that appears to be the cause.

Other forms of treatment include:

  • Sound therapy– uses external noises to suppress the tinnitus so that it is less bothersome and less noticeable
  • Retraining therapy– combines counseling and noise suppression to help the brain naturally habituate to the tinnitus, helping you not to focus on it
  • Medications– although they will not cure tinnitus, medicines in some cases can help reduce the severity of symptoms or complications (examples: anti-anxiety, anti-depressants, sleep aids)

Some general recommendations for anyone experiencing tinnitus include:

  • Schedule a medical examination to determine a cause of your tinnitus and to see if there are any medical treatment options
  • Use hearing protection whenever you are in the presence of loud noise
  • Schedule a hearing evaluation to check for hearing loss
  • Schedule a tinnitus evaluation to determine if sound therapy or retraining therapy may help you
  • Avoid silence- listen to low level white noise (from a sound generator or noisy fan) or soft background music when in a quiet room
  • Visit the websites listed under the Tinnitus section of “Helpful Links”

Self-Hearing Test

The following questions will help you determine if you should have your hearing evaluated by our audiologist:

  • Do you have a problem understanding people on the telephone?
  • Do you have trouble following the conversation when two or more people are talking at the same time?
  • Do people complain that you turn the TV volume up too high?
  • Do you have to strain to understand conversation?
  • Do you have trouble hearing in noisy places?
  • Do you have dizziness, pain, or ringing in your ears?
  • Do you find yourself asking people to repeat themselves?
  • Do people sound like they mumble while talking to you?
  • Do you misunderstand what others are saying and respond inappropriately?
  • Do you have greater difficulty understanding women and children?
  • Do people get annoyed because you misunderstand what they say?

If you have answered YES to more than two of these questions, we recommend you contact our office to schedule a comprehensive hearing evaluation.

Helpful Links

About Hearing Loss

Better Hearing Institute (BHI) —a not-for-profit corporation that educates the public about the neglected problem of hearing loss and what can be done about it.

Healthy Hearing — an online resource for hearing health information. Its goal is to provide high quality content that is understandable and inspirational.

Hearing Loss Association of America (HLAA) – “The Nation’s Voice for People with Hearing Loss.” HLAA is the nation’s leading organization representing people with hearing loss.

National Council on Aging (NCOA) — a nonprofit service and advocacy organization headquartered in Washington, DC. A national voice for older Americans and the community organizations that serve them. They bring together nonprofit organizations, businesses, and government to develop creative solutions that improve the lives of all older adults. To go directly to their section on hearing loss, visit 1. Hearing loss information and, 2. Hearing Loss: It’s a Family Affair (Brochure)

About Tinnitus

American Tinnitus Association — exists to cure tinnitus through the development of resources that advance tinnitus research.

Support Group for Tinnitus Sufferers –  “Welcome to the support you’ve been looking for. Browse our +500 communities of people facing similar life challenges, medical conditions, and mental health issues and find people who understand exactly what you’re going through.”

Tinnitus Talk support forumA social enterprise dedicated to informing and educating the tinnitus community while expanding the knowledge base, and offering safe self-treatment solutions.

Noteworthy Tinnitus Facebook Pages:

Phones for Hearing Impairment

Depending on which state you live in you may be eligible for free or reduced-cost telecommunications equipment such as phones with volume control and phones to use with captioned telephone service. To find out if your state has a telecommunications equipment distribution program go to TEDPA site.

Did you know there is a captioned telephone, just like captioned TV, so you can read along as you listen to the other party on the phone? Check out these links to view different options.