When hearing loss occurs

You’re having a meeting in a quiet room with just a few people, and you can hear just about everything people say. Later, you’re on a noisy train coming home and a neighbor sits down beside you. He tells you a joke — you know it’s a joke because he’s laughing. You laugh, too, even though you haven’t heard enough to understand the joke.

This experience is typical of people whose hearing has begun to decline, especially those whose hearing loss is age-related, noise-related, or a combination of both. Hearing loss usually comes on so gradually, over so many years, that it can be hard to realize that you don’t hear as well as you used to. The difference at first may not be that great, because people have a marvelous capacity to compensate for what they can’t hear. For example, you may fill in gaps by picking up on the facial expressions and gestures of your conversational partner.

But with age, the first sounds to go tend to be high-frequency sounds. What this means in practical terms is that you can hear the vowels just fine, but consonants like “f” and “th” give you trouble. You may not be able to tell whether someone said “fish” or “this,” “thing” or “sing.” And you may have the most difficulty hearing over the phone or when there’s a lot of background noise. In a quiet room, you may do just fine.

As years pass, high-frequency sounds become harder to hear, even when the room is quiet. That’s when the doorbell and the telephone may ring and ring before you realize it. Lower-frequency sounds may also become problematic. You may find yourself increasingly asking others to repeat themselves, or shrinking back from conversation to avoid embarrassment.

Kinds of hearing loss

There are two basic types of hearing loss, sensorineural and conductive. Many people have a combination, especially as they age. These people are said to have mixed hearing loss. Hearing loss that is strictly due to aging is called presbycusis, a form of sensorineural hearing loss.

Although hearing loss that’s related to noise damage and age comes on gradually, other kinds of hearing loss occur suddenly. Knowing which type of hearing loss you have is the first step in determining which treatment is right for you; treatment options may include being fitted with a hearing aid or, in some cases, surgery.

Sensorineural hearing loss. More than 80% of people who are hard of hearing have sensorineural hearing loss. It’s the result of the destruction of the sensory cells, or hair cells, in the ear or the nerves that help transmit sound messages to the brain. Sensory cells can be damaged or killed off by loud noises, toxic drugs, head injuries, and above all, aging. When sensorineural hearing loss is caused by aging or by an ongoing exposure to loud noise, it comes on gradually, over a period of many years. But it can start suddenly when the cause is a head injury, a toxic drug, or an extremely loud noise, such as an explosion. Sensorineural hearing loss is usually permanent.

Conductive hearing loss. This type of hearing loss is caused by something that blocks or hinders sound waves from passing through the outer or middle ear. The source of the obstruction can be any number of things, including earwax, an accumulation of fluid, inflammation from an ear infection, a cyst or other abnormal growth, or a foreign body that became lodged accidentally in the ear. Unlike sensorineural hearing loss, conductive hearing loss is often treatable with medicine or surgery. For example, you can remove excess earwax with a cleaning kit used at home, or you can ask your doctor to remove it.

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What is Hearing Loss?