'Say What?!'

Hearing loss doesn't just happen to the elderly. Many people in their 40s and 50s have some degree of hearing loss.

By Richard Trubo
WebMD Feature

Reviewed By Brunilda Nazario

If you're in or approaching middle age and were raised on ear-splitting concerts by bands such as Grand Funk Railroad and Led Zeppelin, today you might find hearing loss an unwelcome fact of life. More often than you'd like, you may strain to hear conversations and music that once were as clear and pure as a Santana riff. Whereas you used to be able to hear a pin drop -- quite literally -- you now might find yourself coping with hearing loss at a younger age than you imagined possible, asking people to repeat themselves and making a habit of saying "pardon?"

For the Woodstock generation, hearing is no longer something to take for granted. About 28 million Americans have hearing loss, and according to the American Speech-Language-Hearing Association (ASHA), it occurs among adults of all ages. In fact, the prevalence of hearing loss among younger men and women is on the rise. About 14% of people between ages 45 and 64 have hearing loss (an increase of 26% in this age group since 1971). And as the baby boomers continue to age, the incidence of hearing loss is expected to grow.

Missing Out on Life

The scenario is much too common -- and often too painful -- for men and women in their 40s and 50s. They might sit silently at dinner parties, having difficulty following the conversation. They may feel completely lost when attending the theater, straining to hear what the actors are saying.

Specialists in assessing hearing loss, whose waiting rooms were once filled primarily with the elderly, are now routinely treating people who otherwise consider themselves to be in the prime of life. "I see much younger people in my office who have 'notches' in their hearing that we know come from noise exposure," says audiologist Angela Loavenbruck, EdD, immediate past president of the American Academy of Audiology. These so-called noise "notches," which show up on the graph of a hearing test called an audiogram, can indicate a sharp drop in hearing ability.

"I recently treated a drummer who is constantly exposed to very loud music," says Loavenbruck, who is in private practice in New City, N.Y. "He has absolutely normal hearing across most frequencies, but at about a 2,000 or 4,000 cycle tone, his hearing takes a sharp drop. We see the same thing in many people exposed to workplace noise."

In their 20s, these individuals might not notice any hearing loss, even though they may have already begun to experience damage within the inner ear. But by the middle years, says Loavenbruck, the hearing loss may become progressively more noticeable and significant.

Louder Isn't Better

A history of listening to rock music is only one of the window-rattling noise hazards that people in middle age have been encountering for decades. Today's world presents much more of a noisy free-for-all than any previous generation ever faced -- blaring police sirens, ear-shattering power tools, head-splitting hairdryers, and the ever-present Walkman-type personal stereos. Over time, their bombing and strafing can wreak cumulative havoc on the inner ear's 20,000-plus sensory receptors (or hair cells), causing permanent hearing loss.

While the Occupational Safety and Health Act of 1970 protects us from noise exposure in the workplace, there are no controls on the din and the racket that greet us in the rest of our lives. In fact, we've become so accustomed to noise that we're barely aware of just how loud the world has become.

"You open the door to many restaurants, and the way that architects have designed them, it sounds like a great party is under way, and it's a place where you definitely want to be," says Pamela Mason, MEd, director of the ASHA's Audiology Practice, Policy & Consultation Unit. "But once you sit down, it's so noisy that you can't hear what the people at your own table are saying."

Even your get-away-from-it-all moments can increase the risk of hearing loss. "Each time you ride a motorcycle, a snowmobile, or a Jet Ski, you might experience some permanent damage to your hearing," says Mason. "You can't even go to the Grand Tetons and get away from noise completely!"

No matter how loud the noise levels in your life, there might also be a genetic component to your hearing loss. Particularly in combination with noise exposure, your genetic predisposition for hearing difficulties may surface at a younger age than it might have otherwise.

"There's reasonably good evidence of a genetic susceptibility to noise-induced hearing loss," says Rick A. Friedman, MD, PhD, chief of the Section of Hereditary Disorders of the Ear at the House Ear Clinic in Los Angeles.

Hearing Loss Denial

Whatever your age, particularly in your 40s and 50s, you may resist admitting that you have a hearing impairment. You could be embarrassed ("I wouldn't be caught dead wearing a hearing aid"). Or you might be skeptical that a problem exists at all ("Everyone knows that hearing loss happens only to old people").

"About three-fourths of the men and women who have a hearing loss never show up at an audiologist's office," says Mason, former director of the audiology program at George Washington University Hospital. Patients often tell her, "My spouse made me come in. She told me that the TV is so loud that she was going out of her mind."

Ironically, the person with the hearing deficit may be the last person to realize he has a problem. Hearing loss tends to occur gradually over a number of years, and people often adjust and may not even be aware that their hearing has steadily worsened -- although family members and co-workers certainly know it. "Their hearing loss may become the norm for them," says Friedman. "They may feel it's normal to miss out on parts of conversations. They often blame the people they're speaking with, complaining that others mumble."

Do You Hear What I Hear?

Your primary care doctor can test your hearing in her office with a portable handheld sound-production device (called an audioscope) that generates tones of various frequencies. If you show signs of possible hearing loss, you probably will be referred to an audiologist, who is trained in assessing hearing disorders and fitting hearing aids.

The available diagnostic tools are more sophisticated now than in the past, says Friedman, and are better able to identify hearing loss, including the site of any damage (in the outer, middle, or inner ear). The audiologist will perform a comprehensive battery of tests.

Once hearing loss is identified, people in their 40s and 50s are frequently intent on "fixing" the problem. "Baby boomers have different expectations about their hearing loss," says Loavenbruck. "Unlike many older people, they're less likely to say, 'It's part of getting older; I'm just going to live with it.' They want to take care of the problem. I find that these younger people are much more likely to say, 'I'm willing to wear a hearing aid if it will help me avoid the communication difficulties that annoy me,' whereas years ago, there was a terrible stigma attached to hearing loss."

Pump Up the Volume

Thanks to new technology, says Friedman, today's hearing aids are much better and much smaller than their predecessors. The most significant recent development in is the availability of digital technology for people with hearing loss.

"The first digital hearing aid was available in the late 1980s," says Mason. "It was a large device that was fitted behind the ear, with a hard wire that went to a large power supply and speech processor worn on the waistband."

But when the public turned a deaf ear to these bulky devices, the manufacturers went back to the drawing boards. "Today, all of the digital components fit into a hearing aid that can be placed into the ear canal and is virtually invisible," says Mason.

There are now several levels of digital hearing aids, says Loavenbruck, "from what are called 'economy' or 'entry level' digital aids, to very sophisticated and quite expensive digital aids that permit a lot of sophisticated programming." The cost of these digital devices ranges from about $1,400 to more than $3,000 per ear.

Do You Have a Hearing Loss?

Here are some questions that can help you determine whether your hearing needs to be formally tested:

  • Do you feel frustrated speaking with friends and family members, straining to hear (and often misunderstanding) what they say?
  • Do family and friends need to raise their voices or repeat themselves when talking with you?
  • Do others complain that you keep the volume on the TV set too loud?
  • Do you have hearing difficulties when conversing on the telephone?
  • Do you feel that hearing limitations are interfering with your social life?
  • When ambient noise is present, such as in restaurants, do you have trouble hearing what others are saying?
  • Do you get into arguments with family members because of an apparent hearing loss?

For a referral to a certified audiologist in your community or information about hearing loss, contact the ASHA at (800) 638-8255 or www.asha.org.

Published July 7, 2003.


SOURCES: Rick A. Friedman, MD, PhD, chief of the Section on Hereditary Disorders of the Ear, House Ear Clinic, Los Angeles. Angela Loavenbruck, EdD, audiologist, New City, N.Y. Pamela Mason, MEd, audiologist; director of Audiology Practice, Policy & Consultation Unit, American Speech-Language-Hearing Association.

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