Season 1 | Episode 5
Description: Hearing loss is often thought of as an inevitable part of getting older. But how much do things such as noisy entertainment venues, audio devices, and powered recreational equipment expose people to damaging levels of sound– especially the younger generation? Dr. Lustig is here with us today to discuss and break down the biggest myths around hearing loss and how consumers can prevent it.
>> Narrator: Welcome to the medical myths podcast. Where we set the record straight on today’s most talked about medical topics and questions. On every episode, we’ll hear stories from the front lines of medical care to help dispel common myths and answer the questions you’ve been itching to ask your doctor. And remember you can always find more information on this week’s topic and hundreds of others on MerckManuals.com. Now here’s your host editor-in-chief of the Merck Manuals, Dr. Robert Porter.
>> Dr. Robert Porter: Welcome to the medical myths podcast where we set the record straight about today’s most talked about topics and questions. I’m your host Dr. Robert Porter, editor in chief of the Merck manual, one of the world’s most trusted medical resources. On this episode we welcome Dr. Lawrence R. Lustig, Professor and Chair of the Department of Otolaryngology and Head and Neck Surgery at Columbia University Medical Center at New York Presbyterian Hospital. Dr. Lustig also authors the hearing loss sections of the Merck Manual. Now some of you might be thinking this isn’t your problem because hearing loss is just something that happens when you get old, so you don’t have to worry about it when you’re young. Well that’s one of the myths Dr. Lustig is here to talk about with us today. He’s also going to talk about how we can prevent hearing loss. Dr. Lustig, maybe we can start by explaining to our listeners how hearing loss works, how do you actually lose something that you were born with?
>> Dr. Lawrence Lustig: First of all, thank you for having me on your program Dr. Porter, it’s really exciting to be here to speak to the audience. I think a good place to start is how the ear works, and then backtracking to what happens when we lose hearing. So, in a nutshell, sound comes down the ear canal and it hits the eardrum and the vibrations of sound travel down the three middle ear bones to get to the inner ear. Within the inner ear there are these little, tiny cells called hair cells that then convert those sound vibrations into an electric impulse that then goes off to the brain.
So, we can lose hearing in any number of ways along that pathway. For example, if you have wax in your ear, that blocks sound. Or if you have a hole in your eardrum and fluid in the middle ear. Those types of hearing losses that block sound from getting to the inner ear, we call those conductive hearing losses. In contrast, there’s inner ear or sensory neural hearing loss, and that’s usually due to problems with those little, tiny hair cells that make the conversion of soundwaves to electricity. If those die then you lose hearing as well. The kind of hearing loss we get from each of those different types of problems are treated very differently.
>> Dr. Porter: What’s the role of aging with that? Do things just wear out when you get older? I know my hearing isn’t what it used to be.
>> Dr. Lustig: Well, first of all, hearing loss is really a problem for everybody. Every single one of us loses hearing as we age. If you look in the inner ear of people who have age related hearing loss, we see a number of things. We see loss of some of those hair cells that make those sound wave conversions. We also see loss of some of the neurons that bring sound from the hair cells to the brain. It’s a subject of great debate in our field, but when you look at people, they really have a combination of those problems. There are some other abnormalities of the inner ear as well. Now, even though we all lose hearing as we age, what differs is the rate at which we lose that hearing and that’s different for everybody. Some people may lose hearing relatively quickly in their 50s and other people may have relatively good hearing into their 70s or 80s. One of the biggest determinants of that rate of hearing loss is your genes and whatever you were born with. Some people have genes that just make their hearing loss go much quicker, whereas other people have really much stronger genes that allow them to hear better until much later in life. There are other things like noise exposure, there’s certain kinds of medication, and certain medical conditions that can also contribute to that age-related hearing loss as well.
>> Dr. Porter: Dr. Lustig, a lot of parents are concerned about their child’s ear infections. What role do they play during hearing loss?
>> Dr. Lustig: Absolutely. Ear infections in kids are a major cause of hearing loss. The reason why kids get ear infections is because their eustachian, which is the tube that goes from the middle ear to the back of the nose and helps regulate air pressure, isn’t fully developed, and when it cannot regulate that air pressure what happens is that fluid builds up in the middle ear, and the presence of the fluid can block sound, so you can end up with the inability to get sound to the inner ear. If that fluid gets infected you can end up with an ear infection, and then those infections can do even more damage by causing such problems as holes in the eardrums or even skin cysts in the middle ear cholesteatoma.
There is no question that ear infections can lead to hearing loss. Now, the kind of hearing loss you get from an ear infection is different than the kind of hearing loss you get when you’re elderly and have age related hearing loss. The hearing loss we get from ear infections is called conductive hearing loss, or blockage of sound to the inner ear. When you get that kind of hearing loss, your inner ear can still process sound, so if you have a way of getting sound to the ear, your inner ear being normal can process sound normally. So, for example, patients with these conductive hearing losses, if we can’t fix the conductive hearing loss, hearing aids work terrific because getting sound to the inner ear, the ear will process it fine. The other issue with those kinds of hearing losses is we can often times fix it. So, little kids with fluid in the ears, we put tubes in to help drain the fluid. If you have a hole in the eardrum, we fix the hole. If you have some other pathology related to those infections, we try to fix that other pathology. In other cases, we can improve, if not completely reverse the hearing loss from ear infections. Not always, but in many cases.
>> Dr. Porter: Thanks for the explanation. It is good for our listeners to know about the different types of hearing loss. Now noise is something that is really ubiquitous in our environment anymore, what kinds of noise are particularly damaging to the ear, or is just any noise a problem?
>> Dr. Lustig: Well noise is a really important one. Noise is just a part of life these days. You’ve got kids listening to their iPods with their earbuds, you’ve got workers on the construction site, you’ve got musicians and people going to concerts- sound is just a part of life. Noise can cause damage to the ear in a whole host of ways.
>> Dr. Porter: Does it have to be super loud like a rock concert? That’s what I usually think of when I think of something that’s too loud.
>> Dr. Lustig: Yes, so rock concerts, nightclubs, I’ve been to weddings and bar mitzvahs where the noise was so loud that I had ringing in my ears, I knew it was too loud. So, there are a couple of things that really determine how noise and loud sounds can cause hearing loss in the combination of two very important factors. Number one the loudness and number two the length to that exposure. So, for example, a factory razor, you know one of those electric shavers, puts out about 85 decibels and if you were to put that next to your ear for eight hours continuously everyday that could lead to hearing loss.
>> Dr. Porter: Fortunately, it does not take me that long to shave in the morning.
>> Dr. Lustig: Exactly, or maybe grow a beard. But there are other sounds that are much more powerful that even an isolated exposure can cause permanent hearing loss. Things like gunshots, standing next to a jet engine, jackhammers, those kinds of things where the sound decibel level is very powerful and it does not take much exposure to cause a permanent hearing loss.
>> Dr. Porter: I date my hearing problems back to when I was a teenager. I used to do a lot of high-power rifle shooting, and that was in the day where we didn’t wear any hearing protection and my ears haven’t been right since then. Can you tell about other sounds that are damaging you? You know like if you pick up something hot it obviously hurts and you don’t do it but can sounds hurt you that aren’t necessarily painfully loud?
>> Dr. Lustig: Explosions can cause painfully loud sounds and can also physically damage the eardrum, middle ear and inner ear structures, fire crackers. You know another really important source of noise exposure are these modern stadiums. You’ve been to some of the football games or watched them on tv, and you see a sound meter and people get very excited when they see that sound meter go up to 130-140 decibels. That’s like standing next to a jet engine, and I have no doubt that people exposed to that level of sound are causing damage to their ears. Fortunately, sound exposure is also one of the easiest things to treat because it’s preventable, and it is preventable with a very simple and easy solution called an earplug and you can go to your local drug store, spend a couple dollars for some foam or silicone earplugs, I personally tell my patients to put them in their glove compartments and their jacket pockets. If you know you are going to be exposed to a loud sound bring them with you and put them in their ears. It’ll save you a world of pain later in life when suddenly you can’t hear as well when you go out to a restaurant, or you have permanent ringing in your ears.
>> Dr. Porter: Thanks Larry. We are going to take a quick break here. Stay tuned for more.
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>> Dr. Porter: Are there some rules of thumb people can use to tell when noise is too much and if they ought to wear their protection? I mean obviously we can’t all carry decibel meters around with us, although I do know there is an app for that. You can download pre-decibel meters, but even that’s not practical so what rules of thumb can people use to tell when they are in an environment that’s a bit too loud?
>> Dr. Lustig: So, my general recommendation to patients and friends and family members is if you are in a situation where you have to yell above your normal speaking voice to be heard, then it’s probably too loud and you need some type of ear protection. If you are at the gym and you have your earbuds on and your music blasting and someone walks up to you and starts to talk and you can’t hear them because its too loud, it is probably too loud and you should turn the volume down. Those are two generally pretty good rules of thumb to use.
>> Dr. Porter: Now speaking of these earbuds and speakers, how common is it that people listen to them too loudly?
>> Dr. Lustig: Well, it’s hard to know, but its interesting if you look at recent studies of adolescents today compared to 15-20 years ago, there’s no question that there’s more hearing loss today than there was back then. Now we listened to loud music. We went to concerts too, but the hearing loss seems to be more ubiquitous today and we don’t know why. It certainly could be that more people are exposed to loud noises through earbuds, but I can’t tell you how many times I’ve been on an elevator and I see somebody with earbuds on and I can hear the music, and I’m not wearing the earbuds. That’s probably too loud, but I think the general rule of thumb is when people speak to you and you can’t hear them it’s probably too loud.
>> Dr. Porter: Well that sounds like most of the people at my gym that are wearing earbuds. Let’s jump over and talk about the consequences of hearing loss. I know it’s certainly inconvenient, I know my wife mentions to me that my favorite word is “what,” but isn’t it something more than that?
>> Dr. Lustig: Well, all you have to do is talk to someone who can’t hear. Ask them what kind of problems they have. Think about Grandma or your favorite uncle sitting at the dinner table who can no longer take part in a dinner conversation because they can’t hear through all of the background. Think about all of the people who have difficulty at work because they have a hard time hearing in a meeting. People who don’t enjoy going to a restaurant anymore because they can’t hear the people, they are dining with because of all of the background noise. There’s a number of consequences to hearing loss in adults. In kids it’s even more important because it can start to affect school performance and their ability to achieve scholastically in some instances. But what is really interesting is some data that has come out over the last decade that equates hearing loss with dementia. Now, we know that there is a link between hearing loss and dementia. What we don’t know is whether the hearing loss causes the dementia, the dementia causes the hearing loss, or is whatever is driving both of those just so happen to coexist. That is currently under very active study by researchers around the country.
>> Dr. Porter: Well that sounds like something we don’t want to take a chance with then.
>> Dr. Lustig: No, it doesn’t. But it makes sense, right? Think about the fact that if you’re withdrawing from conversation because you can’t hear, you become more withdrawn. It probably exacerbates whatever depression or dementia that might already exist, or it could even spark depression because you can no longer enjoy the activities that you used to be able to enjoy.
>> Dr. Porter: Well that certainly makes sense. Once you’ve lost hearing does it ever come back?
>> Dr. Lustig: That’s a great question. As a general rule, no. But I am going to put an asterisk on that. Again, there are two types of hearing loss in the world. There are conductive hearing losses which prevent sound from getting to the inner ear, and there are sensory neural or inner ear losses. With conductive hearing losses, let’s say there is wax in the ear or a hole in the eardrum, fluid in the eardrum or a fixation of the middle ear bones, we can oftentimes intervene and improve the hearing loss. With sensory neural hearing loss, we don’t really have a way of restoring the function that has been lost, but what we can do is we can give people hearing aids for mild to moderate or severe losses we can them cochlear implants for severe or profound losses, and get them some hearing back that they’ve been missing. It’s not perfect. It certainly does not restore normal hearing but it is far better than any sort of rehabilitation.
>> Dr. Porter: I know in my medical practice in the emergency room, I’d often have people that were hard of hearing and it was very hard to communicate with them and I would say “Where’s your hearing aid, let’s put that in,” and they would say, “I don’t need a hearing aid,” and they would become very angry when I suggested that maybe they did need some hearing assistance. Why are people reluctant to wear hearing aids?
>> Dr. Lustig: That is a really, really great question, and it brings into mind a bunch of social factors that play here. I think some of it has to do with the historical concept of the deaf and dumb. That somehow if you’ve lost your hearing you’re not as smart as everybody. Which, of course, as we know today is completely erroneous, it was really that they couldn’t effectively communicate. The second issue is that many types of hearing loss that we see are in the elderly, and there is no question that our society values being young and healthy, and I think a lot of people don’t want to admit that they’re getting older and don’t want to admit to having hearing loss. This makes no sense to me because people wear glasses and nobody equates wearing glasses with getting older even though many of the elderly wear glasses. The other issue is if you look at kids with hearing loss and you give them hearing aids, kids today are completely accepting of hearing aids and they don’t have any problems with it. So, this is something that we learn when we get older that somehow wearing hearing aids is not socially acceptable or desirable. Hopefully we can change that because of all of the downsides to hearing loss.
>> Dr. Porter: I guess now, for the kids, it’s normal to see someone walking around with things in their ear, they probably think its abnormal if you don’t have something in your ear when you’re walking around.
>> Dr. Lustig: Many times, our kids choose the most outrageous colors like zebra stripes or hot pink. It is not something they are trying to hide. They are very proud of the fact that they have this fun little instrument in their ear that helps them hear.
>> Dr. Porter: Good for them. What are some other barriers to hearing aid use? I understand they are pretty expensive, aren’t they?
>> Dr. Lustig: Yes. Unfortunately hearing aids are pretty expensive. Like cars, they all can get you from A to B, but the more you spend the more bells and whistles you get. Hearing aids will amplify sounds. Some of the more expensive ones will do things like cancel out background noise, or allow you to hear better in a noisy background with microphones that preferentially amplify in one direction or another. But you pay for these, and a really good quality set of hearing aids can run you sometimes as high as $8,000. Now, I think what we’re going to see over the next couple of years is a lot more consumer friendly devices that will be marketed directly to people where you don’t need to come in to a doctor or audiologist.
>> Dr. Porter: So, are these those personal sound amplification devices that I’ve started hearing about?
>> Dr. Lustig: Yes. This was created through legislation by our government that now allows direct to consumer selling of simplified hearing aids, if you will. They are called personal sound amplification devices. They are much less expensive than your typical hearing aid that you would get from an audiologist or hearing aid dispensary, and many times they will communicate with your smart phone, and they will be much more reasonable to obtain. The other great thing about them is I think they will be an entry way for a lot of people, even though they are not adequate, but it will make them realize every moment that they are missing from their hearing loss. They are not for everybody, but they will be a first step for many people and hopefully will allow many more people to access hearing amplification than are currently getting it and need it.
>> Dr. Porter: Yeah, that reminds me a lot of how you can get reading glasses in the drug store just by picking up a pair, trying them on, and they are really good enough for a lot of people but at some point you may need a prescription correction, but for people who don’t they are certainly a reasonable alternative. What would you say are some of the biggest myths people have about hearing loss?
>> Dr. Lustig: There are a couple of huge myths about hearing loss that we hope will someday be corrected. One is there is nothing you can do about hearing loss. We know now that there are many things, we can do about hearing loss- there is hearing aids, there is cochlear implants. Even coming down the pike there is a number of new molecular technologies that are not yet available but hope will be in the next 5-10 years or so.
A second big myth is that it’s natural to have hearing loss in the elderly and you should just leave it alone because old people don’t need to get it fixed. I think to deny treatment based on someone’s age, not only is it discrimination but it’s wrong. Again, with all of the great treatment we have for hearing loss, it is important to try to correct the hearing loss. We don’t know if the relationship between hearing loss and dementia is a direct one, meaning that one causes the other, but there is no question that fixing your hearing loss will undoubtedly help all of the other issues going on, like depression and dementia, in somebody’s life because at least you will give them access to their surroundings in a better way. The last thing, that I think is very important, is to protect your hearing. The easiest thing to do to protect your hearing when you’re getting older is to use good quality protection when you’re being exposed to loud noises. They are simple, they are inexpensive, they are easy to obtain, and it is the one intervention that we have that can really and truly prevent hearing loss for those of us who are exposed to noise.
>> Dr. Porter: So, protect your ears, and if you notice some problems, get your doctor to check you out and make sure it is nothing that cannot be fixed easily, and then if you need, get a hearing aid. Where can our listeners go to learn a little more about hearing loss?
>> Dr. Lustig: The best place to go is to your local audiologist or ear specialist. There are a number of fantastic resources on the internet. I would stay with the really reputable sites like the National Institute of Deafness and Communication Disorders. They have some fantastic consumer information on there. The websites for the Academy of Otolaryngology and the American Academy of Audiology also have a really extensive amount of information on hearing loss. Lastly, of course, there is the Merck Manual, which has fantastic information on hearing loss as well.
>> Dr. Porter: Written by Dr. Lustig.
>> Dr. Lustig: Yes.
>> Dr. Porter: Well thanks, Dr. Lustig, for your time and expertise. I think we’ve all learned a lot about how hearing loss works, as well as some tips for preventing it. For information on these and hundreds of other medical topics please visit merckmanuals.com.