When teenagers complain that you have the radio on too loud, you might have a hearing problem.

Such was the case with Pam Seighman years ago when her teenage children entered the room one day. And, when the Uniontown woman and her family would watch a television sitcom, she’d notice everyone laughing but not know why. It’s not that she didn’t get the joke—she just couldn’t hear it.

On another occasion, she and her husband, Tom, were dining at a restaurant when, upon responding to a question from a waitress, Pam ordered an iced tea. Only, the waitress was asking the couple if they wanted menus. “Sometimes it’s not good to just assume what someone’s going to say,” Pam recalls.

Today, having worn hearing aids now for 17 years, the 62-year-old woman chuckles when recounting her auditory gaffes from the past. But hearing loss is no laughing matter. When your hearing ability declines, so does your quality of life. Research suggests a link between hearing loss and a number of health concerns, ranging from depression to memory and concentration problems.

Trouble is, most people with hearing impairment don’t realize what they’ve lost. In fact, research suggests that, on average, seven to 10 years elapse between the time a person notices hearing loss and does something to correct it. And, according to a 2013 study, only one in seven people with hearing loss actually uses a hearing aid.

“If, when we had hearing loss, our ears bled, we’d immediately do something about it,” says Dr. Catherine Palmer, director of the Center for Audiology and Hearing Aids at the University of Pittsburgh Medical Center’s Eye & Ear Institute. “The issue with hearing is you don’t know what you’re missing. It tends to be the people around us who realize it.”

Palmer and other experts stress the importance of understanding the causes of hearing impairment, seeking prompt help for hearing loss, and finding the right specialist who can tailor treatment to your individual hearing needs.

The hazards of hearing loss

The effects of hearing loss go beyond the ear. Many people who can’t hear avoid social situations, leading to feelings of isolation, loneliness and depression.

“We notice social isolation a lot with elderly patients,” says Dr. Sara Mason, an audiologist at Yareck’s Better Hearing Center, in Uniontown. “They stop going to church or the senior center. They stop doing things because they’ll inevitably say, ‘I sit there and don’t know what anyone’s saying,’ and they feel bad. We don’t want people to stop living.”

Socialization engages your brain, but when you can’t hear what’s being said or you avoid social situations because of hearing impairment, your brain loses a vital source of stimulation. Consequently, your cognitive health may suffer.

Several studies have linked hearing loss to declines in memory and other aspects of cognitive health. For example, a 2011 study involving 659 people, ages 36 to 90, found that those with hearing impairment were significantly more likely to develop Alzheimer’s disease and other forms of dementia. And, the more severe the hearing loss, the greater the risk of these cognitive problems, the study found.

Some older adults have even been misdiagnosed with Alzheimer’s disease simply because they can’t hear well enough to remember or comprehend what they hear. “One research study that has come out of our lab is looking at a group of people we know to be cognitively normal, and we can simulate hearing loss and do cognitive tests,” Palmer says. “When you do that, they appear to have dementia and score in a range where you think there’s a problem. Absolutely, the inability to hear can impact those scores and potentially lead to a misdiagnosis.”

And, in research published in 2013, investigators from Johns Hopkins University reported that hearing loss was independently associated with increased hospitalizations and poorer self-reported health among adults age 70 and older. One potential explanation for this finding, Palmer says, is that these patients may not hear well enough to follow their doctor’s recommendations.

Why your hearing declines

Sound travels through the ear canal to the eardrum, which vibrates and sets in motion the bones of the middle ear. The bones then forward sound impulses to the hearing organ of the inner ear (cochlea), where tiny hair cells transmit signals to the auditory nerve that your brain interprets as sounds. The process of hearing requires the proper functioning of all of these structures.

Just as many people eventually need reading glasses by a certain age, many also notice gradual declines in their hearing. The most common form of hearing loss, known as presbycusis, occurs due to age-related changes in the inner ear, particularly the hair cells of the cochlea, brought on most commonly by cumulative exposure to loud or prolonged noises.

Historically, the noise from loud working environments was the leading cause of noise-induced hearing loss, but today, the chief culprit is recreational noise from sources such as loud concerts, sporting events or iPods. “We’re seeing more and more people in their late 40s and early 50s with hearing loss purely from recreational noise,” Mason says.

Chronic medical conditions that affect blood supply to the ear, including high blood pressure, diabetes and heart disease, may contribute to hearing loss. “When you think of the inner ear, where the business of hearing happens, it’s a very sensitive vascular system,” Palmer explains. “If something’s going wrong with your vascular system, it’s going to impact your ear.”

Also, some medications, including chemotherapy drugs, high-dose aspirin and certain antibiotics, may cause hearing loss, so tell your doctor if you experience hearing changes after starting a medication. Hearing loss also may result from something as simple as a buildup of earwax or fluid clogging the ear canal, or something as severe (but less common), as a tumor on the auditory nerve.

Seek prompt medical attention if your hearing loss is accompanied by ringing or buzzing in the ears (tinnitus) or any dizziness or unsteadiness. An otolaryngologist (ear, nose and throat specialist) can address any medical causes of hearing loss. However, about 90 percent of people with hearing loss have the type that requires the services of an audiologist, Palmer says.

Addressing hearing loss

Mason recommends undergoing a baseline hearing exam with an audiologist at age 40 and repeating the test in 10 years if the initial results are normal. Undergo repeat testing at an interval your specialist recommends.

“You should feel very comfortable with the place you choose to go,” Mason advises. “You should have good office staff and a good rapport with your hearing professional and be comfortable that the person you’re dealing with has your best interests at heart.”

As part of the evaluation, the audiologist will perform a battery of tests to evaluate the severity and type of hearing loss, and may also test your vision and dexterity. But the key component of any hearing-loss assessment is a detailed conversation between you and the audiologist about your hearing needs and how your hearing impairment affects your day-to-day life. Any choice of hearing aid should be based primarily on your daily activities and lifestyle.

“When you think about what you’re going to do about your hearing, you’re looking for a communication solution,” Palmer adds. “It might involve hearing aids, a device for your phone and TV, or communications strategies. What’s essential is to work with an audiologist you like and trust and to match the technology to the individual person.”

Not your parents’ hearing aids

Modern hearing aids aren’t the clunky sound amplifiers that your parents or grandparents used to wear. Smaller and more discreet, today’s hearing aids are sophisticated computers that automatically adjust to keep sounds at comfortable levels by amplifying soft noises while limiting loud ones. They’re less likely than older models to feed back, or squeal, and they’re better able to reduce background noise in crowded rooms or adjust for better hearing in quiet environments. And since most people require two hearing aids, many newer devices work in tandem so the user has a better spatial awareness of a sound’s source.

“One of the biggest leaps in hearing aid technology is the wireless technology,” says Benjamin Richard, regional sales director with Yareck’s Better Hearing Center. “The hearing aids share information and process as a unit, so it does help locate speech and limit noise.”

Some newer hearing aids connect directly to cell phones via BlueTooth technology. This same technology also allows people to hear their radio, computer or television directly through their hearing aids. And, with the help of a wireless remote microphone that communicates with the hearing aids, users, for instance, can better hear lecturers or even a dining companion in a noisy restaurant.

Hearing aids come in a variety of styles, from models that fit behind the ear and leave the ear canal open, to devices that fit in the ear and completely in the ear canal. Each style has advantages and disadvantages.

As hearing aid technology continues to evolve and manufacturers tout their newest high-tech offerings, be sure that you base your choice of hearing aid on your needs, not the marketing of the hearing aid manufacturers, Palmer says. You might pay for technology you don’t really need.

“There is no best hearing aid, but there is a best hearing aid for each individual,” she says. “The best hearing aid is the one a person will wear.”

You’ll need to wear your hearing aids for a week or two, then return to your audiologist to make any fine adjustments. It takes time for your brain to adjust to all the sounds it’s been missing, and you might be overwhelmed when you first try your hearing aids.

“I have found that first-time wearers will come in at about the three-month mark and inevitably say that they don’t hear as well as when they first put them on,” Mason says. “That’s what we like to hear. That means the brain has acclimated.”

To help your brain adapt to your new hearing capabilities, you should wear your hearing aids from the time you wake up until the time you go to bed, Palmer says. Also, consider taking part in auditory training programs, some of which are available online.

Most hearing aids last at least five years, Palmer says, although many last longer. Follow up with your audiologist, and schedule routine appointments to clean and maintain your hearing aids. Most hearing aids have a two-year warranty, so be sure to have them cleaned and checked just before the warranty expires.

Sweet sounds

Despite the benefits that hearing aids can provide, they’re still widely underused, research suggests. One reason, Mason says, is vanity: People simply believe they’ll be perceived as “old” by wearing hearing aids.

Another is cost. A good pair of hearing aids costs about $3,000 to $6,000 per set, Richard says, and most insurance providers do not cover the cost. But the cost includes not only the devices, but also the expertise of the audiologist.

“This isn’t just a science. It’s an art and a science,” Richard adds. “The technology is the science part, but the audiologist is the artist who can help you hear better. People are trying to do Internet hearing aid sales, but you don’t get the human touch and the art. There’s no way you can just program a hearing aid and ship it out to someone and have it be right for them. It takes a partnership with your hearing professional.”

Since 2006, Seighman has benefited from the treatment she’s received at Yareck’s, although she still has difficulty hearing in certain situations. For instance, she avoids the bank drive-thru because she has trouble hearing the teller speak over the intercom. From time to time, she still calls upon her husband to be her “designated listener.” And, whether she’s at home or volunteering at Fallingwater, she might have to ask someone to repeat what they’re saying to her or remind them to look at her when they speak.

After all, Mason emphasizes, hearing aids don’t cure hearing loss.

However, Seighman says, she’s thankful for the sweet sounds of life that her hearing aids and Mason’s “art” have restored to her.

“I took notice of my hearing loss early and did something about it, which I would encourage anyone to do,” she says. “So many people shy away from hearing loss, but you really need to step up and take as much control of it as you can.

“The first time I put in the hearing aids, the first thing I said was, ‘Please, don’t take these out,’” Seighman recalls. “I heard the zipper of my purse close, the turn signal in my car, things that go missing that you don’t think of. And then the next morning I heard the chirping of birds. When it comes back after so many years, you forget what a wonderful sound that is.”

Action points

 Wear hearing protection while working or playing in loud environments.

 Seek an immediate medical assessment if your hearing loss develops suddenly or is accompanied by dizziness or ringing.

 Visual cues are necessary for effective communication, so make sure you have the optimal eyeglass prescription.

 Find out if your insurance provider will cover the cost of hearing aids.

 If you’re in a noisy environment, try to sit with your back to the wall and keep noises in front of you so you can cut down on background noise.

 If you have hearing difficulties, consider these tips to help you communicate more effectively with or without hearing aids:

- Face the person who is speaking, and make sure he or she faces you, maintaining eye contact throughout the conversation.

- Ask the person to keep his hands away from his face and mouth when speaking.

- Ask the person to speak clearly and not too rapidly.

- If you have trouble understanding what the person has said, ask him or her to rephrase the statement.

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