Teaching patients how to prevent hearing loss

Most should expect hearing loss with age

While some hearing loss is inevitable as people age, there are steps that people can take to help protect their hearing. The most important, as would seem obvious, is to avoid exposure to excessive noise, says Robert Dobie, MD, professor of otolaryngology at the University of California, Davis.

The most hazardous exposure is in the work environment, although there are federal laws that require employers to provide protective devices and annual hearing tests in some work situations. However, the construction and agriculture industries are exempt.

Therefore, it is important for individuals to know when they need to purchase devices to protect their hearing in their work environment whether federal laws require it.

"The basic rule of thumb that I give people is that if they have to shout to have a conversation at arm’s length or get closer than arm’s length to have a conversation, the environment is excessively noisy," says Dobie.

Also, if their ears ring or hearing is dull immediately following work and they recover in a couple hours or by the following morning, these are signs that they need to use protective devices in their work environment.

According to the American Academy of Oto-laryngology — Head and Neck Surgery based in Alexandria, VA, prolonged exposure to noises above 85 decibels can damage hearing, so protective devices should be worn.

Hearing loss occurs when loud noise kills the nerve endings in the inner ear, and as exposure time to loud noise increases, more nerve endings are destroyed, according to the academy.

That is why work environments where the noise is not constant but broken up so that the ears have a chance to rest and recover between exposures are less harmful than those with constant noise.

"It is not just how loud the noise is, but how long it is. It’s just like when a person sticks their hand into the oven for five seconds or even 20 seconds, nothing bad happens; but if they leave their hand in the oven for an hour, it will bake it," says Dobie.

In addition to work, recreational activities also can cause excessive noise exposure for extended periods of time, and in such cases, ear protection should be worn. Shooting a firearm is one of the most hazardous recreational activities whether a person is target practicing or hunting. A shotgun blast measures 170 decibels.

People who work in noisy environments often are required by federal law to have yearly exams to determine if they are experiencing hearing loss. Those who experience hearing loss frequently admit that they are not wearing the proper protection or their earmuffs are old and need to be replaced. The tests help employers evaluate whether the steps they are taking to protect workers are effective, says Dobie.

However, hearing tests in general for adults who are not exposed to excessive noise and have no symptoms of hearing loss are not cost-effective, he adds.

Signs of hearing loss include difficulty using the telephone, talking to people when their face cannot be seen, and hearing and understanding people and children with soft, quiet, high-pitched voices. The problem often can progress to the point where a person frequently asks others to repeat what they said. Missing an increasing number of words during a conversation in a noisy environment such as a restaurant also is a sign of hearing loss.

"With gradual, very slow loss of hearing in both ears, the time to see the doctor is when it is bothering you in your daily life enough to make the visit worth the trouble," says Dobie.

However, when people experience a rapid or sudden hearing change or if they have a loss of hearing in only one ear, they should see their physician right away. These signs and symptoms could signal a more urgent health problem such as a tumor on the hearing nerve, he notes.

While hearing tests are not necessary for adults who aren’t experiencing signs of hearing loss, children do need to be tested. Babies should have their hearing tested to determine if they have been born deaf or hard of hearing because early detection can make a difference in their speech and language development, says Dobie.

Also, children should be tested intermittently during childhood. Typically, they are tested in kindergarten and first grade, he explains, but they also should be tested if their parents notice that their speech and language ability are not developing properly.

For those who have trouble hearing, the use of a hearing aid can help. Yet there are many factors that prohibit people from getting one, says Dobie. These include the stigma of wearing a hearing aid, the cost, and the fact that lots of people who have purchased a hearing device are not happy with them.

"Hearing aids are just amplifiers. They make soft sounds louder so people can hear them, but they don’t correct the distortion that comes with having a hearing loss," he says.

Hearing aids have improved within the last 10 years, and federal laws require those who sell hearing aids do so on a 30-day trial basis. That means that people who are not happy with their aids can get their money refunded minus the service charge for fitting, says Dobie. 


For more information on the prevention of hearing loss or to obtain handouts and brochures for patients, contact:

  • American Academy of Otolaryngology — Head and Neck Surgery, One Prince St., Alexandria, VA 22314-3357. Telephone: (703) 836-4444. Web site: www.entnet.org.