By Dr. Mercola
Nearly 20 percent of Americans, or 48 million people, report having some degree of hearing loss.1 After age 65 that percentage continues to rise as age is the strongest predictor of hearing loss.2 Almost 15 percent of school-age children also have some degree of hearing loss. While hearing loss affects millions, it is an invisible condition, often creating a barrier between the sufferer and society.
In adults, the most common cause of hearing loss is noise pollution and aging. As you get older changes occur in the inner ear that may trigger a slow and steady loss of hearing. Noise-induced hearing loss may happen suddenly or more slowly over time, while hearing loss that results from an infection more often occurs suddenly.
It may be easy to take your hearing for granted as it happens without effort on your part. However, it is a complex process that begins with sound occurring in your environment and ends in your brain. Unlike other senses that involve a chemical process, such as smell, taste or sight, hearing involves strictly physical movement.
Loss of hearing may increase your risk of other health conditions and of becoming socially isolated. In an effort to reduce this risk, many turn to hearing aids to amplify the sounds in their environment. However, the cost of these little pieces of equipment may be outside your budget, and they are not covered by traditional Medicare or private insurance companies.
Recent research has found alternatives for mild or moderate hearing loss that are more cost effective. By understanding how your hearing works, and how the equipment interacts with hearing function, you may be better equipped to choose the right device for your individual needs.
How You Hear
Sound is created by causing vibrations through the air, which your ears capture. The structure of your outer ear helps you decipher the direction from which the sound originates. Once past the outer ear, the sound waves enter the ear canal and vibrate your eardrum, a thin piece of skin that sits between the outer and middle ear. However, your eardrum is far from passive. When exposed to loud noises for a prolonged period, it becomes more rigid, essentially dampening the noise level.
Once in the middle ear, the sound waves move a group of tiny bones called the malleus, the incus and the stapes. Collectively called the ossicles, these are the smallest bones in your body. They are used to amplify the force of the sound from your eardrum as it passes through the middle ear to the inner ear and the cochlea. Fluid in the cochlea conducts the sound where it is translated into nerve impulses your brain can recognize.
Finally, as sound waves reach fibers with a resonant frequency, a burst of energy is released that moves tiny hair cells in the organ of corti, a structure stretching across the length of the cochlea. The movement of these hair cells generates an electrical impulse through the cochlear nerve that transmits information to your cerebral cortex in your brain for interpretation.
The concept of how hearing works is fairly straightforward, but the specifics of how these small structures produce recognizable patterns of sound in your brain is complex. Scientists are still learning how your brain interprets these electrical signals, especially as it relates to prevention and treatment of hearing loss.
Over-the-Counter Amplifiers May Help Mild to Moderate Hearing Loss
A hearing aid is a small electronic device that makes some sounds louder.3 The device contains a microphone that accepts the sound, an amplifier that makes the sound louder and a speaker that delivers the sound into your ear.
They are primarily used to help improve both speech and hearing in people who suffer hearing loss. However, only 20 percent of people with a hearing loss actually use hearing aids, as the cost often averages $4,700 for a pair.4 Traditional Medicare plans and many private insurance companies don't pay for hearing aids.
Recent research published in the Journal of the American Medical Association5 found over-the-counter amplifiers sold at a fraction of the cost of hearing aids can potentially improve your hearing almost as well as hearing aids. A comparison was made between five different personal sound amplification products (PSAPs) and conventional hearing aids, which require a physician's prescription and adjustment by an audiologist.6
Forty-two adults whose average age was 72 and who suffered mild to moderate hearing loss participated in the comparison study. In a sound booth, the participants listened to sentences with "speech babble noise" in the background and were asked to identify what was said without assistance, equipped with a hearing aid and then with the PSAPs.7
Without a hearing aid, the participants understood 77 percent of what was said. With a hearing aid, they understood 88 percent, and with four of the PSAPs, accuracy was between 81 percent and 87 percent, depending upon the model. The fifth $30 model resulted in a 65 percent accuracy, less than what the participants experienced without assistance, as the amplifier was poor quality and distorted the sound.
Hearing aids are regulated by the U.S. Food and Drug Administration (FDA), but PSAPs are not. The PSAPs are available online and at stores. According to the FDA, PSAPs are designed to be used by people who do not have hearing loss, to help them distinguish distant sounds. Study author Nicholas Reed, an audiologist at Johns Hopkins School of Medicine, commented on the use of PSAPs and hearing aids:8
"Hearing aids are regulated medical devices and should all be able to aid someone with hearing loss. While not all hearing aids are the same, they should all be able to meet this minimum requirement of making sound louder at appropriate frequencies and with minimal distortion. The results suggest that the [PSAP] devices are technologically and objectively capable of improving speech understanding in persons with hearing loss."
What Are Your Options?
With advances in technology, some of the PSAP devices are performing as well as many prescribed hearing aids. By law, manufacturers of PSAPs are not allowed to advertise or label their products as intended to help with hearing loss.9 Without regulation, PSAPs do not have design control requirements or performance standards, meaning consumers must do their due diligence before purchasing a product that may lead to results worse than not using any product.
However, without regulation, the industry is advancing the technology more quickly. Companies such as Samsung and Panasonic say they are working on options for consumers that include Bluetooth capability that connect wirelessly to smartphones, tablets and digital assistants such as Apple's Siri.10 It's anticipated these products will be sold over-the-counter. Customers will test their own hearing using apps on their smartphones or online programs.
In an effort to reduce barriers to purchase of products that help you communicate, both the President's Council of Advisors on Science and Technology and the National Academies of Sciences, Engineering and Medicine came out in favor of making low-cost, over-the-counter devices available to consumers. Both organizations point to a significant body of research that links hearing loss to further health risks, creating a financial and emotional burden on families and communities.
Options for PSAPs and hearing aids are changing as technology advances. Sens. Charles Grassley (R-Iowa) and Elizabeth Warren (D-Mass.) recently announced they intend to introduce legislation that endorses the manufacturing and sale of over-the-counter hearing aids without requirement of a medical prescription or audiologist evaluation.
Their goal is to lower cost and increase access, as six companies currently control 98 percent of the market, contributing to the high price of the products. The four amplification devices Reed used in his study that resulted in an 81 percent to 87 percent accuracy rate in hearing were:
• Sound World Solutions CS50+
• Etymotic Bean
• Tweak Focus
The fifth was a low-cost MSA 30X Sound Amplifier, which yielded accuracy results that were worse than not using anything. Dr. Frank Lin, otolaryngologist at Johns Hopkins School of Medicine and a member of the National Academies committee, commented on the use of PSAPs: "Some PSAP companies are very good, founded by former hearing aid executives and engineers. The devices you see in Walmart for $40 … are terrible."
Health Risks and Costs Associated With Hearing Loss
The cost of mild to moderate hearing loss, which may be addressed by making amplifiers available over-the-counter cheaper than hearing aids, may make a significant financial impact on your community and your family. Loss of hearing isn't just frustrating; it may also be linked with other health risks that are both emotionally and financially costly.
In a study at Johns Hopkins, researchers tracked over 600 adults for 12 years, and found even mild hearing loss doubled the risk of developing dementia, while moderate hearing loss tripled the risk.11 Hearing loss may contribute to an increase in brain atrophy and social isolation that may contribute to the development of dementia.
In another study from Johns Hopkins, researchers found those with moderate to severe hearing loss over age 70 had a 54 percent higher risk of death.12 Yet another study found middle-aged adults who had untreated hearing loss experienced 33 percent higher medical bills compared to people who didn't have a hearing loss.13
Psychologist Mark Hammel damaged his hearing in his 20s while serving in the Army. It wasn't until he was 57 that he got his first pair of hearing aids. He said:14 "People with hearing loss often don't realize what they're missing. So much of what makes us human is social contact, interaction with other human beings. When that's cut off it comes with a very high cost."
Those suffering from hearing loss that is left untreated are also more likely to experience anger, depression, cognitive impairments and paranoia. A survey of over 2,000 hearing impaired individuals also uncovered the frustrations of family members who were saddened by misunderstandings and difficulty communicating with their loved one.15
People who have hearing loss also find they experience greater fatigue, stress and headaches as a result of trying to hear and understand during the day.16 They also report greater problems with eating, sleeping and sex. People who have a hearing impairment are likely to earn less, or be unemployed. Hearing loss may also impact your ability to pick up on auditory signals such as alarms, bells or shouts of warning, raising your risk of being injured in an accident.
Use Nutrition to Support Your Hearing
Your body has an amazing system to protect your hearing that you can support using good nutrition. In fact, nutritional imbalances may contribute to some hearing loss.17 Age-related hearing loss results from how your brain processes information By filtering out unwanted sound, your brain gives you proper feedback on what you hear. This begins to decline in your 40s and 50s, making it more difficult for you to sort out what you're hearing. Nutrients that appear to be the most beneficial to protect and improve your hearing are:18,19,20,21
• Carotenoids, especially astaxanthin and vitamin A
These nutrients support your hearing in a number of ways, including:
• Protecting against oxidative stress in the cochlea
• Preventing free radical damage
• Improving blood flow, thereby reducing cochlear damage related to a compromised vascular system
• Improving homocysteine metabolism
The support for vitamin A is mixed. In one large study that included data from more than 65,500 women, no correlation was found between vitamin A intake and risk for hearing loss.22 However, a number of other studies have found a positive correlation. Researchers have found zinc may help to improve idiopathic sudden sensorineural hearing loss (SSNHL).
This sudden and unexplained loss of hearing has been typically treated with high-dose steroids, even though the evidence to support the effectiveness of treatment is limited. In one study, intravenous (IV) magnesium was found effective against SSNHL;23 48 percent of patients achieved recovery using a combination of IV magnesium and carbogen inhalation (17) (a mixture of carbon dioxide and oxygen gasses).
Researchers discovered that by increasing the production of a protein, neurotrophin-3 (NT3), they could reverse hearing loss in mice that had been partially deafened by loud noise. This NT3 plays a key role in communication between your ears and your brain in the synapses that link hair cells in your inner ear to nerve cells in your brain. These cells are damaged with loud noises, resulting in hearing loss. Astaxanthin raises your body's expression of NT3, thereby helping your body to heal.
Protect Your Hearing
Noise-induced hearing loss may happen suddenly or slowly over time. Reducing your everyday exposure to loud noise, such as music, noisy work environment or even using a lawn mower may help to reduce your potential for experiencing hearing loss over the years.24
Throughout the world, nearly 360 million people suffer from moderate to severe hearing loss and it's estimated that nearly half may have been avoidable.25 Protecting yourself from loud noises is a foundational principle to preventing hearing loss. The following recommendations may also help protect your hearing and avoid hearing loss:
✓ Turn down the volume on personal audio devices
✓ Try a decibel meter app for your smartphone, which will flash a warning if the volume is turned up to a potentially damaging level
✓ Wear earplugs when you visit noisy venues, and if you work in a noisy environment, be sure to wear ear protection at all times
✓ Use carefully fitted noise-canceling earphones/headphones, which may allow you to listen comfortably at a lower volume
✓ Limit the amount of time you spend engaged in noisy activities
✓ Take regular listening breaks when using personal audio devices
✓ Restrict the daily use of personal audio devices to less than one hour
✓ If you live in a very noisy area, you may want to consider moving.
If that's not an option, consider adding acoustical tile to your ceiling and walls to buffer the noise.
Double-paneled windows, insulation, heavy curtains and rugs can also help.
Use sound-blocking headphones to eliminate occasional sound disturbances such as that from traffic or lawnmowers
✓ Wear ear protection when using your lawnmower or leaf blower