6 Reasons You’re Losing Your Hearing
Most of them have nothing to do with your age.
It’s a Saturday morning, and you’ve just popped into your neighborhood coffee shop for a cappuccino. “Whole milk?” the barista asks while punching your order into the system. You struggle to hear him behind his double-layer mask. “Did you say oat milk?” you reply. He tries raising his voice: “Whole milk, WHOLE!” You smile politely (not that anyone can see the lower half of your face). “Let’s do almond,” you respond, hoping that word sounds different enough from “whole” and “oat” that he’ll hear it and this awkward exchange can be over with.
Pretty much everyone is wearing a mask these days—thanks, COVID!—and for the most part, they’re nothing more than a minor inconvenience with a major safety payoff. But masks do make it impossible to read people’s lips, an essential tool we use to communicate, along with hearing. For those with hearing loss, this can be a real detriment to their everyday life. “Masks reduce the volume and high-frequency component of people’s speech,” explains William Shapiro, Au.D., supervising audiologist NYU Cochlear Implant Center in New York City. “We’re seeing patients who were borderline for a hearing aid now agreeing to get one, and patients who were wearing a hearing aid realizing they need a cochlear implant.” According to a new survey from the Hearing Loss Association of America (HLAA) and Cochlear, 95% of people with hearing loss in the U.S. say masks impact their ability to communicate, and 70% say they are more aware of their hearing loss due to the pandemic.
It’s not just elderly people who are struggling to hear behind the masks—in fact, hearing loss is on the rise throughout the world. The World Health Organization (WHO) estimates that one in four people will have hearing problems by 2050. That’s nearly 2.5 billion people worldwide. There are multiple reasons for this, including the fact that hearing loss is better diagnosed now than it used to be, and people are generally getting older due to medical innovation. But also, noise pollution is a real and alarming threat to public health. “We live in a society that is not taking care of their ears in terms of staying away from noise,” Shapiro says. And depending on the type of hearing loss, it might very well be irreversible.
Types of Hearing Loss
Hearing loss falls into two major categories: conductive and sensorineural.
Conductive hearing loss. This type of hearing loss affects your outer or middle ear. “Often, you’ll have some fluid from a cold in the middle ear or some issues with the bones in the middle ear,” explains Susan Waltzman, Ph.D., otolaryngology professor and co-director of NYU’s Cochlear Implant Center. An ear infection, earwax, or tumor could all cause conductive hearing loss. If a child is born with a deformed ear canal or other outer or middle ear abnormality, this is a conductive issue that could affect their hearing.
The good news is that conductive hearing loss is usually treatable with medication (to cure the infection) or surgery (to reshape the affected part of the ear). Even people born with conductive hearing loss can go on to hear and communicate normally after treatment.
Sensorineural hearing loss. This is the hearing loss you’re thinking of when you picture someone wearing a hearing aid or implant. Sensorineural hearing loss affects your inner ear, the part that converts sound to an electrical signal that your auditory nerves send to your brain. This happens via tiny hair cells that contain protruding microscopic hair-like projections. When the hair cells in your inner ear become damaged, this reduces your ability to hear high-frequency sounds like consonants, background noise, and high-pitched voices. If the hearing loss is progressive, it can eventually affect the way you hear middle and lower frequencies as well.
“Sensorineural hearing loss is usually permanent,” Waltzman says. “That’s the reason for hearing aids and cochlear implants, depending on the severity of the hearing loss.”
Causes of Permanent Hearing Loss
There are a variety of factors that put you at risk for sensorineural hearing loss.
Age. Over the course of your life, the hair cells in your inner ear can become damaged, leading to progressive hearing loss in your middle-age to elderly years. One in three people in the U.S. between the ages of 65 and 74 have hearing loss, and that number increases to half in the over-75 crowd.
Genetics. If someone in your immediate family has hearing loss (at birth or later in life), that increases your likelihood for developing it.
Noise exposure. Repeated subjection to loud noises can be a dangerous practice for your hearing. “Noise can damage hair cells,” Shapiro explains. “Hearing preservation is very important nowadays because younger and younger people are starting to get noise-induced hearing loss.” Live music events, loud workout classes, and city living can all increase your proximity to loud noises—not to mention work environments where people are forced to interact with loud noises daily (like construction workers or military personnel).
Medications. Common medications like aspirin, NSAIDs, and antibiotics have been linked to sensorineural hearing loss, although this hearing loss is not always permanent; sometimes the person’s hearing returns after stopping the medication. These drugs are called oxotoxic—literally toxic to your ear—and experts still don’t understand exactly how to fix the problem. Don’t let this freak you out, though, and don’t run to your pill cabinet to throw everything out. Aspirin only damages your inner ear when taken in large doses (eight or more pills per day), and antibiotics are most likely to exacerbate hearing damage in people who already struggle with hearing loss. Some life-saving cancer meds can also contribute to hearing loss. If you’re really concerned about this, bring it up with your doctor to get their opinion.
Viruses. Viral infections like HIV, measles, mumps, and chicken pox can cause hearing loss. Some cause hearing loss directly, while others trigger inflammation that does the damage. There have also been reports of COVID-19 causing hearing loss, though this side effect appears to be rare.
Autoimmune diseases. Autoimmune inner ear disease (AIED) is a rare type of sensorineural hearing loss caused by an abnormal immune response in your body. It often, though not always, occurs in the context of another autoimmune disease like IBD or RA. AIED is still somewhat of a medical mystery—experts don’t know exactly how it happens or how to reliably diagnose it—but it does illustrate a link between chronic illness and hearing loss.
One thing to note here: The cause of hearing loss isn’t always clear-cut. For those who develop sudden sensorineural hearing loss—defined as a rapid loss of hearing in one or both ears—only 10% have an identifiable cause. “Very often the reason for it is unknown,” Waltzman explains. Regardless of the cause, the doctor will likely choose to focus on the treatment.
Treatments for Hearing Loss
Medication or surgical intervention. Cases of conductive hearing loss can often be fixed with a medication regimen or surgical treatment. These people can go on to hear normally without the need for additional support.
Hearing aid. A hearing aid is the treatment of choice for people with “mild or moderate hearing loss,” Waltzman says. It’s a small device worn in your ear that you can put on and take off as you please. There are multiple types of hearing aids available that work through different mechanisms, but they all do essentially the same thing: They help your ear convert sound into signals your brain can understand.
Cochlear implant. This is the first-line treatment for people with severe to profound hearing loss, those for whom a hearing aid just doesn’t cut it. “Basically, what a cochlear implant does is stimulate the nerves,” Waltzman says. “If we no longer have those hair cells to convert the sound to an electrical signal, we have to have something else do it for us. And that’s the job of the cochlear implant.” These implants are surgically inserted and look similar to a hearing aid to the naked eye.
How Hearing Aids and Implants Can Help
Hearing technology has come a long way since your grandmother’s day. In the early days of cochlear implants in the 1970s and 1980s, “a patient carried around something akin to what looks like a midsize ladies’ handbag,” Waltzman recalls. “Now you can hardly see it—it’s either behind the ear or all on the head.
Cochlear, one of the major providers of this device, has distributed over 600,000 devices in 180 countries since its inception in 1981. As the device has grown in popularity, it has also become more advanced and efficient. “Early cochlear implants used one electrode, which really didn’t translate the sound very well,” Waltzman says. “Then multi-channel cochlear implants came into being.” Now, the device uses several different electrodes to better convert sound to signals for your auditory nerve.
Cochlear implants and hearing aids both have the capability to connect straight to your smartphone. “If someone calls you, the Bluetooth connects the hearing aid right to your ears,” Shapiro explains. “They also connect to TVs and other electronics. We’ve come a long way.”
Still, unless you’re a close follower of the hearing aid market (which most people probably aren’t), you might not realize how great the options are these days. “If adults have a progressive hearing loss, and they’ve worn hearing aids during that time, they sometimes don’t really know about cochlear implants,” Waltzman notes. “Their hearing aid dispenser may not be knowledgeable about cochlear implants, so they just continue using a hearing aid, not knowing there is something out there that might help them more.” Similarly, you might be wearing an old hearing aid without realizing you could get a more advanced or effective version.
If you’re finding yourself struggling to hear people behind their masks—especially if you suspect this might be due to some underlying hearing loss—it never hurts to get an evaluation. “There is no ‘best’ hearing aid,” Shapiro says. “Just find a professional you’re comfortable with and take their advice.” If your hearing loss is moderate to severe, make sure to connect with someone who has familiarity with cochlear implants as well.
You don’t have to commit to buying one, and even if you do take the plunge, most hearing devices come with a trial period of at least one month. Unfortunately, hearing aids usually aren’t covered by insurance and can run in the hundreds or even thousands of dollars. Cochlear implants are more likely to be covered by your insurance provider because they are considered the standard treatment for deafness.
It’s a big decision to make, and it shouldn’t be made lightly, so the key is finding a pro you can trust to help you maximize your options. Maybe this pandemic can be the catalyst for something positive for you: a more effective and life-changing intervention for your hearing.
- HLAA Survey on Hearing Loss & COVID: Cochlear. (2021.) “Face masks inhibit communication for 95 percent of people with hearing loss, new survey finds.” cochlear.com/us/en/corporate/media-center/media-releases/2021/face-masks-inhibit-communication-for-95-percent-of-people-with-hearing-loss-new-survey-finds
- WHO Hearing Projection: World Health Organization. (2021.) “WHO: 1 in 4 people projected to have hearing problems by 2050.” who.int/news/item/02-03-2021-who-1-in-4-people-projected-to-have-hearing-problems-by-2050
- Types of Hearing Loss: (1.): Centers for Disease Control and Prevention. (n.d.) “Types of Hearing Loss.” cdc.gov/ncbddd/hearingloss/types.html
- Types of Hearing Loss: (2.): American Speech-Language-Hearing Association. (n.d.) “Types of Hearing Loss.” asha.org/public/hearing/types-of-hearing-loss/
- Age-Related Hearing Loss: National Institute on Deafness and Other Communication Disorders. (n.d.) “Age-Related Hearing Loss.” nidcd.nih.gov/health/age-related-hearing-loss
- Sudden Deafness: National Institute on Deafness and Other Communication Disorders. (n.d.) “Sudden Deafness.” nidcd.nih.gov/health/sudden-deafness
- Medications & Hearing Loss: University of Michigan Medicine. (n.d.) “Medicines That Cause Hearing Loss.” uofmhealth.org/health-library/tf3092
- Viral-Induced Hearing Loss: Trends in Hearing. (2014.) “Viral Causes of Hearing Loss: A Review for Hearing Health Professionals.” ncbi.nlm.nih.gov/pmc/articles/PMC4222184/
- COVID & Hearing Loss: International Journal of Audiology. (2020.) “Does coronavirus affect the audio-vestibular system? A rapid systematic review.” tandfonline.com/doi/full/10.1080/14992027.2020.1776406
- Autoimmune Inner Ear Disease: International Journal of Immunopathology and Pharmacology. (2018.) “Autoimmune inner ear disease (AIED): A diagnostic challenge.” ncbi.nlm.nih.gov/pmc/articles/PMC6213300/