How Do We Hear
Hearing depends on a series of events that change sound waves in the air into electrical signals. Your auditory nerve then carries these signals to your brain through a complex series of steps.
Can I Prevent Hearing Impairment
Many cases of hearing loss or deafness are not preventable; however, hearing loss caused by loud noise can be prevented, and prevention efforts can start at any age . There are steps you can take to reduce your risk of this type of hearing loss.
The intensity of sound is measured in units called , and any sounds over 80 decibels are considered hazardous with prolonged exposure. These include things like loud music, sirens and engines, and power tools such as jackhammers and leaf blowers.
To reduce the risk of permanent hearing damage, you can:
- Turn down the volume on your stereo, TV, and especially the headset on your music player.
- Wear earplugs if you’re going to a loud concert or other event . Special protective earmuffs are a good idea if you operate a lawn mower or leaf or snow blower, or at a particularly loud event, like a car race. If you feel your hearing is different after being at;an event with a lot of noise , it means you’re probably experiencing a temporary hearing loss due to noise. Don’t worry, it will go away , but it means that next time you want to participate in the same event, you should wear protection for your ears to avoid a permanent hearing loss.
- See your doctor right away if you suspect any problems with your hearing, and get your hearing tested on a regular basis.
There Are Two Main Types Of Hearing Loss
‘Conductive’ hearing loss is caused by obstructions or malfunctions in the outer or middle ear. It can be caused by:;
- outer or middle ear infections and malfunctions
- a damaged ear drum
- impacted ear wax.
‘Sensorineural’ hearing loss is caused by damage to the hair cells in the inner ear. It can be caused by:;
- ageing;
- exposure to loud noise, such as machinery or loud music;
- diseases such as meningitis
- certain chemicals and medications, known as ototoxic medications.
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Symptoms And Signs Of Hearing Impairment In Children
If hearing loss is severe, the infant or child may not respond to sounds or may have delayed speech or language comprehension. If hearing loss is less severe, children may intermittently ignore people talking to them. Children may appear to be developing well in certain settings but have problems in others. For example, because the background noise of a classroom can make speech discrimination difficult, the child may have problems hearing only at school.
Not recognizing and treating impairment can seriously impair language comprehension and speech. The impairment can lead to failure in school, teasing by peers, social isolation, and emotional difficulties.
Estrogenfar More Than A Sex Hormone
We have primarily understood the function of estrogen as a sex hormone. However, estrogen is a multifaceted hormone whose mode of action is governed by a complicated network of signaling pathways. Estrogen is a lipid-soluble hormone synthesized from cholesterol in a series of consecutive steps that end with the conversion of testosterone into estrogen by the enzyme aromatase. In females, estrogen is mainly produced by the ovaries, but it can also be synthesized locally in extragonadal tissues in both sexes. In premenopausal women the most abundant form of estrogen is 17–estradiol, with serum levels ranging from 0.11 to 2.20;nM according to the stage of the menstrual cycle. Postmenopause 17–estradiol levels decline in women and are more comparable to those reported for men; 0.04 versus 0.10;nM, respectively . For simplicity, hereafter I shall refer to 17–estradiol as estrogen.
In the brain, there is much evidence that estrogen has a role in neuroprotection . Given this neuroprotective role, it is perhaps unsurprising that there is a wealth of literature that estrogen, the classical estrogen receptors , and the estrogen-related receptors play a critical role in maintaining auditory function . Despite this, our understanding of the modes of action of estrogen in the cochlea are far from clear.
4.1.1 Mechanisms of estrogen signaling
4.1.2 Classical estrogen receptors in the cochlea
4.1.3 Nonclassical estrogen-related receptors in the cochlea
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Children And Hearing Loss
Hearing loss is harmful to people of all ages, but for children, it has special implications. Because babies and young children need to hear in order to develop spoken;language, good hearing is the foundation for spoken communication, social development and educational success.
Most hospitals screen every newborn for potential hearing loss. Those infants identified by the screening are referred for further testing to confirm the presence of hearing loss and gather more information so decisions can be made regarding intervention. If your child has a hearing loss, you are encouraged to talk with a pediatric audiologist. Pediatric audiology is a specialized field of professionals dedicated to the specific needs of babies and children with hearing loss.
Hearing loss in children can be caused by congenital factors, head trauma, medications, childhood illnesses, persistent middle ear infections, deformities of the ear canal or malfunctioning eardrums. Treatment of childhood hearing loss depends largely on the underlying cause. Identification of hearing loss and intervention prior to 6 months of age has been shown to dramatically improve outcomes for kids.;;
What Causes Hearing Impairment
The most common cause of conductive hearing loss in kids and teens is otitis media, which is the medical term for an ear infection that affects the middle ear. Ear infections cause a buildup of fluid or pus behind the eardrum, which can block the transmission of sound. Even after the infection gets better, fluid might stay in the middle ear for weeks or even months, causing difficulty hearing.
But this fluid is usually temporary, and whether it goes away on its own or with the help of medications, once it’s gone a person’s hearing typically returns to normal. Blockages in the ear, such as a foreign object, impacted earwax or dirt, or fluid due to colds and allergies, can also cause conductive hearing loss.
People also get conductive hearing loss when key parts of the ear the eardrum, ear canal, or ossicles are damaged. For example, a tear or hole in the eardrum can interfere with its ability to vibrate properly. Causes of this damage may include inserting an object such as a cotton swab too far into the ear, a sudden explosion or other loud noise, a sudden change in air pressure, a head injury, or repeated ear infections.
Sensorineural hearing impairment results from problems with or damage to the inner ear or the auditory nerve. Its causes include:
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Hearing Aids And Cochlear Implants
New Cochlear Implants in 2001
Number of new cochlear implants per 10,000 deaf or hard-of-hearing persons in 2001, by sex and age.
Use of Hearing Aids in 2006
Number of hearing aids per 1,000 adults in 2006, by sex and age.
Use of Hearing Aids by Adults With Hearing Loss
Reports on the Healthy People 2020 objective to increase the proportion of adults aged 70 years and older with hearing loss who have ever used a hearing aid.
Hearing Loss Increases With Age
Percent of the U.S. population aged 20-69 with hearing loss > 25 decibels, by decade.
Noise Exposure at Work and Hearing Loss in Adults
Percent of the U.S. population aged 20-69 with hearing loss > 25 decibels, by occupational noise exposure.
Age at Which Hearing Loss Begins
Clustered bar chart showing the age at which people first began to have hearing loss. Displays the percentage distribution by sex and age, based on subjects’ report of any permanent hearing loss.
Noise-Induced Hearing Loss Among Adults
This chart depicts the prevalence of noise-induced hearing loss from 2 time periods in adults by race/ethnicity and sex .
Noise-Induced Hearing Loss Among Adolescents
This chart shows the prevalence of noise-induced hearing loss from 2 time periods in adolescents .
Genetics Of Hearing Loss
Hearing loss has many causes. 50% to 60% of hearing loss in babies is due to genetic causes. There are also a number of things in the environment that can cause hearing loss. 25% or more of hearing loss in babies is due to environmental causes such as maternal infections during pregnancy and complications after birth. Sometimes both genes and environment work together to cause hearing loss. For example, there are some medicines that can cause hearing loss, but only in people who have certain mutations in their genes.
Genes contain the instructions that tell the cells of peoples bodies how to grow and work. For example, the instructions in genes control what color a persons eyes will be. There are many genes that are involved in hearing. Sometimes, a gene does not form in the expected manner. This is called a mutation. Some mutations run in families and others do not. If more than one person in a family has hearing loss, it is said to be familial. That is, it runs in the family.
About 70% of all mutations causing hearing loss are non-syndromic. This means that the person does not have any other symptoms. About 30% of the mutations causing hearing loss are syndromic. This means that the person has other symptoms besides hearing loss. For example, some people with hearing loss are also blind.
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Onset Of Hearing Loss
So you can see that in general, men are more likely to have hearing loss than women. And just as you continue to age, that hearing loss is more and more likely to be more prevalent. So let’s talk a little bit about hearing loss onset. How does this happen? So even though in rare cases, people can develop a sudden hearing loss. You might just wake up one day and have a hearing loss. That is not common. Most commonly hearing loss develops just really gradually and very slowly over time. Because this hearing loss is developing so slowly and so gradually over years, this becomes really hard to detect for the person who’s developing hearing loss. Something that’s quite common is often friends or family will actually notice the person is developing hearing loss first.
Devices To Help With Hearing Loss
Your doctor or specialist may suggest you get a hearing aid. Hearing aids are electronic, battery-run devices that make sounds louder. There are many types of hearing aids. Before buying a hearing aid, find out if your health insurance will cover the cost. Also, ask if you can have a trial period so you can make sure the device is right for you. An audiologist or hearing aid specialist will show you how to use your hearing aid.
Assistive-listening devices, mobile apps, alerting devices, and cochlear implants can help some people with hearing loss. Cochlear implants are electronic devices for people with severe hearing loss. They dont work for all types of hearing loss. Alert systems can work with doorbells, smoke detectors, and alarm clocks to send you visual signals or vibrations. For example, a flashing light can let you know someone is at the door or the phone is ringing. Some people rely on the vibration setting on their cell phones to alert them to calls.
Over-the-counter hearing aids are a new category of regulated hearing devices that adults with mild-to-moderate hearing loss will be able to buy without a prescription. OTC hearing aids will make certain sounds louder to help people with hearing loss listen, communicate, and take part more fully in daily activities. OTC hearing aids are expected to become available in stores and online in the next few years.
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Signs Of Hearing Loss
Some people have a hearing problem and dont realize it. You should see your doctor if you:
- Have trouble hearing over the telephone
- Find it hard to follow conversations when two or more people are talking
- Often ask people to repeat what they are saying
- Need to turn up the TV volume so loud that others complain
- Have a problem hearing because of background noise
- Think that others seem to mumble
- Cant understand when women and children speak to you
Sex Differences In Genetic Architecture
To date the GWAS on ARHL do not explain the heritability estimates for ARHL in the literature. Early studies did not reach genome-wide significance, but they have revealed a wealth of important candidate genes associated with ARHL and/or hearing function . Many explanations have been proposed for this so-called missing heritability in ARHL, including genetic variants that are rare in the population that each contribute a small effect on ARHL risk, the definition used to define the phenotype and the size of the population under study . All these factors impact the power of the GWAS to detect a significant genetic association. Recent studies that have sought to increase sample size by meta-analysis , or by using extremely large cohorts have yielded more significant genome-wide loci. However, our understanding of sex differences in the genetic architecture driving ARHL is largely unknown.
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The Hidden Risks Of Hearing Loss
Hearing loss is frustrating for those who have it and for their loved ones. But recent research from Johns Hopkins reveals that it also is linked with walking problems, falls and even;dementia.
In a study that tracked 639 adults for nearly 12 years, Johns Hopkins expert;Frank Lin, M.D., Ph.D,;and his colleagues found that mild hearing loss doubled dementia risk. Moderate loss tripled risk, and people with a severe hearing impairment were five times more likely to develop dementia.
The Serious Implications Of Untreated Hearing Loss
Untreated hearing loss can cause all sorts of direct relationship issues, from minor miscommunication to long-term disagreements over what someone perceives to be improper behavior.
It can also have a negative impact on emotional well-being.
can cause fatigue, disengagement, isolation, depression and just general malaise, Gross said.
In the workplace, untreated hearing loss also has major implications. People may miss important points discussed in meetings or on conference calls or may not follow through on promised tasks because they misunderstood what they agreed to do. It can even also lead to errors if a worker cannot hear numbers or directives correctly.
Employees could even diminish their earning potential over time.
People with untreated hearing loss may lose as much as $30,000 a year in income, Gross said.
There are countless reasons to treat hearing loss beyond the obvious of being able to hear with more clarity.; Hearing loss is also linked to serious physical health issues including conditions that might seem unrelated, such as sleep apnea, diabetes, cardiovascular disease and rheumatoid arthritis, falls and overall health.
Untreated hearing loss has about the same effect on lifespan as smoking, Gross said.
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Sex Differences In Cochlear Structure And Function
The hypothesis that estrogen could modulate cochlear physiology is not new. A greater amount of myelination and an increased fiber diameter of the auditory nerve fibers, increased synaptic efficiency, and a more rapid hormonal-related nervous conduction in females compared to males have all been postulated since the late 1970s . Differences in the extent of the efferent inhibitory medial olivocochlear fibers due to sex differences in prenatal androgen exposure has also been extensively discussed in the literature by McFadden and proposed to underlie the greater hearing sensitivity and larger OAEs in women compared to men .
The Impact Of Sex As A Biological Variable In Human Disease
Historically basic and preclinical research studies have largely ignored the impact of sex as a biological variable . Information on the sex of the animals/participants included in the studies was either not clarified, or studies were conducted on just one sex, typically male, and research outcomes assumed to translate to both sexes . Many studies on ARHL have not escaped this sex bias despite the fact it has long been known that ARHL, like many other complex traits, exhibits sex differences in prevalence , severity , and age at onset .
In a recent study Villavisanis, Schrode, and Lauer reported that of 231 original research articles on ARHL over a 10-year period , one third did not disclose the sex of the animals used in the study. Of those that did report sex, only half used both sexes and one third used males only . A similar preference for only using male animals in experiments was identified in research studies conducted on noise-induced hearing loss over the 5-year period between 2011 and 2015 .
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