Call for a greater focus on the causes ofhearing loss

The US education and advocacy group Quiet Communities recently posted a piece on how the area of prevention of hearing loss should be given more attention.

In many medical fields, prevention is not top of the list in terms of investment or research efforts. The need for treatments often takes precedence because of the urgency of helping affected individuals. Hearing loss is a good example of this mechanism.

Quiet Communities, a non-profit organization dedicated to protecting health, the environment, and quality of life from noise, recently pointed out in an article by Daniel Fink, MD, Interim Chair of the Health Advisory Council, that one major aspect of tackling the hearing loss epidemic is not being addressed: prevention.

The article cites the recent report from the US President’s Council of Advisors on Science and Technology (PCAST) on aging America and hearing loss as a good example of the issue. The report’s focus was the imperative of improved hearing technologies, looking only to technology and treatment as a solution to the problem. It assumed, according to Fink, that this is simply a natural consequence of aging.

Fink points to noise as the well-known cause of many cases of hearing loss. He believes that reducing exposure to environmental noise is a logical and cost-effective alternative to technology long-term. The US Institute of Medicine’s Committee on Accessible and Affordable Hearing Health Care for Adults is to publish a report on hearing loss in June. Quiet Communities hopes this will be an opportunity to “change the national discussion about how to prevent hearing loss and make treatment of hearing loss more effective,” by going beyond evaluation and treatment strategies, and addressing root causes.

Source:Quiet Communities

People of any age can be screened for hearing loss. Newborn infants are now routinely screened before leaving the hospital. Most preschoolers and school-age children are screened periodically at their schools or in their doctors' offices. Adults can receive screenings from their doctor or at health fairs.

More information on this topic can be found in ourAudiology Information Series.

Hearing loss increases as a function of age, especially for frequencies of 2000 Hertz (Hz) and above. Sounds above 2000Hz are the soft consonant sounds such as /s/ in "sun" and /th/ in "thumb." While more than 30% of people over age 65 have some type of hearing loss, 14% of those between 45 and 64 have hearing loss. Close to 8 million people between the ages of 18 and 44 have hearing loss. Adults should be screened at least every decade through age 50 and at 3-year intervals thereafter.

Certainly, anytime you have a concern about your hearing or your child's hearing, you should ask your doctor about getting a hearing screening. Anyone failing a hearing screening should be referred to a certified audiologist for a more comprehensive audiologic (hearing) evaluation. The follow-up evaluation should be conducted as soon as possible after the failed hearing screening and no more than 3 months later.

The difference between hearing screening and hearing evaluation can sometimes be confusing. A hearing screening is usually a preliminary step in which an individual’s hearing is checked to see if further evaluation is required.

In other words, hearing screening is a quick and cost-effective way to separate people into two groups: a pass group and a fail group. Those who pass hearing screenings are presumed to have no hearing loss. Those who fail are in need of more detailed hearing evaluation by a qualified audiologist.

It is recommended that all hearing screening programs be conducted under the supervision of an audiologist holding the ASHA Certificate of Clinical Competence (CCC).

A hearing evaluation is an in-depth assessment of an individual’s hearing by an audiologist. The purpose of this evaluation is to determine the nature and degree of the hearing loss and the best treatment options. Audiologists use a number of different tests in this evaluation.

Degree of Hearing Loss

Degree of hearing loss refers to the severity of the loss. The table below shows one of the more commonly used classification systems. The numbers are representative of the patient's hearing loss range in decibels (dB HL).

Open fit hearing aids are fast becoming more popular. Open fit hearing aids are very small and nearly invisible on the ear. Essentially, open fit hearing aids are small BTE units that sit up on top of and behind the ear. There is no earmold needed - a clear thin tube with a dome tip delivers the sound from the hearing aid to the open ear canal. Open fit digital hearing aids are also lightweight - many users find that after a few minutes of wearing them, they cannot feel them at all.

The biggest benefit to open fit digital hearing aids is that they minimize occlusion. Open ear hearing aids are ideal for those who have normal and mild loss of low frequency hearing but who are experiencing problems with high frequencies - which usually occurs with early hearing loss. They are also easier to fit because they are not custom made, unlike many in the ear hearing aids. Although they utilize the latest technology, open ear hearing aids should not cost much more than standard hearing aids and may even cost the same.

Because of their size, open fit hearing aids use smaller batteries and will have a shorter battery life than other devices.

About Child’s Hearing

Many children under the age of 18 have some hearing loss including four out of every thousand newborns. Hearing loss can increase the risk of speech and language developmental delays. So, every parent and caregiver should be aware of the signs of hearing loss in his/her child and seek a professional diagnosis.

How the Ear Works

The ear has three main parts: the outer, middle and inner ear – please see the picture for more detail. The outer ear (the part you can see) opens into the ear canal.

The eardrum separates the ear canal from the middle ear. Small bones in the middle ear help transfer sound to the inner ear. The inner ear contains the auditory (hearing) nerve, which leads to the brain.

Any source of sound sends vibrations or sound waves into the air. These funnel through the ear opening, down the ear, canal, and strike your eardrum, causing it to vibrate.

The vibrations are passed to the small bones of the middle ear, which transmit them to the hearing nerve in the inner ear. Here, the vibrations become nerve impulses and go directly to the brain, which interprets the impulses as sound (music, voice, a car horn, etc.).

Indicators for hearing loss

During pregnancy

• Mother had German Measles, a viral infection or the flu
• Mother drank alcoholic beverages

Newborn

• Weighed less than 1.5 kg at birth
• Has an unusual appearance of the face or ears
• Was jaundiced (yellow skin) at birth and had an exchange blood transfusion
• Was in neonatal intensive care unit (NICU) for more than five days
• Received an antibiotic medication given through a needle in a vein
• Had meningitis
• Failed newborn hearing screening test

Family

• Has one or more individuals with permanent or progressive hearing loss that was present or developed early in life

Infant

• Received an antibiotic medication given through a needle in a vein
• Had meningitis
• Has a neurological disorder
• Had a severe injury with a fracture of the skull with or without bleeding from the ear
• Has recurring ear infections with fluid in ears for more than three months

Response to the environment – speech and language development

Newborn (Birth to 3 Months)

How to tell if your child’s hearing is normal – some signs there may be a problem with your child’s hearing

• Does not startle, move, cry or react in any way to unexpected loud noises
• Does not awaken to loud noises
• Does not freely imitate sound
• Cannot be soothed by voice alone
• Does not turn his/her head in the direction of your voice
• Does not point to familiar persons or objects when asked
• Does not babble or babbling has stopped

Infant (3 months to 2 years)

• Does not accurately turn in the direction of a soft voice on the first call
• Is not alert to environmental sounds
• Does not respond on first call
• Does not respond to sounds or does not locate where sound is coming from
• Does not begin to imitate and use simple words for familiar people and things around the home
• Does not sound like or use speech like other children of similar age
• Does not listen to TV at a normal volume
• Does not show consistent growth in the understanding and the use of words
• By 12 months does not understand simple phrases by listening alone, such as “wave bye-bye,” or “clap hands”

Hearing tests: How, when, and why

If you suspect that your child may have hearing loss, discuss it with your doctor. Children of any age can be professionally tested.

Tests for newborns and infants under one year

Hearing tests are painless, and they normally take less than half-an-hour.

Newborns are tested with either the otoacoustic emissions (OAE) test or the automated auditory brainstem response (AABR) test. During the OAE test, a microphone is placed in the baby’s ear. It sends soft clicking sounds, and a computer then records the inner ear’s response to the sounds. In the AABR test the child must wear earphones. Sensors are placed on his/her head to measure brain wave activity in response to the sound.

For infants over six months of age, the diagnostic auditory brainstem response and the visual reinforcement audiometry (VRA) tests are commonly used. The diagnostic auditory brainstem response test is similar to the AABR test, but it provides more information. The VRA test presents a series of sounds through earphones. The child is asked to turn toward the sound, and then he/she is rewarded with an entertaining visual image.

Tests for older children and adults

Children between two and four years old are tested through conditioned play audiometry (CPA). The children are asked to perform a simple play activity, such as placing a ring on a peg, when they hear a sound. Older children and adults may be asked to press a button or raise their hand.

All children should have their hearing tested before they start school. This could reveal mild hearing losses that the parent or child cannot detect. Loss of hearing in one ear may also be determined in this way. Such a loss, although not obvious, may affect speech and language.

Hearing loss can even result from earwax or fluid in the ears. Many children with this type of temporary hearing loss can have their hearing restored through medical treatment or minor surgery.

In contrast to temporary hearing loss, some children have nerve deafness, which is permanent. Most of these children have some usable hearing. Few are totally deaf. Early diagnosis, early fitting of hearing aids, and an early start on special educational programs can help maximize the child’s existing hearing.

Please note that this information is not a substitute for an ear examination or a hearing test.

What you should do

If you have checked one or more of these indicators, your child might have hearing loss and you should take him or her for an ear examination and a hearing test. This can be done at any age, as early as just after birth.

If you did not check any of these factors but you suspect that your child is not hearing normally, contact your local doctor who will arrange for you to see an ear nose throat specialist and have your child’s hearing tested by an audiologist and when appropriate, have his or her speech evaluated by a speech and language pathologist.

For the majority of individuals with a hearing loss, two things are happening, often at the same time.

First it’s unusual to lose the ability to hear equally across all frequencies (pitches). Typically you lose higher frequencies first. The higher frequencies are where many consonant sounds can be found. In all likelihood what you’re able to hear are a lot of vowel sounds and lower frequency consonant sounds (for example m, b, p) and what you’re not able to hear are the higher pitched consonant sounds (for example s, t, c, f, th, sh). In other words depending on your hearing loss, you’re hearing far less than 100% of every word. The effect of a high frequency loss is that you may be able to decifer what a person is talking about in a complete sentence but that may not always be the case.

Secondly you may face is a less than ideal signal to noise ratio. The signal to noise ratio is essentially the level or volume of what you want to hear compared to the level or volume of what you don’t want to hear. As the noise level increases, the signal to noise ratio becomes poorer and the sounds you were barely able to hear before are becoming much more difficult to hear. The percentage of every word you hear is declining and as it declines so does your ability to figure out or to understand what someone is saying.
Hearing loss comes is many variations.

Unless you’re an audiologist, when you think of hearing loss, severe hearing loss or deafness probably come to mind. But mild, moderate and high frequency hearing losses are actually much more common. With these hearing losses, the only symptom may be subtle difficulty with word understanding, especially in situations where there is competing noise.

Certain voices or words may be sound garbled, as if others are mumbling. At times, you may play the television and radio at louder than normal volume levels, but still some words may not come through clearly. Hearing on the telephone may be difficult sometimes, especially if the person on the other end has an accent. Music may sound distorted at times, even when the overall volume of the music is comfortable, leading to a decreased enjoyment of music.

Other symptoms of hearing loss may include asking people to repeat what they say, perception of people not speaking clearly, difficulty with women’s and children’s voices, and difficulty hearing when the person speaking is at a distance. In general, in situations where there is background noise – such as in restaurants, family gatherings, parties, etc. – hearing (or rather, understanding what is said) is much more difficult for people with hearing loss.

If you have difficulty understanding words, voices or conversations at times when others around you don’t seem to be having difficulty, you may have a hearing loss. In this case, a comprehensive hearing evaluation by a professional is recommended.

Our owner, Robert Hutchcraft, explains why you can hear sound but not understand what is being said. This video talks about how hearing loss starts out.

According to the ASHA (American speech-language-hearing association), There are several types of hearing tests. Here’s a list of the hearing tests we offer.

• Pure-Tone Testing
• Speech Testing
• Tests of the Middle Ear
• Auditory Brainstem Response (ABR)
• Otoacoustic Emissions (OAEs)

Pure-Tone Testing

This is the test most people think about when the think “hearing test”. The pure-tone air conduction test determines the faintest tones a person can hear at selected pitches, from low to high. You wear earphones for this test to gain information from each individual ear. During the test you may be asked to raise your hand, or press a button when you hear the tones.

Speech Testing or Live Speech Mapping

With special equipment a hearing professional can actually measure the live speech of your spouse or family member. A microphone is placed between the hearing aid’s speaker and your eardrums to measure exactly how much amplification at every frequency the hearing aid is producing. Speech testing may be done in a quiet or noisy environment. Difficulty understanding speech in background noise is a common complaint of people with hearing loss, and this information is helpful.
A live speech test allows your hearing professional to program your hearing aids with a proportionate amount of amplification to offset your specific hearing loss at each frequency.

Middle Ear Tests

The audiologist may also take measurements that will provide information about how the middle ear is functioning. These measurements include tympanometry, acoustic reflex measures, and static acoustic measures. This type of testing is particularly important in preschool children (ages 3–5), for whom hearing loss is more often associated with middle ear disease.

Auditory Brainstem Response (ABR)

Performed by an Audiologist, the auditory brainstem response (ABR) test gives information about the inner ear (cochlea) and brain pathways for hearing. The test can be used with children or others who have a difficult time with conventional behavioral methods of hearing screening. The ABR is also indicated for a person with signs, symptoms, or complaints suggesting a type of hearing loss in the brain or a brain pathway. This is a specialized test that is not usually required until simpler test have determined a further investigation into a person’s hearing loss.

Otoacoustic Emmissions (OAEs)

Otoacoustic emissions (OAEs) are sounds given off by the inner ear when the cochlea is stimulated by a sound. When sound stimulates the cochlea, the outer hair cells vibrate producing a nearly inaudible vibration. The sound can be measured with a small probe inserted into the ear canal.

People with hearing loss greater than 25–30 decibels (dB) do not produce these very soft sounds. The OAE test is often part of a newborn hearing screening program. However this particular test can also detect blockage in the outer ear canal, as well as the presence of middle ear fluid and damage to the outer hair cells in the cochlea.

It is well recognized that hearing is critical to speech and language development, communication, and learning. Children with listening difficulties due to hearing loss or auditory processing problems continue to be an underidentified and underserved population.

The earlier hearing loss occurs in a child's life, the more serious the effects on the child's development. Similarly, the earlier the problem is identified and intervention begun, the less serious the ultimate impact.

There are four major ways in which hearing loss affects children:

1. It causes delay in the development of receptive and expressive communication skills (speech and language).
2. The language deficit causes learning problems that result in reduced academic achievement.
3. Communication difficulties often lead to social isolation and poor self-concept.
4. It may have an impact on vocational choices.

Specific Effects

Vocabulary

• Vocabulary develops more slowly in children who have hearing loss.
• Children with hearing loss learn concrete words like cat, jump, five, and red more easily than abstract words like before, after, equal to, and jealous. They also have difficulty with function words like the, an, are, and a.
• The gap between the vocabulary of children with normal hearing and those with hearing loss widens with age. Children with hearing loss do not catch up without intervention.
• Children with hearing loss have difficulty understanding words with multiple meanings. For example, the word bank can mean the edge of a stream or a place where we put money.

Sentence Structure

• Children with hearing loss comprehend and produce shorter and simpler sentences than children with normal hearing.
• Children with hearing loss often have difficulty understanding and writing complex sentences, such as those with relative clauses ("The teacher whom I have for math was sick today.") or passive voice ("The ball was thrown by Mary.")
• Children with hearing loss often cannot hear word endings such as -s or -ed. This leads to misunderstandings and misuse of verb tense, pluralization, nonagreement of subject and verb, and possessives.

Speaking

• Children with hearing loss often cannot hear quiet speech sounds such as "s," "sh," "f," "t," and "k" and therefore do not include them in their speech. Thus, speech may be difficult to understand.
• Children with hearing loss may not hear their own voices when they speak. They may speak too loudly or not loud enough. They may have a speaking pitch that is too high. They may sound like they are mumbling because of poor stress, poor inflection, or poor rate of speaking.

Academic Achievement

• Children with hearing loss have difficulty with all areas of academic achievement, especially reading and mathematical concepts.
• Children with mild to moderate hearing losses, on average, achieve one to four grade levels lower than their peers with normal hearing, unless appropriate management occurs.
• Children with severe to profound hearing loss usually achieve skills no higher than the third- or fourth-grade level, unless appropriate educational intervention occurs early.
• The gap in academic achievement between children with normal hearing and those with hearing loss usually widens as they progress through school.
• The level of achievement is related to parental involvement and the quantity, quality, and timing of the support services children receive.

Social Functioning

• Children with severe to profound hearing losses often report feeling isolated, without friends, and unhappy in school, particularly when their socialization with other children with hearing loss is limited.
• These social problems appear to be more frequent in children with a mild or moderate hearing losses than in those with a severe to profound loss.

What You Can Do

Recent research indicates that children identified with a hearing loss who begin services early may be able to develop language (spoken and/or signed) on a par with their hearing peers. If a hearing loss is detected in your child, early family-centered intervention is recommended to promote language (speech and/or signed depending on family choices) and cognitive development. An audiologist, as part of an interdisciplinary team of professionals, will evaluate your child and suggest the most appropriate audiologic intervention program.

HOW TO TELL IF HEARING LOSS IS SNEAKING UP ON YOU

Hearing loss is rarely sudden or total, unless you are exposed to an exceptionally loud noise. It’s usually gradual – sometimes so gradual that your family and friends may notice the problem before you do.

Here are ten questions that will help you determine whether you (or a friend or family member) should have your hearing professionally tested by a hearing healthcare professional.  

1.Do you have a problem hearing over the telephone?

2.Do you have trouble following the conversation when two or more people are talking at the same time?

3.Do people complain that you turn the TV volume up too high?

4.Do you have to strain to understand conversation?

5.Do you have trouble hearing in a noisy background?

6.Do you find yourself asking people to repeat themselves?

7.Do many people you talk to seem to mumble (or not speak clearly)?

8.Do you misunderstand what others are saying and respond inappropriately?

9.Do you have trouble understanding the speech of women and children?

10.Do people get annoyed because you misunderstand what they say?

If you answered “yes” to three or more of these questions, you may want to schedule a professional hearing evaluation with a hearing healthcare professional.

The material on this page is for general information only and is not intended for diagnostic or treatment purposes. A doctor or other health care professional must be consulted for diagnostic information and advice regarding treatment.

Hearing problems are serious. The most important thing you can do if you think you have a hearing problem is to go see a hearing healthcare professional. Your primary doctor may refer you to an otolaryngologist, a doctor who specializes in the ear, nose, and throat.

An otolaryngologist will try to find out why you have a hearing loss and offer treatment options.He or she may also refer you to another hearing professional, who may be an audiologist. An audiologist can measure your hearing. Sometimes otolaryngologists and audiologists work together to find the treatment that is right for you. If you need a hearing aid, an audiologist or hearing aid provider can help you find the right one.

Your friends and family can also help make hearing easier. Here are some things you can do:

Tell your friends and family about your hearing loss. They need to know that hearing is hard for you. The more you tell the people you spend time with, the more they can help you.

Ask your friends and family to face you when they talk so that you can see their faces. If you watch their faces move and see their expressions, it may help you to understand them better.

Ask people to speak louder, but not shout. Tell them they do not have to talk slowly, just more clearly.

Turn off the TV or the radio if it does not have to be on.

Be aware of noise around you that can make hearing more difficult. When you go to a restaurant, do not sit near the kitchen or near a band playing music. Background noise makes it hard to hear people talk.

Working together to hear better may be tough on everyone for a while. It will take time for you to get used to watching people as they talk and for people to get used to speaking louder and more clearly. Be patient and continue to work together. Hearing better is worth the effort.

Nothing helps ease your morning commute more than listening to some music on your iPod, or maybe the latest news podcast so you’ll be up-to-date with what’s going on in the world before you get to the office.  Whatever the reason, the accessibility of MP3 players means more people are using headphones than ever before, and with that comes the risk of hearing loss.

Between 1988 to 1994 hearing loss in the United States increased 14.9 percent; this was also around the time Walkmans were highly popular.  With the rise of the iPod and other MP3 players more and more people are watching movies, listening to music or podcasts and completely tuning out the world around them.  Chances are people don’t even realize the amount of damage they are doing to their ears; if you are able to hear someone’s music even when they are wearing headphones, then chances are there is damage being done.  One study shows that about one in five teens, roughly 6.5 million people, have some form of hearing loss.

There are some easy ways to avoid damaging your hearing; earplugs can be helpful if you’re going to concerts.  Lots of people leave concerts with a ringing in their ears, which is a sure sign hearing damage has been done; wearing earplugs can help prevent the damage.

Making sure your music is being played at an acceptable level is important, too.  Not only will it save your eardrums but keeping your music at a lower level helps you be more aware of your surroundings, especially if you are in a major city.  Some commuters only use one headphone while on a train or walking down the street so they can be more aware of what’s happening around them and the music is more of a background experience.

Technology is a great thing, and can have some amazing benefits if used responsibly; but if you’re not careful, the next piece of hardware you’ll need to buy is a hearing aids.

Does "deaf" mean hear nothing ?

"Deaf" means hearing loss in different types and level. Few people hear nothing. We can use "hearing loss"and "hearing difficultly"to replace "deaf". Please consult your audiologist if you can't be sure how is your hearing.

Range of hearing loss

Can hearing aids help me ?

Hearing aids and cochlea can help you listen to the sound, but can't recovery to normal. There are many factors influenced the hearing development. Experts surgest that paitent should fit two hearing aids to balance the hearing, in order to hearing clearly and natural.

Do a single ear hearing loss intervention?

Yes

Results of infant OAE is refer. Does he or she need intervention?

You can't intervent until you know the true hearing loss. You'd better not give intervention before 6 month year old.

What's the gold standard in children hearing loss?

Usually speaking, the BOA ,VRA ,PA and questionnaire are the gold standard in diagnosing children hearing loss.

Tips for dealing with Tinnitus

A 'cure' for tinnitus is yet to be developed, and many report that it may appear and disappear in relation to other underlying conditions. Relief from tinnitus is not an exact science, but here are the three most popular tips that have helped some of our clients in the past. We hope they’re of use to you, too.

1. Relax

Easy to say and not so simple to do, there is evidence that stress and high levels of anxiety can worsen, or even bring on, symptoms of tinnitus. A tinnitus counsellor will be able to offer more in-depth advice on this method, but a more relaxed lifestyle has certainly helped some of our clients relieve the symptoms of tinnitus.

2. Counselling

While tinnitus might not be ‘curable’, don’t discount the benefits of seeking help from a suitably qualified hearing therapist. The British Tinnitus Association will be able to recommend individuals in your area.
3. Sound therapy

The use of sound therapy to relieve the symptoms of tinnitus is becoming more and more popular, and depending on the individual, it can be implemented in several different ways. Essentially, it works by giving you something else to listen to, and in the process distracting you from the noise of the tinnitus. Amplification can help, and your local Hearing Aid Dispenser will be able to judge whether you have any degree of hearing loss, and recommend an appropriate course of action.

Based on practical experiences, good hearing care have three steps:

• Audiologist must understand your feelings and needs.
• Choose the most suitable hearing aids for you.
• Keep in touch with the audiologist frequently.

After hearing aids fitting, the patient should have four weeks rehabilitation program:

First weekAfter hearing aids fitting, the patient should use it in quiet-environment 1-2 h/d. For many people, they can't adapt to the envitonment when they suddently hear the noise after a long time hearing loss.

Second weekAfter the first week adaptation process, the patient should go outside to adapt the environment for 4-6 h/d. For example, park, farmland.

Third weekPeople who wear the hearing aids 8 h/d can go to the public place. Such as public square,supermarket,street.

Fourth weekPeople can wear hearing aids all day if you like.

As a result, people who wear hearing aids should keep in touch with the audiologist so that the audiologist adjust the hearing aids to the ideal state. The first wearer should be patient. We will go with you in the hearing rehabilitation.

If you have noticed that you, or a member of your family, are experiencing hearing loss, there are several different experts who can offer you help and support.

We have made a list of experts with a brief description of their work in order to help you find the expert who is right for you.

Ear, Nose and Throat Doctor（ENT specialist）

ENT specialists diagnose and treat problems related to the ears, nose and throat. In most cases, the ENT specialist will diagnose hearing loss. In some regions, they are known as ENT surgeons or other common professional titles. Your primary care physician will be happy to give you the information you need.

Audiologist

An audiologist is a healthcare expert who focuses on all aspects of audiology, i.e. the science of hearing. An audiologist offers services in connection with preventing hearing loss, evaluation and rehabilitation, selection and fitting of hearing aids and other related issues such as communication or balance problems. The science of hearing loss in children is a separate field and this service is usually provided by specialist paediatric audiologists.

Speech Therapist

The speech therapist works with the theoretical and practical issues of the prevention, diagnosis, therapy and rehabilitation of speech problems. In healthcare, this field is called logopaedics, focussing on people with limited interpersonal communication abilities.

Psychologist

The support of a psychologist can be helpful under certain circumstances: He or she will support you or your family member in examining human behaviour or dealing with extraordinary stress. Psychologists may specialize in certain areas, e.g. school or training.

Sounds at or above 85 decibels (dB) can damage your ears. A decibel is a unit that measures the intensity of sound. Sounds that humans can hear are measured on a scale from zero to 140. A normal conversation is about 60 dB. Chainsaws, hammer drills, and bulldozers ring in at over 100 dB. So if you are a construction worker, harmful sounds may be a regular part of your job. The same goes for people working around lawn mowers and factory machinery every day. Airport workers and farmers are two more groups that are regularly exposed to loud noise. However, loud noise does not have to be an everyday happening to cause damage. One-time exposure to very loud noises, such as the sound of a gun firing at close range, can harm your ears permanently.

See the How Loud Is Too Loud bookmark.

How can I protect my hearing in noisy situations?

Wear ear plugs or special earmuffs when you are exposed to dangerous levels of noise; they can keep your hearing from being damaged. Hearing protection is important any time you're exposed to loud noise.

Where can I buy hearing protection devices?

Several types of protective earplugs and earmuffs are available in most pharmacies, hardware stores, and sporting goods stores.

What should I tell others about hearing protection?

You can share what you know about NIHL with your family, friends, classmates, and co-workers. If you have children, explain to them that hearing is delicate and important. Call their attention to sounds that are harmful. Encourage them to protect their ears by avoiding loud noises or using special earmuffs. If they are too young to protect themselves, do it for them. For your co-workers and other family members, make a copy of this flyer and share what you know about NIHL.

Communicating Better With Older People

Communicating with older people often requires extra time and patience because of physical, psychological, and social changes of normal aging.

Even more effort is needed in nursing homes where 60% to 90% of residents may actually have communication disabilities.

Speech-language pathologists Martin Shulman and Ellen Mandel offer these tips for family members and caregivers to make communicating with older people easier:

• Reduce background noisesthat may be distracting (e.g., turn off the radio or TV, close the door, or move to a quieter place)
• Begin the conversation withcasual topics (e.g., the weather or what the person had for lunch). Avoid crucial messages at the beginning.
• Talk aboutfamiliar subjects such as family members and special interests of the person
• Stick to a topic. Avoid quick shifts from topic to topic.
• Keepsentences and questions short.
• Give older personsa moment to reminisce. Their memories are important to them.
• Allow extra time for responding.Don't hurry them.
• Give the older personchoices to ease decision making. (e.g., "Do you want tea or coffee?" rather than "What do you want to drink?")
• Be an active listener. Look for hints from eye gaze and gestures. Take a guess (e.g., "Are you talking about the TV news? Yes? Tell me more. I didn't see it.")

After your visit, tell others who visit (relatives, physicians, nurses, aides, etc.) what you've learned to improve communicating with the older person.

The Outer Ear

The outer ear consists of the pinna, or auricle, and the ear canal (external auditory meatus). The pinna – the part of the "ear" that we see on each side of our heads – is made of cartilage and soft tissue so that it keeps a particular shape but is also flexible. The pinna serves as a collector of sound vibrations around us and guides the vibrations into the ear canal. It helps us decide the direction and source of sound.

The Middle Ear

The middle ear begins with the eardrum at the end of the ear canal. The middle ear contains three tiny bones, called the ossicles. These three bones form a connection from the eardrum to the inner ear. As sound waves hit the eardrum, the eardrum moves back and forth causing the ossicles to move. As a result, the sound wave is changed to a mechanical vibration.

The Inner Ear

The inner ear contains the sensory organs for hearing and balance. The cochlea is the hearing part of the inner ear. The semicircular canals in the inner ear are part of our balance system.

The cochlea is a bony structure shaped like a snail and filled with two fluids (endolymph and perilymph). The Organ of Corti is the sensory receptor inside the cochlea which holds the hair cells, the nerve receptors for hearing.

The mechanical energy from movement of the middle ear bones pushes in a membrane (the oval window) in the cochlea. This force moves the cochlea's fluids that, in turn, stimulate tiny hair cells. Individual hair cells respond to specific sound frequencies (pitches) so that, depending on the pitch of the sound, only certain hair cells are stimulated.

Signals from these hair cells are changed into nerve impulses. The nerve impulses are sent out to the brain by the cochlear portion of the auditory nerve. The auditory nerve carries impulses from the cochlea to a relay station in the mid-brain, the cochlear nucleus. These nerve impulses are then carried on to other brain pathways that end in the auditory cortex (hearing part) of the brain.

Also housed within the inner ear are the semicircular canals, the utricle, and the saccule. These structures help control one’s sense of steadiness or balance. These balance organs share the temporal bone space with the cochlea. These organs also share the same fluid that is in the cochlea.

How quickly and - and deeply - can deafness penetrate the brain? For a study on this, researchers at Duke University Medical Center turned to male zebra finches.

Songbirds differ from most animals in that males' mating songs fall apart when they lose their hearing. This feature makes them an ideal organism to study how hearing loss may affect the parts of the brain that control vocalization, said Richard Mooney, Ph.D., professor of neurobiology at Duke. He is the senior author of the study's report.

Portions of a songbird's brain that control how it sings began to decay within 24 hours of the animal losing its hearing. As the size and strength of nerve-cell connections visibly changed under a microscope, researchers could even predict which songbirds would have worse songs in coming days.

"When hearing was lost, we saw rapid changes in motor areas in that control song, the bird's equivalent of speech," Mooney said. "This study provided a laser-like focus on what happens in the living songbird brain, narrowed down to the particular cell type involved."

Using a protein isolated from jellyfish that can make songbird nerve cells glow bright green when viewed under a laser-powered microscope, they were able to determine that deafening triggered rapid changes to the tiny connections between nerve cells, called synapses, which are only one thousandth of a millimeter across.

The study was published last week in Neuron journal online.

"I will go out on a limb and say that I think similar changes also occur in human brains after hearing loss, specifically in Broca's area, a part of the human brain that plays an important role in generating speech and that also receives inputs from the auditory system," Mooney said.

About 30 million Americans are hard of hearing or deaf. This study could shed light on why and how some people's speech changes as their hearing starts to decline, Mooney said.

How often have you accused a loved one of having selective hearing? Perhaps it’s more apparent when you ask them to take out the rubbish. But what if it wasn’t a sly tactic to get out of doing household chores? What if they really had problems hearing you?

‘Hearing loss is now not just something associated with the elderly,’ says Boots audiologist Alan Pretty. ‘We are seeing more youngsters coming in with hearing problems caused by things such as MP3 players, concerts and festivals.’

Emma Harrison, of Action On Hearing Loss (formerly RNID), says the charity’s research has uncovered a worrying attitdute among young people.

‘We found people think they are toughening up their ears by standing next to loud music,’ she says. ‘People aren’t that aware of their hearing and it’s only when they lose it they realise they’ve actually done some damage – and by then it’s too late.’

So how high does the sound level have to be before it’s dangerous?

Wendy Davies, national sales and audiology manager at Siemens Hearing Instruments, says the volume of music played at concerts and festivals will vary but most likely average around 110 decibels. ‘By way of a comparison, a normal conversation is 60 to 65dB and a high volume is classified as more than 80dB, a level similar to standing at the side of a very busy road,’ she says.

Pretty thinks festivals can reach between 110dB and 130dB. ‘Ambulance sirens usually hit around 125dB and you know how loud that is when it goes past,’ he says. ‘Would you like to be in a room with that for hours on end? When you get to 130dB, that’s the threshold of pain and when it will physically hurt your ears.’

In fact, experts say prolonged exposure to anything over 85dB will cause hearing loss. ‘Just to put that into perspective,’ explains Pretty, ‘a very busy workplace where printers and various other things are going on around you can reach up  to 80dB, and so can the blender in  your kitchen.’

However, hearing loss doesn’t  happen suddenly, it occurs over a  period of time. ‘The important thing to remember is that it’s very uncommon  for hearing loss to occur straight after hearing a loud sound,’ says Nick Clive, audiologist at The Audiology Room.  ‘It usually happens after being exposed  to loud sounds for a length of time,  such as clubbing on a regular basis. When you’re subjected to high input sound for a long period of time, you don’t give your hearing a chance to recover and that’s what can cause the permanent damage.’

In Britain, an estimated 10million people are affected by hearing loss and on average they struggle for ten years before seeking help. With this in mind, Boots Hearingcare launched its Great Big Hearing Test campaign last month, designed to encourage those with hearing loss to seek treatment. The first step was to launch a free online hearing test.

Action On Hearing Loss has been working with festivals, nightclubs and music devices for its hearing protection campaign. ‘It’s aimed at getting music lovers to look after their hearing,’ says Harrison. ‘We tour all the major festivals with a marquee offering advice and selling earplugs and T-shirts, etc.  ‘Our research shows that 90 per cent of  young people have had a ringing in their ears at least once. Many top DJs and musicians wear earplugs, which filter the noise but don’t block it. However, the people in the crowd don’t realise their idols are doing this so we try to inform them as much as possible.’

Clive agrees that education is key. ‘Risk of hearing loss is much more common in youngsters than we realise,’ he says. ‘This is because the attitude about protecting your ears just isn’t there. We are unknowingly putting ourselves at risk. Rather than being seen as a hearing aid practice, which we are, we are trying to appeal to youngsters through mediums such as Facebook and Twitter. We want to let people know that there is a lot you can do to protect your ears that isn’t stuffy and old fashioned. We supply a lot of DJs with hearing protection devices. There’s a lot of trendy and discreet items out there.’