Neurotologist Dr. Chang joins us to discuss the symptoms of hearing loss, its different stages, how to protect your hearing, and why hearing aids shouldn't get such a bad rap.
Shelby Stockton: Welcome to the Texas ENT Audio blog. I'm Shelby Stockton, and today I'm talking to neurotologist, Dr. Chang. We discuss the symptoms of hearing loss, it's different stages, how to protect your hearing, and why hearing aids shouldn't get such a bad rap.
Shelby Stockton: Hi, Dr. Chang, thanks so much for spending some time with me today.
Dr. Chang: Well, thanks for having me. It's my pleasure to be with you.
Shelby Stockton: That's great. So I really want to hear about hearing loss and how you treat your patients.
Dr. Chang: Yes. Well, we all take hearing for granted until we kind of lose it over time. Sometimes it's sudden onset, sometimes it's progressive, and whenever you have these symptoms of difficulty hearing or ringing in the ears or noises in the ears, it's called tinnitus, you should undergo an evaluation by an otolaryngologist like me, and we have many in our group who do this kind of evaluation.
Dr. Chang: So if have these symptoms, you'll see one of our doctors who will do a full medical evaluation to see what's going on and do diagnostic testing, like a hearing test, it's called an audiogram, and other tests that are needed to do a full medical examination for your problem. It turns out that the large majority of hearing losses are the general age related hearing loss. You age, you lose hearing at various rates, depending on your genetics and things like that. And on top of that, you have other exposures like noise exposures. If you do loud music or machinery or gunfire without ear protection, you can progressively lose hearing that way, so that kind of hearing loss is called a sensory neural hearing loss, and it's probably the most common type in adults. So ...
Shelby Stockton: Oh, sorry. Yes, go on.
Shelby Stockton: I was just going to ask, usually we think of hearing loss happening to a certain age group, but have you noticed that especially the gen X generations coming up and all the loud concerts that they went to and such, are you seeing younger people more often?
Dr. Chang: Well, I think it's been about the same over time. So the noise induced hearing losses are kind of cumulative, so you don't usually get bad symptoms immediately. Sometimes you do. Let's say you're at a concert and you're right next to the speaker for a couple of hours and you walk out and you can't hear and your ears are ringing, so that means you've damaged your hearing. But a lot of times, if it's not too long of an exposure, you'll have recovery. But then if you keep doing this over time, over several years or decades, then you can have more of a permanent hearing loss that may need to be treated.
Dr. Chang: So youngsters, even if they are exposed, may not get a lot of symptoms until let's say ten years later, but everyone is a little bit different. The large majority of this kind of hearing loss does occur in the older population because of the age related hearing loss that a lot of people get.
Shelby Stockton: Right.
Dr. Chang: But for the rest of us, it's important to protect your ears, because this is a type of hearing loss unlike other types of hearing losses that are surgically correctable, this cannot be corrected with any kind of surgery or medicines, and it requires a hearing aid or some type of device for hearing.
Shelby Stockton: I see. So the last of time I remember getting hearing tests was when I was in elementary school. Should adults be getting hearing tests more often?
Dr. Chang: So yeah, the kids, they don't complain about hearing loss, even if they have it, so it's a good idea for them to get screened like in school. And in Texas, all the newborn babies are supposed to be tested for a congenital, meaning at birth, type of hearing loss or early onset hearing loss. As adults if you have significant symptoms, most will seek medical attention so they don't necessarily need screening regularly unless you have high risk, such as at a job that has a lot of noise. And typically, I think there are legal requirements for companies in such situations to protect the employee's ears with earplugs and earmuffs and to do yearly testing.
Dr. Chang: But anyone who has any kind of symptoms like they're having difficulty hearing, especially when it's noisy, or they're having ringing or buzzing or crickets in their years should get evaluated. Most of these hearing losses are not that serious and just require hearing aids or some other remedy, but there are occasional cases where hearing loss could be something more serious.
Shelby Stockton: Right. So one thing that's so great about Texas ENT is it's kind of the one stop shop for hearing loss. Could you explain how it works if someone comes in and they have some of these symptoms? What's the procedures?
Dr. Chang: Yeah, so anyone who is seen by one of our physicians undergoes a full history and physical and any testing that's needed. Typically, it's a hearing test in the minimum, and then from there, the doctor will figure out what kind of things may be going on and whether you need additional testing, such as MRI scans, other tests that may be needed to rule out other more serious things.
Dr. Chang: Now the hearing tests can tell the difference between what's called the sensory neural hearing loss, which I already discussed, and a conductive hearing loss. And a conductive hearing loss is different. It's a problem with the sound transmission between the outside, like the ear canal, to the inner ear. So the inner ear nerves and the sensory organs are working okay, but there's a blockage. For example, if you have wax stuck in the ear canal, that would cause a conductive hearing loss if it's blocking the canal.
Dr. Chang: There are other conditions that are a little more serious that can cause a conductive hearing loss like a hole in the ear drum, middle ear infections, certain kinds of bone conduction problems. We have three little bones of hearing and the bone that can be damaged by trauma or infections or some other genetic conditions, and those can be evaluated by the exam and the testing. And unlike the sensory hearing loss where we can't really fix it, the conductive hearing losses can often be fixed with a surgery, or if they don't want surgery, you can still get a hearing aid in a lot of cases.
Shelby Stockton: Great. What would you say to a patient who is hesitant to come in, they don't want to hear the diagnosis, they're frightened of what might come next. What would you say to a patient that's really nervous?
Dr. Chang: Yeah, so I think one of the biggest issues is the stigma of the hearing aid. So people are afraid that the doctor will tell them, "Well, you really need a hearing aid." And it makes them feel old, and when you wear a hearing aid, the perception in a lot of cases is that it's a sign of old age and other things, and other negative things. Now aging, I think, is a natural process, you have to kind of go with it and deal with whatever it brings you.
Dr. Chang: As far as hearing aids, they are very sleek and small now, and even the ones that go behind the ear are pretty ... not that noticeable, and there are some that also go into the canal where you can't see them. And the type that a patient may be eligible for depends on the degree of hearing loss and how their ear canal looks and things like that. And so if a patient is found to be a candidate for a hearing aid, then one of our audiologists from the audiology department will counsel the patient in the same office and recommend a particular type of device that the patient may benefit from.
Dr. Chang: And well, a lot of times, even hesitant patients who eventually come in and get the hearing aid, they're often very happy because they actually don't know what they're missing, and their spouses are also very happy too because ... And then the person is in denial and says, "I'm fine. I'm fine. I'm fine." And they get the hearing test and they have really bad hearing loss.
Shelby Stockton: Yeah, as somebody who has spent time with someone who didn't want to get a hearing aid, I completely agree with you on that. This is all really great information. Thank you so much for taking time out of your day to speak with me.
Dr. Chang: Well, you're very welcome.
