- The Washington Times - Monday, March 7, 2005

All newborns in the Greater Washington area are required by law to have their hearing tested before leaving the hospital. From then on, in most cases, a person is responsible for his own ear health — an increasingly difficult assignment in today’s noisy society.

According to the Rockville-based American Speech-Language-Hearing Association, an estimated 28 million Americans have some degree of hearing loss and up to 50 million are affected with some degree of tinnitus, a ringing sensation in the ears.

A number of issues are involved, as audiologists well know. They are the professionals who measure hearing loss, tinnitus, balance and related disorders and recommend treatment for them. If a hearing aid is recommended, audiologists fit the device and give the necessary counseling.

Insurance usually covers the screening but not the expense of a hearing aid.

The McLean-based American Academy of Audiology has a lower estimate of the number who need help. It says 24 million Americans have hearing loss — nearly one-half of them younger than 65. Hearing usually decreases with age, but many other causes are at work.

“It has gotten worse. We are definitely a noisy society,” says audiologist Teri Wilson-Bridges, director of Washington Hospital Center’s Hearing and Speech Center.

“Everything is bigger and louder. Toys are louder. Television sets are humongous, and they are loud. And all those Walkman radios and CD players. That is the worst because the sound is right at your ear. If I am sitting next to you wearing one and you hear it, it is too loud. Over time, it definitely can cause some hearing loss, and people aren’t aware of it.”

An audiogram is a test that shows the profile of a person’s condition. Even people who do not suspect they have a hearing problem would benefit from undergoing the test, audiologists say, because results establish a baseline for the future.

The tests are required by the U.S Department of Labor for people surrounded by continuous loud noises on their jobs, such as construction workers who operate jackhammers. Medical doctors — usually ear, nose and throat specialists, known as otolaryngologists — will send patients for testing when they suspect a problem and need help with a diagnosis.

The District of Columbia and 32 states, including Maryland and Virginia, mandate screening for newborns. “The problem was that a lot of kids were being identified at age 3 or 4 when they have missed a lot of language,” says Mrs. Wilson-Bridges. “We started it at Washington Hospital Center in 2001, a year before the District required it, and it was definitely a big undertaking because we have about 5,800 births a year.”

Usually the baby is asleep and unaware of the test, which is given at least 12 hours after birth because, she explains, before then there could be debris in the ear. A tiny plug that gives off a very soft clicking sound is put into the ear to see whether it registers an echo. A normal baby’s hearing shows an echo. If it does not, the test will be repeated another day and possibly again two weeks later. (About 2 percent of babies tested show some hearing problem, she says.)

The majority of people who see audiologists are adults in their 60s or 70s who have been persuaded to come in by physicians or family members or else have noticed an appreciable hearing loss on their own.

Such was the case with Catherine Mitchell, a retired government worker who lives in the District’s Southeast. She had been having what she calls “popping sensations” in her left ear for several months and thought the cause might be an excess amount of ear wax or a reaction to medicines she takes for emphysema. Her physician found out that the problem wasn’t wax and sent her to Washington Hospital Center for an audiogram before taking further steps.

Mild loss seldom presents a problem except, possibly, when one is listening to someone talk in a crowded restaurant. Someone with “profound” loss has no hearing and may need a cochlear implant to function normally.

Apart from excess noise, the most frequent cause of diminished hearing is nerve loss from aging. According to Mrs. Wilson-Bridges, if the loss progresses with age, there is little a person can do besides investing in supplementary medical devices.

Should the audiologist in a preliminary exam see any obstruction in the ear — wax or even pieces of hair, for instance, he will send the person to a physician to have it removed either by suctioning or with a delicate tool that can scoop it out. Finding tiny hairs (as from a haircut) in the ear is common, Mrs. Wilson-Bridges notes, adding that the danger is the hair can cause pain.

“Wax is a normal secretion that everyone produces — some more than others,” she says. “It serves a purpose to help keep debris from coming in. Normally, it comes out as we shower and bathe.”

The audiogram, which takes 45 minutes, is administered in two rooms. The client wears headphones and sits in a small soundproof chamber. The audiologist asks the patient to repeat the words spoken to him and to react when he hears different tones or sounds. Results are printed out on a chart showing the response in both the left ear and right ear.

“If there is a difference in the readings between the ears, that could be a red flag for other medical matters,” Mrs. Wilson-Bridges says. “Or if someone is regularly exposed to loud noise in just one ear, say from shooting off guns, that might explain the difference.”

A portion of the test devoted to the eardrum is called a tympanogram and is done by putting a plug in the ear. If an eardrum doesn’t move in response to pressure, the computer registers a flat line, indicating there is fluid behind the eardrum, wax buildup or possibly an infection.

Hints to help avoid hearing loss:

Hearing loss is predicted for anyone continuously subjected to sounds of 80 decibels or higher. (A typical home smoke alarm can sound at around 85 decibels; a garbage truck can reach 100.) An extremely loud explosion can cause damage as well, says Teri Wilson-Bridges of Washington Hospital Center’s Hearing and Speech Center.

• Avoid putting anything in the ears, including Q-tips, she warns, because these and other small objects may push ear wax farther into the canal and injure the eardrum.

• Anyone using a power lawn mower should wear some form of protection, if only over-the-counter ear filters or plugs. People who regularly attend or perform in concerts where music is played loudly should be aware that they are liable to injure their hearing in the long run. Custom-made ear plugs are available for such people.

• Another simple preventive, she suggests, is making sure water drains out of the ear after swimming or a shower. Everyone’s ear canal is different, and the water cannot always be eliminated with a single shake of the head. Water left inside might allow bacteria to build up, often resulting in a painful condition known as swimmer’s ear.

• Wax buildup is best resolved by using an over-the-counter kit rather than trying warm oil or by “candling,” a method espoused by some alternative health sources, says Dr. Dennis Fitzgerald, a Washington Hospital Center otolaryngologist. (Candling is applying a lit hollow candle to the ear, said to create suction that can help remove wax.)

• Based on a double-blind study he conducted, Dr. Fitzgerald also discourages trying vitamin therapy to “cure” tinnitus. “Tinnitus is not a diagnosis or a condition, but a symptom — just as hearing loss is a symptom,” he says. It’s caused, he notes, by a weakening of tiny hair cells in the inner ear that change the physical energy of sound by releasing chemicals called neurotransmitters.

“When they get beat up for one reason or another, they not only stop responding to sound properly, but they also get leaky and start to leak out their neurotransmitters, so a person gets the perception of sound without a sound stimulus.”

— Ann Geracimos

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