WebMD Health - Ear Disorders

Sep 15, 2010 4:31 PM

Living With Severe Hearing Loss

Samuel R. Atcherson, PhD, was a toddler when his babysitter noticed he didn't respond to sound the way other kids do. He was diagnosed with mild hearing loss that progressed to severe hearing loss by the time he was in college.

"Growing up, I rarely used the phone, because I could not understand," Atcherson recalls. "This affected my social life considerably, and I certainly had moments of feeling isolated."

Atcherson used hearing aids, but still had trouble following conversations. "I continued to struggle, especially in the classroom," he tells WebMD. So he decided to try a cochlear implant. After an adjustment phase, he noticed real improvements in his hearing skills. Atcherson went on to earn a PhD in audiology.

Like Atcherson, many people struggle with hearing in the classroom, at the movies, and in other everyday situations. Fortunately, there are a growing number of technologies and strategies that can help.

What Is Severe Hearing Loss?

According to the National Institute on Deafness and Other Communication Disorders, about 17% of American adults have hearing loss that ranges from mild to profound. Severe hearing loss generally means a person can't hear the speech of others without technological assistance.

There is no one-size-fits-all strategy for coping with a severe hearing impairment. That's why it's critical to understand your type of hearing loss and know your options.

Conductive Hearing Loss

Conductive hearing loss occurs when the outer or middle ear is unable to conduct sound to the inner ear. This may be the result of excessive ear wax, fluid buildup, or structural abnormalities in the ear. Medical treatment or surgery may be able to restore hearing in some cases.

Sensorineural Hearing Loss

Sensorineural hearing loss refers to a problem with the inner ear or auditory nerve. Most often, the hair cells in the inner ear that detect sound are abnormal or damaged. This type of hearing loss is permanent. A hearing aid is the most commonly used strategy to treat sensorineural hearing loss, but there are a variety of other devices that can help compensate for the loss.

Hearing Aids

Hearing aids work by amplifying sounds so they are easier for the inner ear to detect. The greater the hearing loss, the more amplification necessary. There are several styles of hearing aids:

  • Behind-the-ear hearing aids consist of a plastic case worn behind the ear, along with an ear mold worn in the outer ear.
  • Open-fit hearing aids are worn completely behind the ear with only a narrow tube reaching into the ear canal.
  • In-the-ear hearing aids are worn completely inside the outer ear.
  • Canal hearing aids fit inside the ear canal.

Hearing aids can't always help people with severe hearing loss. People who can benefit "will get their best performance from behind-the-ear style hearing aids," says Craig Newman, PhD, Cleveland Clinic's head of audiology. "These are the most flexible in how they can be programmed ... and they have more power."

Gordon Hughes, MD, of the National Institute on Deafness and Other Communication Disorders, agrees. "Lighter weight and more versatile styles can't reach the power levels that the other devices can."

But there are times when no amount of power will be enough. If the inner ear is too damaged, it can't convert sounds into signals the brain can understand. In that case, the person may be a candidate for a cochlear implant.

Cochlear Implants

Cochlear implants offer a way to bypass the damaged hair cells of the inner ear, also called the cochlea. The implant is placed in the cochlea, and an external microphone and speech processor send signals to a device that is implanted under the skin. The cochlear implant delivers impulses directly to the auditory nerve, which carries the signals to the brain. Although the signals are different from normal hearing, they help people recognize speech and other sounds.

Atcherson, who is now an assistant professor of audiology and a fellow of the American Academy of Audiology, says many people with severe hearing loss could benefit from a cochlear implant. He tells WebMD that people with less severe hearing loss may be eligible for cochlear implants in the near future because of the high success rate.

Cochlear implants can treat severe hearing loss in people from infants to older adults. In adults, Hughes tells WebMD, the implants work best when the brain still remembers how to interpret sound signals. The longer a person waits to receive treatment, the less receptive the auditory system becomes. This makes the outcome more difficult to predict.

Atcherson points out that adults need to have realistic expectations about how they will hear with a cochlear implant, especially in the beginning. At first, he had trouble distinguishing voices. "But in those first two months and the next two years, my brain adjusted. Music sounded better, speech was clear, and I got to the point that I use a cell phone."

While cochlear implants are not right for everyone, they have "a lot of potential to make a huge difference in someone's life," Atcherson says. "If someone makes the decision and they are self-motivated to get a cochlear implant, I recommend doing it as early as possible."

Cochlear Implants in Children

Time is of the essence in children, too. "The younger you implant a profoundly impaired child, the more receptive the brain and the better the outcome," Hughes says. "These children develop an incredible vocabulary."

Some children who receive a cochlear implant at a young age can attend mainstream school with minimal to no assistance. The outcome depends on several factors, such as parental involvement, other medical conditions, cause of deafness, age of implantation, and the underlying abilities of the individual.

To help with speech recognition, children with cochlear implants usually benefit from auditory-verbal therapy. This approach encourages children to rely on hearing, rather than visual cues, as they develop language skills. Kids learn to use their cochlear implants to listen to their own voice, the voices of others, and everyday sounds in order to develop their hearing skills.

Auditory-verbal therapy coaches parents to become the main facilitators in developing their child's hearing skills. A similar strategy, auditory-oral-therapy, relies on teachers and therapists to guide children in developing these skills. The goal of either approach is to help children comprehend and use spoken language in a way that enables them to participate in mainstream society.

Middle-Ear Implants

Middle-ear implants are an alternative to conventional hearing aids. They also boost sound to the inner ear, but the devices are implanted within the middle ear to directly drive the ossicles. These are three tiny bones that amplify sound signals and transmit them to the inner ear, from the ear drum.

Middle-ear implants may also appeal to people who want an invisible hearing device. They are also beneficial in people who cannot wear a hearing aid such as those with dermatologic conditions affecting the ear canal, or a very small or absent ear canal. The implants may also be helpful in those who did not get the desired effect with a traditional hearing aid. Another advantage is that patients "do not sound like they are in a barrel when they are talking, Atcherson says." This is a common complaint with hearing aids that block the ear canal.

Bone-Conducting Hearing Aids

For people with severe hearing loss on only one side, one type of implant can simulate two-sided hearing. A bone-conducting hearing aid uses a component that is attached to the side of the head with poor hearing. Vibrations picked up on that side travel through the skull to the normal ear. "Research has shown a surprising improvement in quality of life," Atcherson says.

Assistive Listening Devices

Assistive listening devices can be used with hearing aids to create a better result in certain situations. The goal is usually to separate speech from background noise.

  • PortableFM systems use radio technology to broadcast a speaker's words directly to a hearing aid. The classic example is the classroom setting, where a microphone is placed in front of a teacher. This helps the student hear the teacher's voice over other sounds.
  • Infrared systems use light-based technology to transmit sound. They are often used to enhance television listening.
  • Induction loop systems are designed to help people hear announcements in public facilities, such as airports, schools, or auditoriums. These systems send signals directly to specially equipped hearing aids or headphones.

Alerting Devices

Alerting devices use other sensory information to substitute for sound. This may include an alarm clock that vibrates the bed, or lights that blink when the doorbell rings or a smoke alarm goes off. These devices are not meant to take the place of hearing aids or implants, but they can improve independence in people with severe hearing loss.

Captioning

Since 1993, U.S. law has required that all televisions larger than 13 inches have the ability to display closed captions. The trouble, Atcherson says, is that many people don't know their TV can do this. If you're not sure how to turn on captions, check with a techie friend or read the instruction manual.

Captioning at movie theaters is another matter. Some theaters display subtitles during special showings for the hearing impaired. Others offer "rear window captioning" -- a system that displays captions on an adjustable panel at the viewer's seat. But the systems are not yet widespread.

Staying Connected

Hearing clearly over the phone has long been a problem for people with hearing loss. But new technologies are changing that. Bluetooth-enabled smart phones can send signals directly to some types of hearing devices, allowing people to "finally enjoy a phone conversation," Atcherson says. The popularity of text messaging also offers a convenient substitute for people who don't hear well over the phone.

Reading Lips and Body Language

According to Atcherson, lip-reading is not easy to pick up. "However, lip-reading is not the whole picture." It's more helpful for people to learn a holistic approach to communication, which includes reading facial expressions, body language, and other visual cues.

Experts also recommend environmental manipulation strategies. This means taking control of the environment you're in. Find ways to reduce background noise. Situate yourself so you are face-to-face with the speaker. These strategies will enhance the benefits you get from a hearing aid or cochlear implant.

Don't Delay

Learning communication-improvement strategies and using current technologies can reduce frustration, depression, and anxiety, Newman says.

"There have been such great strides in hearing aids, cochlear implants, and assistive technologies over the past few years. If you feel your hearing loss is affecting your life, seek treatment from the doctor and management from the audiologist as soon as possible. The sooner you start using these technologies ... the better off you'll be."

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