WebMD Health - Ear Disorders

Sep 15, 2010 4:30 PM

Severe Hearing Loss Treatment Options

When I was a kid, phone conversations with my grandmother went something like this:

"Hello?"

"Hi Grandma, it's me, Stephanie!"

(Pause) "Hello?"

(Louder) "Hi, Grandma!"

"Hello?"

(Shouting) "HI GRANDMA!!!"

Click.

At family gatherings, my relatives got so tired of repeating themselves that they left Grandma out of conversations. Even as a kid, I realized how isolated she must have felt due to her severe hearing loss.

My grandmother never got a hearing aid because she worried that wearing a huge piece of equipment behind her ear would alert the whole world to her hearing loss. Anyone who shares the same fear today should know this:

Times have changed. These aren't your grandma's hearing aids.

"I like to say that the hearing loss is more visible to others than the hearing aid," says Pam Mason, director of audiology professional practices at the American Speech-Language-Hearing Association (ASHA). "Hearing aids today are behind the ear, very small, with a tiny wire that goes down into your ear canal. They truly are invisible."

Hearing aids are not the only profound hearing loss treatments available. There are other options, including middle ear implants and cochlear implants. But before you can get a hearing aid or any other hearing device, you need to first find out what's causing your hearing loss.

4 Steps to Severe Hearing Loss Treatment

Step 1: Get Your Hearing Evaluated

The time to see a specialist is as soon as you start experiencing signs of hearing loss:

  • You're turning up the TV or radio volume louder than usual
  • You have ringing in your ears
  • You have trouble distinguishing conversations from background noise
  • Your family and friends have to repeat themselves
  • You have difficulty hearing on the telephone

The hearing evaluation and treatment typically involve a team of specialists that includes an ear, nose, and throat (ENT) doctor, also called an otolaryngologist, and an audiologist.

"The first thing is to do a complete evaluation of the patient from a head and neck standpoint and understand the nature of the hearing loss," explains Anand K. Devaiah, MD, FACS, associate professor in the department of otolaryngology-head and neck surgery at Boston University School of Medicine.

Many of the medical conditions that can contribute to severe hearing loss, from infections to tumors, are treatable.

"We might be able to intervene from a medical or surgical standpoint first," Devaiah says. Treatments may include:

  • Using antibiotics to treat ear infections
  • Surgically correcting anatomical problems with the eardrums or bones of the middle ear
  • Removing ear wax that blocks the ear canal by washing it out or dissolving it with ear drops

Once a medical cause of hearing loss has been ruled out, you'll undergo a series of hearing tests to evaluate:

  • Your ability to hear at different pitches and volumes
  • Your ability to understand speech and tell the difference between similar-sounding words
  • How well sound passes through your eardrum and middle ear
  • How well signals are passing from your ears to your brain

The audiologist will record the results on a graph called an audiogram. "Based on the test results, we make a recommendation on treatment options," says Virginia Hull Bell, MS, an audiologist in the department of speech-language pathology and audiology at the University of Memphis.

Step 2: Know Your Treatment Options

The type and degree of your hearing loss will determine which treatment your audiologist or ENT recommends. Here are some of your options.

Hearing Aids

Hearing aids are devices that fit inside or behind your ear. They don't restore hearing, they just electronically amplify the sounds going into your ear. "A hearing aid will never bring their hearing back to normal, but it will improve their ability to understand speech and to hear the sounds their hearing loss is masking," says Hull Bell.

Your audiologist will use the information from your audiogram to choose the best hearing aid for you. Then the hearing aid will be programmed to accommodate your type and degree of hearing loss. Some hearing aids amplify the higher frequencies to improve speech recognition. Other hearing aids can be programmed to accommodate for specific situations, such as noisy or quiet environments.

You can customize your hearing aid further by adding one of these options:

  • Directional microphones boost the sound coming straight at you so that you have an easier time hearing conversations.
  • A telephone switch ("T" setting) filters out background noise while you're on the phone. You can also use the "T" setting with the listening systems available in many public facilities to help you hear plays, concerts, meetings, and worship services.

Finally, your audiologist will test the hearing aid in your ear to make sure the amplification works for you.

Cochlear Implants

Cochlear implants are electronic devices that create the sensation of sound by directly stimulating hearing nerves in the inner ear.

The benefits of cochlear implants can be dramatic, but they're not for everyone. "It's for those people who really cannot get good benefit from hearing aids," says Hull Bell.

It's important to remember that a cochlear implant isn't like a hearing aid. It doesn't amplify what your ears are hearing. Instead, it bypasses your ears and directly stimulates the auditory nerve, which sends the signal straight to your brain. Although cochlear implant surgery is considered to be safe, it is still a surgical procedure. So be sure to talk with your doctor about the risks.

A new technology that combines a cochlear implant with a hearing aid in the same ear is being tested in clinical trials. This technology may help certain patients with high-frequency hearing loss and some residual hearing in the low frequencies. Researchers are still testing these devices with the goal of improving hearing across the spectrum.

The sound you hear with a cochlear implant is not the same as normal hearing. However, with time and practice a person's performance ability improves. Many cochlear implant users report being able to hear very well in quiet environments. They also show significant improvement in hearing in noisy environments. Many use landline and cellular phones, and enjoy music again.

Performance with cochlear implants improves with time and practice. At first, someone might perceive that voices are present but may not be able to understand those voices very well. The brain will adapt, and this adaptation may improve if the user participates in aural rehabilitation.

Although there is a wide range of performance, most people with cochlear implants are satisfied with the results and can actively participate again in the hearing world.

To determine if you qualify for cochlear implants, you'll undergo a thorough hearing loss evaluation. Your ENT will also examine you to make sure you're healthy enough to go through the implant surgery.

Middle Ear Implants

Middle ear implants are an option for people who either can't tolerate or don't benefit from hearing aids, but whose hearing loss isn't severe enough for a cochlear implant.

Here's how it works: You wear an external microphone above your ear that picks up sound. The sound is converted into electrical signals, which travel through the skin to an implant that is attached to the tiny bones of the middle ear. The implant enhances the vibration of the middle ear bones and sends those amplified vibrations to the inner ear. Finally, the nerve signal is sent to the brain, where it is recognized as sound.

You can adjust the middle ear implant much like you would program a hearing aid or cochlear implant.

Middle ear implants may not be covered by insurance and can be quite expensive. Once the implant is placed, a person cannot have an MRI scan without removing the implant.

Auditory Brain Stem Implants

Auditory brain stem implants (ABIs) are different from cochlear implants. Instead of placing the stimulator in the cochlea, an ABI is placed directly on the surface of the brain.

Right now, ABIs are only being used in a small group of people who have a missing or nonfunctioning cochlear nerve. This is usually the case for people who have a rare inherited disorder called neurofibromatosis type II (NF-2). Outside the U.S., auditory brain stem implants are being placed in both adult and pediatric patients without NF-2.

Step 3: Learn How to Use Your Device

Whichever type of severe hearing loss treatment you get, you need to learn how to use it properly.

"They have to put in a lot of effort and they have to be very dedicated to learning how to listen again," says Hull Bell. "You can give them the latest and greatest hearing aid, but if they don't put the time and effort into it, it's not going to be successful."

Before you leave your audiologist's office, make sure you know how to use your new device. Also ask about being enrolled in an aural rehabilitation program. This program can help you improve your communication skills and adjust to your hearing aids.

Keep in touch with your audiologist and/or ENT. They can make adjustments, if needed, to make sure your hearing device continues to work well for you over the long term.

Step 4: Manage Your Hearing Loss

In addition to getting a hearing aid or other hearing device, you can use one of the many hearing-assistive devices available to help you manage your hearing loss:

  • Infrared systems let you set the TV volume to your own headphones, so the rest of your family doesn't have to listen at full blast.
  • Closed-captioning prints a text display across the bottom of your TV screen, so you don't miss any of the dialogue in your favorite shows.
  • Alerting devices use flashing lights to signal sounds, like when the doorbell or phone rings or the smoke alarm goes off. There are even devices that will shake your bed when your alarm clock rings.
  • TTY telephone is a tele-typewriter that allows a hearing-impaired individual to communicate with people who can hear normally. The conversation from the hearing person is typed and displayed on the TTY to the hearing-impaired person.
  • Texting on cell phones now allows hearing-impaired people to communicate more readily.

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