how does hearing work?

LEARN ABOUT HEARING AND HEARING LOSS.

the ear

The ear is made of three components: the Outer, Middle, and Inner ear.

the outer ear

The outer ear is made of all the parts you can see with the naked eye as well as the ear canal leading up to the eardrum. It is made of cartilage and skin. Our outer ears are designed to help funnel sound into the ear canal and beyond. The ear canal is made of different glands that produce earwax and can help protect the middle ear.

the middle ear

The middle ear is behind the eardrum and contains three tiny bones called the ossicles. These three bones are the malleus (hammer), incus (anvil), and stapes (stirrup), and the bones are said to be smaller than a grain of rice. When sound enters the ear canal, the sound waves hit the ear drum, which then vibrate the three bones to activate the organ of hearing, the cochlea.

The middle ear space also connects with the nasal cavity through a tube called the Eustachian tube. This tube helps equalize pressure. When the nasal cavity has extra fluid or pressure, this can affect the middle ear space and hearing.

the inner ear

The inner ear has two different functions: 1) hearing through the organ of hearing, the cochlea 2) maintaining balance through the vestibular system.

The cochlea is a snail-like shape made of small hair cells in two fluid filled chambers. Once vibrations are received from the middle ear space, this vibrates the hair cells, which create electrical signals that are sent to the auditory nerve and brain.

The vestibular system are comprised of the semicircular canals and vestibule. This portion of the ears maintains your balance by sending signals to the brain through the vestibular nerve on which direction an individual is facing and spatial orientation.

types of hearing loss:

The type of hearing loss is determined by where an injury or damage has occurred.

conductive hearing loss

Conductive hearing loss occurs when there is damage within the outer or middle portions of the ear but your inner ear or the cochlea is fully functioning. This can include ear infections, partial or absence of the outer ear or ear canal, obstructions within the ear canal or middle ear space (i.e. fluid or debris), or injuries to the eardrum or the ossicles.

Depending on the cause of the hearing loss, the treatments could include antibiotics, surgical intervention, traditional hearing aids, or bone anchored hearing aids. Once the hearing assessment is complete, your audiologist will make necessary recommendations to an ear, nose, and throat physician if medical intervention is warranted.

sensorineural hearing loss

Sensorineural hearing loss occurs when there is damage within the inner portion of the ear (i.e. the cochlea or hair cells within the cochlea) or the auditory nerve. This could be due to genetic components, acoustic noise trauma from excessively loud noises, aging, chemotherapy, or other ototoxic drugs.

Depending on the cause and severity of the hearing loss, treatments could include traditional hearing aids or cochlear implants. This will be discussed by your audiologist once the hearing assessment is complete.

mixed hearing loss

Mixed hearing loss occurs when there is damage both within the middle/outer ear spaces and the inner ear space. Sometimes, the injury could first start in one space and then affect the other space due to the severity of the injury (i.e. an ear infection becomes severe enough to affect the cochlea).

Potential treatments include traditional hearing aids, bone anchored hearing aids with more power, or a cochlear implant. A referral to an ear, nose, and throat physician for medical treatment may be warranted. This will be discussed further with your audiologist once the hearing assessment is complete.

how do i know if i have hearing loss?

Adapted from the American Speech- Language-Hearing Association Self Test for Hearing Loss

if you say "yes" to at least two of the questions to the right, you may be experiencing hearing loss...

Do you have a problem hearing over the telephone?
Do you hear better in one ear than the other when you are on the phone or listening to headphones?
Do you have trouble understanding when two or more people talk at the same time?
Do people complain that you turn the TV volume up too high?
Do you have to strain to understand what people say?
Do you have trouble hearing in a noisy place?
Do you have trouble hearing in restaurants?
Do you have dizziness, pain, or ringing in your ears?
Do you ask people to repeat what they said?
Do family members or coworkers tell you that you are not hearing what they say?
Do many people you talk to seem to mumble or not speak clearly?
Do you have trouble understanding women and children?
Do people get annoyed because you don’t understand what they say?

hearing health is brain health

Most individuals assume hearing health only affects your ears, but more and more research shows how ears and hearing can affect your whole health. According to Livingston et al. (2020), "untreated hearing loss increases the risk for dementia." Those with untreated hearing loss, social isolation, and depression can experience a lower quality of life but also higher chances of cognitive decline.

hearing loss

Did you know that hearing loss is the "single largest potentially modifiable risk factor for dementia"? Adults with hearing loss have a faster rate of cognitive decline than adults with normal hearing (Lin et al., 2013).

Due to hearing loss, the brain has to work harder because available "cognitive resources" are deciphering what is being heard or said. This limits resources for memory or thinking.

The brain structure can also change negatively (Lin et al., 2014). The brain is a muscle, and if you "don't use it, you lose it."

In a study conducted by Dr. Frank Lin and Johns Hopkins Medicine, they found the degree of hearing loss could increase the risk for cognitive decline:

Mild hearing loss doubled dementia risk
Moderate hearing loss tripled the risk
Severe hearing loss equaled five times the risk

Hearing loss does not cause dementia, but evidence shows hearing loss can contribute to cognitive decline.

social isolation & loneliness

Due to hearing loss, many find themselves retreating from social settings or conversations, especially in background noise. Because of this, they tend to socially isolate themselves, which can lead to loneliness.

New studies and literature have shown individuals experiencing loneliness are at a "heightened risk of developing dementia-related disorders compared to non-lonely individuals" (Guarnera et al., 2023). They also found loneliness seemed to affect how quickly an individual could recall information, memory issues, how smoothly an individual talked, and how quickly they processed information.

Through the chain reaction of hearing loss causing social isolation leading to loneliness, this can contribute to a higher chance of cognitive decline.

depression

Individuals with hearing loss can experience a lack of social interactions, bad moods, which can then lead to depression. are experiencing loneliness and a lack of social interactions, "there is a strong relationship between depression and hearing loss among US adults of all ages" (Li et al., 2014).

Li and colleagues also state "regular hearing aid use is associated with a lower prevalence of depression. Some other studies have shown "reductions in depressive symptoms within three months of hearing aid use" (Mener et al., 2013).

how to best protect your ears & hearing

At Hear & There, we are serious about hearing protection! We live in a noisy world, and there are many opportunities for permanent acoustic noise damage.

wear hearing protection in loud environments.

Noisy environments, like using lawn equipment, music concerts, sporting events, work settings, construction sites, or gun ranges, can lead to excessive noise. But how loud is too loud? OSHA guidelines state an individual can be in a work environment for a workday if the noise levels are 85 dBA or lower. A good rule of thumb is if you have to shout to be heard by another person, hearing protection is recommended.

Free cell phone apps are available to check the decibel level of your environment. If you wear a health watch, many also have a health feature to alert you if the noise level is excessive. You may be surprised how loud your environment actually is!

Hearing protection comes in inexpensive, basic options, like foam earplugs found at drugstores or pharmacies or headphones found at sporting goods stores. If you do choose to use a basic option, especially the foam earplugs, be sure to properly and fully insert the earplugs for maximum protection.

For more sophisticated or custom hearing protection options, check out our offerings here.

keep down the volume of your earphones.

With the popularity of earbuds and "hearables", more and more Americans are exposing themselves to more direct sound in their ears. Many cell phones have safety features built in that monitor the volume of your streaming that can be enabled.

A good rule of thumb is if you cannot hear a conversation three feet away when wearing your earphones, the volume is excessive.

To help reduce the overall volume, custom earpieces to fit on certain earphones are available. Through a more secure fit of the earphone, the sound does not leak out, which could reduce how much the volume is increased. Talk to your audiologist if you are interested in this option.

check your hearing regularly.

If you have ever attended a concert or sporting event and you leave with muted hearing and/or ringing in your ears, you may have sustained permanent damage to your hearing. If this is occurring more often, a baseline hearing assessment is recommended. After the initial baseline, regular monitoring of your hearing is encouraged.

Call our office today if you have any concerns regarding your hearing, especially after being in loud environments.