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Massachusetts Medical Society's Physician Focus

November 2015

Hearing Loss
Causes, Prevention, Remedies


  • More than 30 million Americans age 12 and older have some level of impaired hearing.
  • Among older Americans, hearing impairment is the third most common chronic condition, and can lead to social isolation, functional decline, and depression.
  • An increasing number of young people are experiencing hearing loss due to exposure to loud noises, many from personal listening devices.

Hearing loss is one of the most prevalent medical conditions affecting Americans of all ages. And it’s something we can’t avoid: as we age, our hearing begins to deteriorate.

“Hearing starts to deteriorate naturally at about age 30,” says Jeffrey S. Brown, M.D., a physician with ENT Consultants at Winchester Hospital and President of the Massachusetts Society of Otolaryngology-Head and Neck Surgery.

“But there’s no magic number at which loss occurs,” he adds. “We expect senior citizens to have some amount of hearing loss, but other factors are at play as well, such as ear infection, ear damage, loud-noise exposure, or genetic factors.”

Dr. Brown and his colleague, Theodore Mason, M.D., a physician with Ear, Nose and Throat Surgeons of Western New England in Springfield and President-Elect of the Society, appear as guests on the November edition of Physician Focus with the Massachusetts Medical Society to discuss hearing loss – its signs, symptoms, and causes; what people can do to prevent hearing loss; and what remedies are available for those who do experience such a loss. Hosting this edition is Bruce Karlin, M.D., a primary care physician in Worcester.

No one level of loss determines a disability, say the physicians. That depends on how much trouble someone has with his or her hearing and the ability to function day-to-day.

“There’s also a personal assessment of hearing loss that is very individualized,” says Dr. Mason. “Some people with a mild level of loss are significantly affected; others with a significant degree of loss aren’t bothered by it.”

Besides aging, common causes of hearing loss include exposure to loud noises, principally through work or loud music; ear infection or injury; head injury; and genetic factors.

The physicians note that noise-induced hearing loss is becoming much more frequent, especially among young people, even as young as 16 or 17, who use personal listening devices. The loud noises gradually destroy the nerve endings in the inner ear, and the damage becomes permanent. It cannot be medically or surgically corrected.

So just how loud is too loud?

“The body is pretty good at knowing when something is too loud,” says Dr. Mason. “There’s a certain decibel level of sound that actually becomes painful. Even brief exposures to painfully loud sounds can cause permanent damage.”

Sound is measured in decibels, and “as the sound gets louder,” says Dr. Brown, “the human ear can tolerate it for less and less time.” A refrigerator, for example, has a level of 40 decibels; a jet engine, 140; and loud car stereos, 145. The physicians say even a single blast of sound at a high level can cause permanent damage. Hearing damage can occur as low as 80 decibels, depending on the time of exposure.

For those who do experience hearing loss, some remedies are available.

“There have been some major changes in technology that have really changed hearing aids,” says Dr. Mason. “They are so much better than they use to be.” The key, he says, is to find someone who knows hearing aids well and can fit the right hearing aid to the patient.

For patients with severe to profound hearing loss, the doctors suggest cochlear implants, an outpatient procedure that entails implanting an electronic device into the inner ear.

Dr. Mason notes that “they are amazingly well-tolerated,” and says that they have transformed the lives of many people, particularly elderly, who had become isolated or depressed because of their severe lack of hearing. He notes, too, that many elderly who could benefit from such a procedure, which is covered by insurance, may not know they are eligible for it.

The physicians’ most important message about hearing, however, is one that’s heard throughout many other areas of medicine.

“The most important thing to emphasize is prevention,” says Dr. Brown. “People who are exposed to loud noise at work or play should really protect their ears to prevent hearing loss in the first place.”

“Those who are exposed to loud noise on a regular basis or can’t use protection for a variety of reasons,” adds Dr. Brown, “should get screened by an audiologist and have a thorough, comprehensive hearing test on a regular basis to monitor their hearing.”

View the video above for more conversation, including ways to filter and reduce the sound of personal listening devices, details of decibel levels of sound, and additional discussion about hearing aids and cochlear implants.

MMS/Richard Gulla

American Academy of Otolaryngology

National Institute on Deafness and other Communication Disorders

American Academy of Audiology

Hearing Loss Association of America

U.S. Centers for Disease Control

"Hearing Loss" PSA

From left, Bruce Karlin, M.D., Theodore Mason, M.D., Jeffrey Brown, M.D.
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