Hearing problems:what to do?

Hearing impairments or alterations in auditory function have many causes, but all result in the same symptom:more or less significant deafness that may or may not be associated with tinnitus. Depending on the problem observed, different measures may be proposed, such as hearing protection, advice on exposure to loud noises or a hearing aid (device).

What is presbycusis?

Presbycusis is probably the most common cause of hearing loss in adults over 50.

Presbycusis

It is a gradual decline in hearing caused by the normal aging processes of the auditory system. Presbycusis mainly results from damage to the inner ear with a progressive and continuous decrease in the number of cells in the cochlea. But all the structures of the auditory system (middle ear, inner ear pathways and nerve centers) are affected. Hearing loss is bilateral and symmetrical.

What are the warning signs of presbycusis?

The main signs of presbycusis are:

• difficulty understanding in a noisy environment,
• the increase in the sound intensity of television and radio, often noticed by those around you.

Presbycusis generally manifests after the age of 60, but may be earlier in connection with genetic factors and diseases (diabetes, vascular pathology) or sound trauma.

Presbycusis can be added to other causes of deafness and aggravate the symptoms:chronic ear infections, impairment of the ossicles, etc.

It can also be accompanied by tinnitus.

What is tinnitus?

Tinnitus (ringing or buzzing in the ears) refers to noises perceived by the person without an external physical reason. It can be hissing, buzzing, echoing, etc. Tinnitus affects 15% of the population at some point in life and 30% of the elderly population.

What causes tinnitus?

Tinnitus can be a symptom of a pathology of the auditory system due to damage to the sensory cells of the inner ear.

They can therefore occur :

• after an acute or old noise trauma,
• during presbycusis,
• after a barometric trauma:decompression sickness in the plane or while diving.

Various factors may also be involved:

• certain medications (e.g. non-steroidal anti-inflammatory drugs or NSAIDs, aspirin),
• the presence of an earwax blockage,
• high blood pressure (HTA),
• an emotional shock,
• etc.

How to cure tinnitus?

First of all, the cause must be treated when possible:wax plug, high blood pressure (HTA), wearing hearing aids in case of significant deafness, etc.

There is no specific treatment for tinnitus.

In addition:

• The doctor can sometimes prescribe anxiolytics to calm the anxieties linked to the presence of tinnitus,
• wearing a white tone generator can significantly reduce the perception of tinnitus in normal hearing;
• cognitive and behavioral therapies (CBT);
• alternative medicine (acupuncture, homeopathy, etc.),

How to prevent hearing damage?

Some factors favoring the onset of hearing problems can be avoided. These are essentially harmful exposures to noise. Simple measures can significantly reduce the risks.

Factors that favor the appearance of hearing disorders

Noise:Above a certain threshold, noise can be harmful to hearing. The degree of harmfulness depends on the duration of exposure, the intensity of the noise and its frequency:high-pitched noises are more harmful.

Individual susceptibility related to age, genetic factors and history of ENT problems (e.g. recurrent ear infections).

The accepted threshold of harmful noise is 85-90 dB over a period of 8 hours a day.

How to prevent hearing disorders and impairments?

Four key words sum up the fight against hearing disorders and deficiencies:prevention, early detection, treatment, and rehabilitation.

Prevention:

Minimize exposure to noise (professional and recreational):

• using personal noise protection devices as soon as the noise is high:earplugs, headbands or earmuffs;
• using noise reduction devices:absorption of reflected waves, reduction of wave propagation;
• avoiding placing yourself where the sound is loudest in a performance venue;
• avoiding listening to music too loudly and too frequently with headphones.

Limit environmental noise as much as possible:

• educate children to preserve their hearing capital;
• consult a doctor as soon as you have difficulty understanding or when whistling sounds that are not perceived by the environment are heard.

When should you consult for hearing problems?

Hearing disorders must be detected and treated as early as possible to limit their impact on daily life. An otolaryngologist (ENT) doctor will make an accurate diagnosis and offer appropriate treatment.

Consult at the first signs

When they appear, hearing problems are most often manifested by:

• difficulty understanding in a noisy environment :the person is obliged to make his interlocutors repeat, he has difficulty "sorting" the sound messages he receives and feels a feeling of hubbub;
• diminished perception of sounds , which can result, for example, in the increase in the volume of television or radio. Those around you are often the first to realize this.

As soon as one or other of these signs appears, a medical consultation is essential:an accurate diagnosis will allow the necessary measures to be taken to stop or delay hearing disorders and deficiencies as much as possible.

Consultation with the ENT doctor

The diagnosis of ENT is primarily based on a clinical examination of the circumstances of appearance of the discomfort and their progressive nature.

The ENT will carry out a hearing measurement and additional examinations:

• tone audiometry which will establish a quantitative measurement of hearing for each ear and confirm deafness or hearing loss;
• speech audiometry , based on tests, which will show how well you hear or understand a normal conversation.

The doctor may prescribe a hearing aid as soon as any difficulty in group communication appears.

A hearing aid or hearing aid, at the first signs, will partially compensate for the hearing loss. Wearing the devices must be daily and often requires time to adapt. A trial period for the equipment, of at least 15 days, is also offered by hearing aid professionals.

Auditory rehabilitation and learning to read lips with a speech therapist can, in certain cases of significant deafness, effectively reinforce the contribution of prostheses.

Which hearing aid and at what cost?

The operating principle of hearing aids is relatively simple:they amplify sound. Depending on the technology used, analog or digital, and the shape of the prosthesis, behind-the-ear or in-the-ear, the results differ and the prices vary

BTE or in-the-ear prosthesis?

The form:

• Behind-the-ears are the most used. They consist of a box to be positioned around the ear, to which a custom molded ear tip is connected. Technical progress has made it possible to miniaturize them, manufacturers have also made a lot of effort on their aesthetic appearance. We therefore find today very discreet and very light models (about ten grams). BTEs are the most versatile hearing aids:they can be used in almost all cases of hearing loss, from the mildest to the most severe.

• In-ear hearing aids: their main advantage is their very small size which allows them to be positioned inside the ear canal, thus making them almost invisible. Intra-auricular prostheses consist of a molding of the ear of the equipped person, in which is inserted the electronic part which is used to amplify the sounds. These prostheses are not suitable for all people (size and shape of the auditory canal, excessive earwax production), nor for all types of hearing impairment:they are not very effective in the event of hearing loss greater than 60-70 decibels.

• In some cases, other types of prostheses may be offered:bone conduction prostheses (glasses, headband), bone-anchored hearing aid (BAHA) or cochlear implant.

The amplification technique used:analog vs digital

• Analog amplification: the sound is picked up by a microphone and amplified, then reproduced. This type of amplification is used less and less, in favor of digital systems.
• Digital amplification: it takes advantage of the latest technological advances and offers superior listening quality to analog amplification. In particular, it is more selective in the choice of amplified or reduced sounds, being able to highlight more “useful” sounds (for example voices).

The cost of hearing aids

The cost of hearing aids often seems high because it includes the material (the prosthesis) and the work of the audioprosthetist:molding, adaptation and adjustments of the prosthesis.

The price of the hearing aid varies depending on the type:

• 1000 to 1500 euros for a hearing aid with analog amplifier;
• 1500 to 2500 euros for a digital prosthesis.

The various adjustments necessary to adapt the prosthesis to the person's hearing and lifestyle are included in this package, as well as maintenance over a period of approximately two years. It is recommended to consult your audioprosthetist annually to ensure the proper functioning of your prosthesis and the absence of earwax plugs in the ear canal, favored by the wearing of prostheses.

The basics of hearing aid reimbursement for adults over 20:

• coverage of hearing aids on medical prescriptions from the ENT doctor less than one year old (decree of 6 May 1997),
• hearing aids are reimbursed at 60%, based on a price set at 199.71 euros,
• this package applies regardless of the class of equipment,
• for information:the prescription of the device for a child is 100% covered if it is well established on the CERFA prescription and agreement of the A.L.D. (Long Lasting Affection).

Complementary health insurance can cover part of the cost of hearing aids.

https://www.who.int/en/news-room/fact-sheets/detail/deafness-and-hearing-loss

https://www.journee-audition.org/

http://www.france-acouphenes.org/