On Saturday, October 24, Seniors Today hosted leading ENT specialist Dr Samir K Bhargava to address ENT care and hearing concerns in senior citizens. Dr Noor Gill presents key takeaways from the session.
On Saturday, October 24, as part of the Health Live @ Seniors Today series, leading ENT specialist Dr Samir K Bhargava addressed concerns around ENT care and hearing in senior citizens. Dr Bhargava is National President of the Association of Otolaryngologists of India (AOI) for the year 2020.
Dr Bhargava is currently a Professor in HBT Medical College, Mumbai and the Dr R N Cooper Hospital, Mumbai and Consultant at the Hinduja Hospital, Khar, Mumbai.
He has been a Gold Medalist for securing first rank at both MS (ENT) and DORL exam in the year 1991 from Mumbai. An awardwinning student, he has done his MS ENT from the KEM Hospital Mumbai and DLO from Royal College of Surgeons, London.
He has been invited faculty at more than 70 live surgical and cadaveric workshops all over the country since 1996 and has been a guest speaker and panellist at several conferences and workshops. He has authored books, presented papers and is featured amongst Mumbai’s top doctors by India Today magazine in 2019 and 2020. He has been an active Rotarian.
How hearing loss is different from deafness?
Humans communicate through vision, hearing, speech and gestures. Whenever there is an impairment in the process of hearing – it can be anywhere between mild to severe impairment, we deem the patient to be suffering from hearing loss.
But when the patient has very little or no hearing, that is when we label the patient as deaf. Regardless of the degree of loss of hearing, it is also a social and educational handicap, and anyone who has any degree of impairment, can vouch for that. Hellen Keller rightly said “blindness separates people from things but deafness separates people from people.”
Hearing impairment is a concern that has not gotten its due. Since it is not something that can be seen, so the deaf and the ones with hearing impairment usually go unnoticed and suffer in silence.
Here are some numbers and figures to help you understand how common this is – about 6-12% of our world’s population is affected by it. Around 1 lakh children are born deaf in India. And about 1/3rd of people over the age of 65 years of age have significant hearing loss but only 20% of these seek medical assistance, quiet often in the form of hearing aids. Even then, only 4% continue to use and wear the devices.
What the inside of our ear looks like:
There is an outer ear, a middle and an inner ear. The outer ear has a canal that ends at the ear drum also known as the tympanic membrane, then in the middle ear, we have the hearing bones also known as the ossicle and in inner year we have the cochlea- which helps us with the balance, and the nerves.
When a sound is made, it enters the ear canal, vibrates the ear drum, is conducted through the ear bones and is then transmitted to the nerves and then to the brain to help us make sense of the sounds we hear.
Anything that happens in the outer and/or inner ear can, quiet often be managed by medications or surgical intervention. But, if something goes wrong in the middle ear, is when we need hearing aids.
On hearing levels:
The intensity of sound is measured in decibels (dB). When we whisper, the sound intensity is anywhere between 25-40dB, when you can’t hear a whisper, it is labeled as mild hearing loss.
If you can’t hear someone talking even at the normal/regular volume, it is called moderate or medium hearing loss.
If you cannot hear loud noises, such as the horn of a car or the ongoing traffic on the road, then it will fall under moderate to severe hearing loss.
And if you cannot hear a the sound of a train, or a plane or a sawing instrument, then that would fall under profound hearing loss or it can also be called tone deaf.
We use a pure tone audiometer to find out the degree and nature of the hearing loss. It is only after the pure tone audiometry that we categories the patient.
Hearing impairment can also be experienced by people who work in noisy environments. According to the Workers’ Occupational Diseases Act under the Workman’s Acts, anything over 80 dB exposure of noise for over eight hours is enough to damage to your hearing.
For every increase in the intensity of the sound, say 3dB or 5dB, the duration of acceptable exposure is cut to half.
To protect yourself from an occupational hazard such as this one, you can use headsets or headphones to cover your ears, they can reduce the sound by 15-20dB and protect your ears.
Prevention is better than cure, especially in these cases, because a cure for it, after the damage is done, is difficult to reverse.
Types of deafnesses:
– Conductive hearing loss: Problem in the conduction of sound waves.
– Sensorineural hearing loss: Problem in the nerves
– Mixed hearing loss: Combination of both.
Cause of hearing impairment:
- Impacted wax: Most of us have a problem in the external ear. Impacted wax is one of the common causes of hearing loss.
- Foreign body: Sometimes while cleaning our ears, we forget a piece of cotton behind which can act as a foreign body and that can also cause impairment. Apart from that any foreign body lodged within the ear canal can cause hearing impairment.
- Fungal infection: Fungus/ fungal infection is an extremely common cause of hearing loss during the monsoon season and in swimmers. This can present as itching in the ear, pain in the ear, and of course blockage in the ear. We need to be careful of fungal ear infections in patients with diabetes mellitus as well.
- Infection: Infections including that of Covid-19 can affect the nerves.
- Polyps and tumours.
- Infection in the middle ear: When it comes to the middle ear, most of the patients come with the complain of discharge through the ear. This can be because of an infection of the middle ear which is a very common cause of hearing loss and can sometimes lead to an injury to the ear or a perforation in the eardrum.
- Genetic disorders: You can also have a problem in the hearing bones which can be genetic, which is called otosclerosis, and is very common in the southern and northeastern stretch of our country.
- Nerve deafness/ sensorineural causes
- Presbycusis: The commonest is presbycusis – which is a gradual, age related hearing loss. Poor circulation- due to cardiovascular cause.
- Diabetes mellitus: Patients with uncontrolled Diabetes run the risk of damaging their nerves, the auditory nerve can also be affected by it.
- Medicines: Certain medications, called ototoxic drugs can cause damage to the ear. These include certain medications for tuberculosis, cancer, malaria, to name a few.
Symptoms of Presbycusis:
Some symptoms that one can look for are:
- The speech of the other persons starts to sound like they are mumbling. We often start to find ourselves asking them to repeat themselves.
- You yourself tend to start speaking loudly.
- Certain high pitched sounds make it hard for you to tell them apart, for example- you start making a mistake and confusing between “s” and “th” sounds.
- You observe that you can hear the male voice better than the higher pitched female voice. Typically, age-related hearing loss affects your hearing abilities when it comes to sounds that travel at higher frequencies.
- Noisy environments make it hard for you to understand what one person is trying to coney. You find it hard to hear another fellow when in crowded places.
- Certain sounds become annoying, and hard for you to stand. You can end up with a ringing sound in your ears, which is called tinnitus, in medical terms.
Patients with age related, high frequency hearing loss, experience what is called the recruitment phenomenon– it is a paradoxical phenomenon which leads to reduced tolerance to loud noise, since loud sounds may be perceived louder than the normal. And this can make the patient vertiginous.
If you cannot bear to stand loud noises but cannot avoid the situation, use a cotton ball or ear plugs which cancel out the outside noise by 10-15dB, and that should keep you comfortable.
Hearing aids – how they work:
Hearing aids assist in the process of hearing by catching the sound waves through the microphone, converting this sound into electrical activity, magnifying it, and then re-converting it into sound waves.
Types of hearing aids:
- Pocket model: It is a tiny hearing aid, which fits the ear
- Behind the ear (BTE): As the name suggests, it fits behind the ear
- In the ear hearing aids
- Invisible hearing aids: They are placed completely inside the canal
Earlier, we used to have analogue hearing aids, but with time, medicine and technology, both fields have made some advancements. So, now most of the hearing aids are digital.
Digital hearing aids have a huge amount of benefits over the analogues. An analogue would only carry sound to make it louder but a digital one will break the sound, improve it, amplify it and then reconvert it. Digital hearing devices give a far superior hearing quality.
If you are planning on buying one, and are on a budget, buy one which has around 6-8 channels. Channels are like filters, which tune out the background noise and help you adjust better. They are even priced moderately.
But of course, you can buy one with more channels, depending on how clearly you want to hear and how much you want to spend. The market has hearing aids that vary from 2 to 40 channels, and their prices vary accordingly. As times are changing, we now also have hearing aids that are Bluetooth compatible and can be connected to your smart phones.
Complaints about hearing aids… is it true?
The most common complaints that the wearer has are:
- It does not feel comfortable to wear the device.
- New wearers are unable to make out the direction of sound
- Too much of noise feedback is present, which means that even the background sound is amplified.
And all these complaints can be reduced with a digital hearing aid.
- Hearing aids are still not well accepted, because there is still a social stigma.
- People also find it difficult to maintain the device- it needs frequent battery change, cleaning, etc.
- Some patients also complain that with using the hearing aid, they can feel their ear getting blocked which is called the occlusion effect. And that is something you need to get adjusted to.
A question asked is if one has a problem in both ears, is it okay if one get a hearing aid for just one.Well, If you have a problem in both your ears, it’s best if you use a hearing aid for both, it has a better stereo effect and helps you hear sounds better and also makes the sound more balanced.
The listening is less exhaustive and it’s safer, for example, if you’re crossing a road and are unable to hear the sounds from one side of the road, it can lead to a mishap.
Cochlear impants and and who can get one?
Patients who do not benefit from a hearing aid are the ones who are eligible for a cochlear implant. A cochlear implant is one where we place the electrode directly into the nerve and there are some hair cells around the cochlear nerve that are enough to carry the sound waves to the brain for processing it.
Most patients who are physically and medically fit to undergo a surgery are candidates for a cochlear implant. Age is not a cut-off criteria for cochlear implant surgery.
The cost of a cochlear implant starts from Rs 6 lakh and can go up to Rs 13-14 lakh depending upon how sophisticated the implant machinery is.
Okay to have wax in the ear? How often should one visit an ENT specialist:
Wax is a normal secretion of the ear canal and a little bit is always required, because it is primarily produced to keep the ear clean and to protect itself. It also keeps you ears from getting too dry and traps dust and other foreign particles..
We tend to equate wax with dirt, which is why some of us find the need to clean our ears everyday, which is not required.
Earbuds are a big no. If you use earbuds, and you have a tendency for wax, you can end up pushing the wax further down, which will not help the cause in any way. And it is these patients who need to go to their local physicians and get their ears cleaned out.
Tinnitus is an unwanted sound or ringing in the ear. It can be caused from a multitude of things.
Types of tinnitus:
- Subjective tinnitus; where the ringing in the ear is heard without an external stimulus and by the patient.
- Objective tinnitus: it is a perceived sound or ringing that is heard by the patient in the absence of an external stimulus, and is also heard by the examiner.
An audiogram needs to be done to determine the degree of hearing loss and the find the cause for it. Once you find the cause, you treat the disease.
Some cases of tinnitus can be treated while other tend to continue. Roughly, if the tinnitus is due to nerve deafness, about 60-65% patients of tinnitus can be treated completely. About 20% would reduce significantly and even then 15-20% of tinnitus can stay behind.