Hearing Loss: A Brief Physiology  Since there are many other resources dedicated to this topic, this selection is intended merely as a broad overview of the physical aspects of hearing loss. (A video on hearing loss is available from the Maryland Academy of Family Physicians.)  Newborns can hear extremely high-pitched sounds that we can no longer hear by the time we are 20 years of age. And by the fourth to fifth decade, adults naturally begin to loose the ability to distinguish a range of high frequency sounds. Hearing loss can be due to many causes, including continual exposure to loud noises in a work environment. But by far the most common hearing loss occurs during aging with the degeneration of the hair cells of the cochlea, which do not regenerate. Types of Hearing Loss Conductive hearing loss- Only 5 percent of the population suffers from conductive hearing loss due to impacted cerumen, punctured eardrum, birth defects, otitis media, or heredity. Otosclerosis causes conductive hearing loss. It is often a hereditary condition in which the tiny bones of the middle ear no longer transmit sound properly. Severe head trauma (e.g. an automobile accident) can cause conductive loss. Surgery may be an appropriate therapy for conductive hearing loss. Sensorineural Hearing Loss- Approximately 95 percent of those who can no longer hear well suffer sensorineural hearing loss. This can be caused by prenatal and birth-related problems, viral and bacterial infections (respiratory infections, measles, meningitis, etc.), heredity, trauma, excessive exposure to loud noises, use of ototoxic drugs or a benign tumor in the inner ear. But sensorineural hearing loss (also called “nerve deafness”) is most often simply a natural phenomenon of aging. This condition is called presbycusis, and it results in the inability to understand what is being said more than a perceived loss in volume. Sensorineural hearing loss is caused by degeneration or damage to the microscopic hair cell receptors or cilia in the cochlea, causing irreversible hearing loss. In the vast majority of patients, these hair cells will function well if stimulated more vigorously with amplified sounds. There is still no cure for nerve deafness; however, if there is residual hearing, most “nerve deaf” patients can be helped to hear with properly selected and fitted hearing aids. The use of hearing aids can be a vital step in helping the patient re-establish social ties, which bolster emotional well-being. Consequences of Impaired Hearing  A patient who is suffering from mild to moderate hearing loss may be at serious risk without knowing it. According to a 1989 study by the U.S. Department of Health and Human Services, 40 percent of all hospital admissions for adverse drug reactions occur in people over 60. Experts believe that many of the admissions are due to the patient’s failure to hear the doctor’s instructions about medications. There is also the potential threat to independent living when the patient fails to hear essential environmental sounds such as those from the telephone, doorbell, alarm clock, and even the smoke alarm. Every practice experiences what is known as the “difficult patient syndrome,” when a patient visits one physician after another demanding treatment of often nonexistent maladies. In fact, some of these patients may be exhibiting the frustration caused by undiagnosed hearing loss. But no matter how devastating the physical difficulties and risks are, the psychological repercussions can be far more serious. Psychological Effects of Hearing Loss Hearing loss is an invisible disability. People whose hearing is impaired live in a world where others, including their families, expect them to hear normally. Patients with hearing loss may find themselves ridiculed, ignored or the constant target of anger from family and friends, as well as from strangers. The detrimental psychological impact over time of such treatment is obvious. Patients may even deny the existence of the problem, all the while becoming more and more confounded by the inability to understand conversation. Trying to cope as if nothing were wrong and “to keep up appearances” places patients under a great deal of stress. Patients’ nerves and energy are taxed because they must constantly monitor whether they are speaking too softly or too loudly. They must strain to hear conversation and frequently depend upon speechreading. It is no wonder that people with hearing loss eventually decide that they can no longer tolerate social activities. Patients may withdraw, first from friends and later from their families. Healthy habits for daily living may suffer as patients increasingly live in isolation, and some may turn to alcohol or other substance abuse in order to cope with depression. Screening, Referral and Reimbursement Today’s improved technology makes hearing screening in the physician’s office easy, convenient, and quicker than vision screening. In a matter of seconds, a screening audiometer can identify patients who need to be referred for more extensive review by a hearing care provider.