Hearing With Your Heart

Deaf. Hard of hearing. Unilateral hearing loss. Bilateral hearing loss. Conductive hearing loss. Sensorineural hearing loss. Some of these terms may be confusing to you. After all, hearing loss is hearing loss, right? Actually, no. There are many different types of hearing loss and it affects the way people hear in drastically different ways.

Let's take the first two terms. There are about 10 million people in the U.S. who are hard of hearing and 1 million who are deaf. Hearing loss is classified as mild, moderate, severe and profound. Those who are deaf have profound hearing loss meaning they hear very little or nothing at all. Many of them communicate through sign language. Those who are hard of hearing can have hearing loss that ranges from mild to severe. Some of them may wear hearing aids and most speak and do not use sign language for general communication. Age-related hearing loss usually falls into this category. Hearing loss can affect the ability to hear conversational speech and many people who are hard of hearing may use lip reading to help them understand what is being said.

It is important to note that there is a difference between hearing in terms of volume and clarity. Many people who are hard of hearing can hear voices but they don't have clarity. They can't hear certain sounds or consonants in speech (common ones are s, sh, th, h) so it is difficult to understand what someone is saying. This may also affect the way they speak as well since when they can't hear certain speech sounds, they are less likely to use them in their own speech. Since people who are hard of hearing often struggle to understand what is being said, conversations in a noisy environment, with a group of people or in a place with background noise (i.e. trying to understand dialogue in a movie with background music) can be very challenging. It is also helpful to look at someone who is hard of hearing when you are speaking to them so they have the option of reading your lips. Also, while hearing aids can help with the volume, oftentimes they can't help as much with clarity. So, a person who is hard of hearing may still struggle to understand you though they can hear your voice fine. Speaking clearly and enunciating properly can help them understand you but don't talk too slowly or over-exaggerate your lip movements. Also, don't yell. Not only is it rude but it most likely won't help since the problem is clarity not volume.

In addition to the severity, hearing loss can vary by slope. Slope indicates which pitches are outside of a person's hearing range. There is normal slope or reverse slope hearing loss. Normal slope hearing loss indicates that the person can not hear high pitched or softer sounds i.e. bird songs, smoke detector alarms, whispers, etc. Typically, with a normal slope hearing loss, conversations with someone with a higher pitched voice can be a challenge. Reverse slope hearing loss indicates that lower pitched sounds are outside of a person's hearing range. People with reverse slope hearing loss may be able to hear bird songs but not the rumble of thunder or the crashing of waves. Conversations with people with lower-pitched voices are more challenging.

There is unilateral and bilateral hearing loss. Unilateral simply means that the person has hearing loss in only one ear. This hearing loss can range from mild to profound. So, a person can be deaf in one ear and have normal hearing in the other. This can often affect sound perception, the ability to know where a sound is coming from. Bilateral means that there is hearing loss in both ears. Also note, that balance can be affected with hearing loss because the nerves for hearing and balance are closely related. Also, inner ear problems can affect both hearing and balance.

There are two main types of hearing loss. Conductive hearing loss or bone conducting hearing loss and Sensorineural hearing loss where the nerves are affected. Conductive hearing loss occurs when there are problems with the ear canal, eardrum or the small bones inside the middle ear (which vibrate when sound reaches it, helping to conduct sound waves to the brain where it is interpreted as noise.) Conductive hearing loss can be temporary such as when there is fluid in the ear from colds, ear infections or allergies or when there is earwax that has built up deep inside the ear. Conductive hearing loss can also be permanent and is usually due to a malformation of the outer ear or the ear canal or the bones inside the middle ear. Surgery or a bone conducting hearing aid may be a solution in those cases.

Sensorineural hearing loss is due to damage of the nerves in the inner ear or damage to the cochlea (inner ear) itself. It can have a variety of causes including viruses or trauma, a hereditary condition, aging or an autoimmune disease. Treatments include hearing aids or cochlear implants.

There is also mixed hearing loss where the hearing loss is due to a combination of conductive hearing loss (problems affecting the outer and middle ear) and sensorineural hearing loss (problems affecting the cochlea and auditory nerve.)

So, hearing loss can be a variety of different types and have a variety of different causes. Everyone deals with their hearing loss differently and it is important to respect how they choose to deal with it and their chosen method of communication. Not everyone will want to wear hearing aids or cochlear implants. Hearing aids can affect sound quality though that has greatly improved over the years. Also, some people will prefer to use sign language, others will want to write or type their communications and some will speak and read lips. It is their choice to communicate how they wish and our responsibility to respect that. Understanding that not all hearing loss is the same can help us engage with people with respect and empathy.