Presented by Peter Santa Maria, MD PhD
Assistant Professor of Otolaryngology, Head and Neck Surgery
March 21, 2019
Which is worse—going blind, or deaf? Helen Keller, who endured both, had no doubt.
“Blindness separates people from things. But deafness separates people from people,” she said, as quoted by Peter Santa Maria, MD PhD, a specialist in surgery for hearing disorders. As Dr. Santa Maria sees it, hearing loss can cause profound changes because it damages our most important social connections.
When people can’t hear well enough to have a conversation, their social circles shrink. They may stop talking to extended family. It can be hard to carry on conversations with coworkers.
“You stop going out to dinner,” Dr. Santa Maria told an audience in a public lecture at Stanford Health Library. “Before you know it, you’re changing as a person.”
This predicament is common as people age. By age 65 and older, 1 in 3 people have some degree of hearing loss. It’s the most common reason people see a doctor in that age group, Dr. Santa Maria said.
Risks of hearing loss
If hearing loss goes untreated and worsens over time, it raises the risk of other serious problems:
- Accidents can happen when you can’t hear something coming toward you. “This often leads to falls and fractures,” Dr. Santa Maria said. Hip fractures are linked to increased risk of death.
- Risk for Alzheimer’s disease rises for those who get hearing loss in midlife but go untreated. As they age, there’s a 9% higher risk of Alzheimer’s disease, Dr. Santa Maria said.
Brain in overdrive
There’s a “cognitive overload” that comes with serious hearing loss, Dr. Santa Maria said. “Just think about how much your brain goes into overdrive when you can’t hear. You struggle to hear things as well as to process a car coming this way.”
Getting treatment early for hearing loss can prevent those increased risks. The most common treatment is to get a hearing aid that amplifies the sounds that we hear.
How hearing works
In normal hearing, sound waves come into your outer ear and then travel through the ear canal.
- Once the sound waves hit your ear drum, it vibrates and sends vibrations to the middle-ear bones.
- That gets transmitted into the inner ear, called the cochlea.
- The cochlea has tiny hair cells that vibrate in a way that reflects specific frequencies.
- That vibration is translated into electrical impulses carried to the brain.
Many different kinds of tests are available to screen for hearing loss, Dr. Santa Maria said. But the simplest, and in some ways one of the best, is to simply ask someone, “Do you have trouble with your hearing?”
Hearing test on your phone
Some hearing tests are available on the internet. They may come in an “app” (application) that works on a smart phone. Many of these tests are easy to use and they are legitimate ways to find out if your hearing is a problem, Dr. Santa Maria said.
He added, “Usually when people come to see me in a clinic, they should have come a while ago. By the time you think you’re struggling, it’s probably too late. We should have intervened earlier.”
Resistance to help
Studies show that many people resist getting tested or getting help. The gap between the rising number of people with hearing loss and the number of those getting hearing aids grows wider as they age.
Yet hearing aids are widely available. What explains this gap? Dr. Santa Maria sees 2 reasons:
- Cost and affordability: the average price of a single hearing aid is $2,700 (or $5,400 for a pair). Yet the average annual income from Social Security is $16,461 (and the maximum is $32,000). Yet there are good models available now that are far less expensive, Dr. Santa Maria said.
- The stigma: some people resist being seen wearing a hearing aid. “They don’t want to admit they’re losing their hearing and growing older,” Dr. Santa Maria said.
The stigma can be real. When former President Ronald Reagan started wearing a hearing aid in 1983, some questioned whether that would be seen as a sign he shouldn’t run for re-election, Dr. Santa Maria said.
Stigma may fade
There is reason to be optimistic that this stigma will fade. Young people who are tech savvy are often eager to sport devices, called “wearable electronics,” that often dangle around their ears.
Some devices use Bluetooth or other wireless technology to connect the wearer to music, phone calls, or the internet. A lot of these wearable electronics are getting bigger in size to flaunt their style.
Meanwhile, a lot of hearing aids are getting smaller.
“They’re really getting to be quite discreet,” Dr. Santa Maria said. For people with the most common, “run-of-the-mill” hearing problems, he said, a small device is usually sufficient to help.
Some of the newer models can even communicate with a wearer’s Bluetooth and wireless connections, as well.
There’s a broad range of hearing aid devices, from small and basic to large and powerful. They include:
- Some so small they can be completely hidden inside the ear canal.
- Others are inside the ear but subtly visible.
- Others are larger (and powerful) and sit outside, behind the ear.
One of the most popular trends in hearing aids are devices called PSAPs (personal sound amplification devices). They are now available at drugstores over the counter, without a prescription. Many models are low cost, ranging from $350 to as little as $50. Many are adequate.
“You can get a lot of these devices online,” Dr. Santa Maria said. Some are sold in pharmacies.
“They are really doing the job for most people,” Dr. Santa Maria said. “Most of these PSAPs are good.” They often work well for people who have “run-of-the-mill hearing loss that just needs amplification.”
On the other end of the scale, for people who want “the latest and greatest things,” there are models designed to communicate with Bluetooth or wireless devices. The newest, sometimes called “hearables,” combine a hearing aid with other wearable electronic devices to not only provide sound but also monitor your health or sports performance or even conduct computing and cell phone calls.
For people with mild hearing loss, there is one device that is a sticker fixed to the back of the ear. The stick can be removed any time by the wearer.
For someone who can’t wear a hearing aid on or in their ear, there is a small device that can be attached to a skull bone behind the ear. It can transmit sound to the ear nearby, or to the ear on the other side of the head. Some can be hidden under the skin.
Profound hearing loss
For those who have severe, profound hearing loss, devices called cochlear implants may help. They are implanted into the inner ear, where they translate sound into electrical impulses that go to the auditory cortex of the brain.
With cochlear implants, “we are able to take people who get 0% of speech and actually let them hold conversations,” Dr. Santa Maria said. “We’re able to preserve low-frequency hearing, and get the implants to help high-frequency hearing.”
While cochlear implants are not new, doctors are now pushing the boundaries of how they can use the implants for more people. In some cases, people get a hybrid model that has a hearing aid for low frequency sounds and an implant that delivers higher frequency sounds.
“We still need to do better with cochlear implants,” Dr. Santa Maria said. Only about 5% to 10% of the people who have the kind of hearing loss that makes them candidates for cochlear implants are getting them.
And they often get them late. “There’s still a 10-year delay from when they fall into the criteria for getting one, and when they actually do it,” he said.
Still, researchers at Stanford are pushing ahead to develop better solutions to some specific hearing problems. So far, they are testing:
- A gel that can be squirted to repair holes in the ear drum
- Dr. Santa Maria said a clinical trial may start next year to test this treatment.
- A drug therapy that could replace ear tubes worn by some adults (and children) for hearing loss
- Antibacterial drugs to treat chronic middle-ear infections that afflict communities in third-world countries
- New treatments for noise-induced hearing loss, otosclerosis, an inner-ear disorder called Meniere’s, and other causes of hearing loss
“We should all be really excited about what we have today…and the innovations, the devices, the emerging drugs, and what’s coming on the horizon,” Dr. Santa Maria said.
The Stanford Initiative to Cure Hearing Loss is a program that is exploring more ways to restore hearing. Projects include:
• Studying the genetics of hearing loss to assess potential for gene therapy
• Evaluating stem cell therapies to find any potential to repair damaged ear tissues or to even grow new tissue
• Seeking new drugs that target molecules to protect or repair hair cells in the ear
Restoring hearing can transform lives. Dr. Santa Maria recommended a documentary film, “Inside Alive,” that tells the story of how hearing and music therapy helped Alzheimer’s patients. The film screened at the 2014 Sundance Film Festival and is available on the internet.
“Hearing loss is actually not just important for hearing, it actually goes to being what a person is,” Dr. Santa Maria said.
Dr. Santa Maria is a founder of Auration Biotech, and is a past consultant for Earlens, Abbott Vascular, Stryker, and Elixir Medical.
For more information:
Stanford Initiative to Cure Hearing Loss