The ears

Hearing loss and balance issues can be corrected

 

Special to The Miami Herald

Almost 30 years ago, when Lucille Greenberg was in her early 60s, her colleagues began to complain about the messages she took for them. The phone numbers were all wrong.

With a family history of hearing loss, she knew what was happening. She bought her first set of hearing aids, but they just made sounds louder.

“Flushing a toilet sounded like Niagara Falls,” says Greenberg, a native of Long Island, N.Y.

She retired at 65, but what followed was a slow chipping away at her quality of life. For Greenberg, a World War II sergeant in the U.S. Marine Corp Women’s Reserve, hearing loss affected everything from conversations with her family to watching TV, to grocery shopping and using the phone. She bought a second set of hearing aids, and then a third set that worked better.

“I thought I was home free,” says Greenberg, who lives in The Classic, an independent and assisted living facility in West Palm Beach.

Then came further deterioration and a fourth set. Eventually an audiologist told her about the cochlear implant, a surgically implanted electronic hearing device.

“By then I was reconciled to the idea that I would spend my last years in total deafness … but this news, especially that the operation was fully covered by Medicare, was very exciting.”

On April 12, she celebrated her 90th birthday with a party given by her children and grandchildren. She had never heard her grandchildren’s voices.

“The best thing about my party … was that I could actually hear all those loving words that were said. This was truly one very happy birthday.”

For the aging, experts say, hearing loss can have more of an impact on quality of life than any other health concerns, because they affect the ability to communicate and participate in life.

Likewise, balance problems, which are often caused by problems with the vestibular system or inner ear, are a critical concern for the aging, because they increase the risk of potentially deadly falls.

According to the National Institutes of Health (NIH), age can be a major factor in hearing loss. Eighteen percent of U.S. adults 45-64 years old, 30 percent of adults 65-74 and 47 percent of adults 75 and older suffer from hearing loss. Men are more likely to experience hearing loss than women.

“It’s the third most common ailment that people over the age of 60 have, superseded only by hypertension and arthritis,” said Dr. Sergio Guerreiro, an audiologist with the Ear Institute at the University of Miami Miller School of Medicine. “It’s unbelievable that hearing loss is such a large component of what happens [to the aging].”

And according to the Centers for Disease Control and Prevention, about 70 percent of people over 70 experience problems with postural balance.

“We caution people,” Guerreiro says, “because one fall is all it takes to be the beginning of the end.”

The entire auditory vestibular system must be assessed to determine where the balance problem is coming from. Many aging people with balance problems are overmedicated and become dizzy.

The most common form of hearing loss is caused by the loss of sensory hair cells in the cochlea. While hearing aids and cochlear implants help, once the cells are lost, they do not regenerate. Hair cell loss can be caused by a variety of factors including aging, noise exposure, infections, some antibiotics and anti-cancer drugs.

Guerreiro, a passionate advocate for aging patients, says that often the aging are marginalized, misdiagnosed and then confused by a barrage of advertising for hearing aids that don’t work for them.

Aging patients who lack the optimism and family support experienced by Greenberg, a patient at the University of Miami Cochlear Implant Center, suffer even more, he says.

Greenberg, widowed three times and now living alone, says her niece, Cecile Fuchs, of Boynton Beach, has been her lifeline.

“None of this would have happened without her,” Greenberg says.

Of Greenberg, Fuchs says with affection, “There is no challenge this lady will not attempt.”

Some patients with hearing loss are misdiagnosed with dementia.

“You can’t remember what you didn’t hear,” Guerreiro says.

In addition, family conversations that negatively underscore patients’ hearing loss can have a devastating impact on mental and physical health. “When you see these banters it affects the patient, it affects the family, it affects the patient’s well being, their sense of intelligence … ‘Oh I don’t get involved, because I don’t know what they’re saying, and I feel like an idiot,’ ” he says.

“We hear this with our patients. You have an increase in chemical dependency. You have an increase of depression. It just snowballs.”

About 15 percent, or 26 million Americans, between the ages of 20 and 69 have high frequency hearing loss from exposure to loud sounds, noise at work or leisure activities, according to the National Institute on Deafness and other Communication Disorders (NIDCD), part of NIH.

Only one in five people who need a hearing aid actually wears one, according to NIDCD.

“We’re seeing people develop hearing loss at a much younger age. Yesterdays 70s are today’s 50s as far as the hearing loss,” Guerreiro says. The increase in use of electronic devices — particularly in the ears — noise, lifestyle changes and a large baby boomer population are responsible for much of the increase, he says.

Since hearing loss in each person is different, the patient may need to try more than one hearing aid to find a match.

A small number of global manufacturers produce hearing aids that all work well, Guerreiro says, but every brand does not work well for every patient.

“Each hearing aid has its own proprietary algorithm, and the systems inside may not be a match to you, but match someone else.”

Under Florida law, he says, patients have 30 days to return the hearing aids, and suppliers should adhere to that law if the devices don’t work.

Hair cells, Guerreiro says, are like keys on a piano. If you take out a few keys, you may be able to figure out the melody, but playing louder won’t help. The sound is still distorted.

“It’s not a matter of speaking louder,” he says. “It’s that the person does not have enough hearing in the higher frequencies where the consonants are. They get the vowel, but they don’t get the consonants.’’

Cochlear implants can restore a significant percentage of normal hearing. The surgery lasts about two hours and includes a few weeks of recovery time. The patient returns in a few weeks for the device to be switched on.

“Hearing is supposed to be about 80 percent compared to normal, but actually it is much better than most folks in my age range,” Greenberg says. “It is the most exciting event to happen in my later years, one so life-changing and unexpected that I never even knew to wish for it.”

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