Ear Center: Hearing Loss

Hearing Loss

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Nurses' Health Study II
Hearing loss in children

Hearing loss is the most common disability in the world. It is estimated that of the 28.6 million Americans who are hearing impaired, 18.8 million have moderate-to-severe sensorineural hearing loss (SNHL). The range of hearing loss include: mild, moderate, moderately-severe, severe, and profound.

Recent data from Hoffman et al. have shown that the prevalence of age- and sex-specific hearing impairment in adults 20-69 years continues to decline.

Current hearing loss statistics include:

  • It is estimated that 34.25 million Americans suffer from hearing loss.
  • This rate of hearing loss has doubled from that reported in 1984 (16.2 million hearing impaired).
  • Hearing loss is growing at a rate 60% greater than the rate of growth of the population.
  • 63% of individuals 70 years old or greater have hearing loss.
  • Only 1 in 5 older adults with hearing loss wear hearing aids.
  • 3% of individuals with mild hearing loss wear hearing aids.

Types of Hearing Loss

There are three main types of hearing loss:

  • Sensorineural hearing loss (inner ear, cochlear, or nerve type hearing loss)
  • Conductive hearing loss (ear canal, middle ear, ear bone type hearing loss)
  • Mixed hearing loss (a combination of sensorineural and conductive hearing loss)

Other forms of hearing loss include central auditory processing disorders and auditory neuropathies. Hearing loss may be genetic or occur spontaneously in any particular individual. Hearing loss may be congenital (present at birth), familial, associated with specific syndromes, traumatic, due to infections or tumors, autoimmune, vascular, metabolic, degenerative, or toxic (from medications, chemicals, heavy metals, toxins, etc.)

Evaluation of Hearing Loss

A thorough evaluation of any hearing loss includes a:

  • Complete ear history and physical examination by qualified examiner
  • Hearing testing by a trained audiologist that includes basic audiometric tests: pure tones, bone conduction levels, speech reception thresholds, and word recognitions scores (discrimination). Additional testing may be necessary to diagnose the hearing loss.
  • Sometimes, imaging studies such as CT scans of the temporal bones and/or MRI head scans are indicated.

Treatment of Hearing Loss

Current treatments include:

  • Digital hearing aids
  • Surgical procedures
    • Ear canal and middle ear operations (tympanoplasty, ossiculoplasty, stapedectomy, etc)
    • Middle ear implants
      • Ototronix Maxum hearing implant
      • MED-EL Vibrant SoundBridge hearing implant (not performed at The Ear Center)
      • Envoy Esteem hearing implant
      • Otologic Carina implant (investigational)
    • Cochlear implants
      • Standard cochlear implants (Cochlear Americas, Advanced Bionics, MED-EL)
      • Hybrid cochlear implants (electro-acoustic stimulation)
    • Auditory brainstem implants (ABI not performed at The Ear Center)

Hearing Loss Research

Significant basic science research is on-going concerning the genetics of hearing loss. A promising future technology is "auditory regeneration". Mammalian inner ear cells have been stimulated to differentiate into hearing hair cells in the laboratory. However, the technique has not been performed in any human trials.

A new gene mutation has been identified that may be causing sensorineural hearing loss in children. The gene is called TMTC2. A mutation in TMTC2 may lead to bilateral, symmetric progressive sensorineural hearing loss. In a study with 179 unrelated adults with sensorineural hearing loss, 4% of the patients were positive for a mutation in the TMTC2 gene. TMTC2 testing may lead to early identification of children with hearing loss. See Reference 4 below, Runge et al.

Huddle et.al., sited below, have written about the economic impact of adult hearing loss and found that hearing loss in the United States is associated with billions of dollars of excess costs. Research on the topic varies widely and more comprehensive studies are needed to help guide public policy.

Hearing Loss in Children and Adolescents

Su et al. have analyzed hearing loss in U.S. children and adolescents from 1988-2010. They found that in children 12-19 years old, there were no significant changes in the prevalence of hearing loss despite increase in noise exposure. They did find an association between racial/ethnic minority status and low socioeconomic status with an increased risk of hearing loss.

leClercq et al. have looked at the prevalence of hearing loss in 9-11 year olds in Rotterdam, Netherlands between 2012 -2015. They found that 7.8% of children between 9-11 years old had either low or high frequency hearing loss of at least 16 dB HL in one or both ears. Independent risk factors for hearing loss in this population were a history of recurrent otitis media and lower maternal education level.

Nurses' Health Study II

"Hearing loss is common, often disabling, and can adversely affect communication, quality of life, and health. Some evidence suggests that hearing loss may be associated with faster cognitive decline among older adults. Two-thirds of women in their 60's and over 60 million adults nationwide suffer from hearing loss. Although commonly considered an unavoidable companion to aging, hearing loss may not be inevitable."

The Nurses' Health Study is conducting The Conservation of Hearing Study (CHEARS) as an ongoing investigation of hearing among nurses. They recently published a study among 71,000 NHSII women and demonstrated that "greater adherence to healthy dietary patterns, such as the Mediterranean diet or the DASH diet (Dietary Approaches to Stop Hypertension) , was associated with a 30% lower risk of self-reported moderate or worse hearing loss. Using detailed information from the Hearing Study Supplemental Questionnaire that was completed by over 33,000 participants, they found an even greater reduction (37%) in risk among women who consumed a healthier diet. They found that eating more of certain foods, such as fish, and nutrients, such as beta-carotene, beta-cryptoxanthin and long chain omega-3 fatty acids, was associated with lower risk."

"Studies in CHEARS have revealed that maintaining a healthy weight and staying physically active may help lower the risk of hearing loss, while frequent use of analgesics, such as ibuprofen and acetaminophen, and longer duration of use of post-menopausal hormone therapy were associated with a higher risk."

Using data from 55,850 women in the Conservation of Hearing Study (CHEARS), a special sub-study of the Nurses' Health Study, it was found that longer duration of NSAID and acetaminophen use, greater than 6 years for each drug, was associated with a 10% and 9% increased risk respectively. They also found a 7% higher risk of hearing loss among women who used NSAIDs or acetaminophen for 2 or more days per week. In contrast, duration of aspirin use was not associated with an increase in hearing loss. In approximately 5.5% of cases of hearing loss in older women in the NHS cohort, hearing loss may be attributable to chronic NSAID and acetaminophen use. More study is needed.

The Nurses' Health Study II has found that the regular use of nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen was linked to a slightly greater risk of hearing loss in young women.

The Nurses' Heath Study II has "also been conducting the largest, most geographically diverse, longitudinal study using audiometry (hearing testing) to measure change in hearing. Over 3,700 NHSII women across the US completed baseline clinical hearing tests in the CHEARS Audiology Assessment Arm, and 84% have completed 3 year follow-up testing. As most hearing loss is irreversible, we hope that evaluating hearing loss at earlier stages will identify ways to prevent hearing loss and delay its progression."

If you would like to learn more about hearing loss and its treatment, please contact our office at 336-273-9932 and ask to speak to one of our audiologists.


1. Hoffman HJ, Dobie RA, et al. Hearing threshold levels at age 70 years (65-74 years) in the unscreened older adult population of the United States, 1959-1962 and 1999-2006. Ear Hear 2012:33 (May):437-440.

2. Contrera KJ, Betz J, Genther DJ, Lin FR. Research Letter: Association of hearing impairment and mortality in the National Health and Nutrition Examination Survey. JAMA Otolaryngol Head Neck Surg. 2015:141(10);944-946. Click here to download a .pdf copy.

3. Choi JS, Betz J, Lingsheng L, blake CR, Sung YK, Contrera KJ, Lin FR. Association of using hearing aids or cochlear implants with changes in depressive symptoms in older adults. JAMA Otolaryngol Head Neck Surg. 2016;142(7):652-657. Click here to download a .pdf copy.

4. Runge CL, Indap A, Zhou Y, Kent JW, King E, Erbe CB, Cole R, Littrell J, Merath K, James R, Ruschendorf F, Kerschner JE, Marth G, Hubner N, Goring HH, Friedland DR, Kwok WM, Olivier M. Association of TMTC2 with human nonsyndromic sensorineural hearing loss. JAMA Otolaryngol Head Neck Surg. 2016 June 16. doi: 10.101/jamaoto.2016. 1444. (Epub ahead of print).

5. Simpson AN, Simpson KN, Dubno JR. Letters: Higher health care costs in middle-aged US adults with hearing loss. JAMA Otolaryngol Head Neck Surg 2016;142(6):607-608.

6. Hoffman HJ, Dobie RA, Losonczy KG, Themann CL, Flamme GA. Declining prevalence of hearing loss in US adults aged 20-69 year. JAMA Otolaryngol Head Neck Surg 2017;143(3):274-285. Click here to download a .pdf copy.

7. Nurses' Health Study Newsletter, Volume 25, 2017, page 2.

8. Huddle MG, Goman AM, Kernizan FC, Foley D, Price C, Frick KD, Lin FR. The economic impact of adult hearing loss: a systematic review. JAMA Otolaryngol Head Neck Surg 2017; 143(10):1040-1048. Click here to download a .pdf copy.

9. Su BM, Chan DK. Prevalence of hearing loss in US children and adolescents findings from NHANES 1988-2010. JAMA Otolaryngol Head Neck Surg 2017;143(9):920-927. Click here to download a .pdf copy.

10. leClercq CMP, van Ingen G, Ruytjens L, Goedegebure A, Moll HA, Raat H, Jaddoe VWV, Baatenburg de Jong RJ, van der Schroeff MP. Prevalence of hearing loss among children 9 to 11 years old: The generation R study. JAMA Otolaryngol Head Neck Surg 2017;143(9):928-934. Click here to download a .pdf copy.

11. Loughrey DG, Kelly ME, Kelley GA, Brennan S, Lawlor BA. Association of age-related hearing loss with cognitive function, cognitive impairment and dementia: a systematic review and meta-analysis. JAMA Otolaryngol Head Neck Surg 2018, 144(2):115-126. Click here to download a .pdf copy.

12. Nurses' Health Study II Newsletter, Volume 26, 2018, page 5.

13. Murray ID. Hearing loss and tinnitus among dentists. The Hearing Journal 2020, January 2020:10-13. Click here to download a .pdf copy.

Last revised January 6, 2020