When Should You Get a Hearing Test?

By Ned Radenovic, Reg. AHIP (HIS)

One of the questions I get asked most often is “when should I get a hearing test?” People, in general, are aware, now more than ever, that preventative measures will help you maintain a high standard of health as you get older. This also applies to your hearing health.

The following is my “top 5 list” of red flags that could be a sign that your hearing should be tested.

1. “Hearing loss is the third most prevalent chronic condition in older adults and the most widespread disability. Its prevalence rises with age – 46% of people aged 45 to 87 have hearing loss.”(Cruickshanks et al. 1998) That’s right! Almost half the people in this age group have some sort of loss. This is a wide age range and the percentage does rise with age. So the group at the end of the range has more than a 50% chance of hearing loss and those at the start of the range have less. But it does raise the point that you should start monitoring your hearing, even if you haven’t noticed a problem yet, with a test once per year when you are in that age bracket. As we will see later on, treating hearing loss at its earlier stages is a lot easier than after the loss has progressed to their secondary stages.
2. If you hear ringing, music, chirping or high pitched noise, either occasionally or constantly, especially when in quiet (this is called tinnitus), it can be a flag to get your hearing tested. People describe the sound in a variety of ways. Bottom line, if you hear sounds that no one else is hearing, then that is tinnitus. Tinnitus may be a side effect of hearing loss. One of the prevailing theories to explain it is that the brain expects to receive a certain amount of sound from the ears and will make its own sounds when the sound is lacking because of the hearing loss (this explains why you hear it more often when things are quiet).
3. Your spouse or significant other comments on your loss. With hearing, you are usually the last person to notice a loss because hearing loss is usually a gradual process. I have husbands and wives joke about “selective” hearing and I understand that (I have been married for over 25 years myself ), but keep in mind that the person with whom you spend the most time in your life notices what is normal for you and what isn’t. Also realize that they have the courage to actually tell you that you may have a problem. Nobody wants someone they love to be made fun of or to look awkward in social settings.
4. Other friends and acquaintances will have probably noticed your loss but don’t feel it is their place to say something to you directly. This works up to a certain point in your loss. When others start to vocalize that you have a problem it is usually because they are now finding your loss difficult to deal with and they want you to do something about it! An analogy I like to use is a person you work with has a newspaper. During lunch he comes over and sits with you and says “can you read this article for me? If I squint or hold it at arm’s length then I can usually do it myself but I just can’t seem to get it today. They made the print smaller today or they changed the font.” If you are lucky, they might do it for you. But ask them a second, third or fourth time? How would you react? Probably, you would tell the person to help themselves and to get glasses. Now how about your hearing?
5. Another reason to get a test is when you notice others are hearing things that you aren’t. Some warning flags are you are asking people to repeat themselves over and over because you feel they “mumble” or don’t “enunciate,” there is one particular group of people you can’t hear well (women, children etc.), or if you notice your ability to hear in noisy environments has worsened substantially.

A lot of people don’t realize that not hearing soft sounds is only the first stage of problems associated with hearing and their overall health. The vast majority of hearing loss is “sensory” meaning there is nerve damage to the ears (I like to use the older terminology because I think it makes sense to most people). The secondary stage of hearing loss is much more difficult, the ability to not hear clearly anymore, no matter how loud we make things!

It is important to go into a little more detail to explain this. There are actually two types of nerves that support hearing and there are about 10,000 of them. The first set makes soft sounds louder (I like to call this the “loudness nerve”). Once it has done this it will pass it on to the second type of nerve (which I call the “clarity nerve”). The clarity nerve is the highway that delivers the sound directly to your brain.

At the beginning stage of hearing loss, the nerves that make the soft sounds louder die off (aging is the most common reason, not wearing hearing protection in loud environments is the second leading cause).  When enough of these loudness nerves die off then the clarity nerves no longer get sufficient stimulation.  What happens to anything in your body when it doesn’t get used? It will start to get weaker and weaker and then it will eventually die off. If enough of these clarity nerves die off then the ability to hear clearly is forever gone.

What you want to do is to replace the loudness nerves with the hearing aid BEFORE the clarity nerves have died off. The clarity nerves that have weakened will actually get stronger as more stimulation is applied from the hearing aid, but unfortunately the nerves that have died off cannot be rejuvenated. It is like cutting off your finger and expecting it to grow back. We just can’t do it (not yet anyway, there is research at several universities trying to do just that).

Research studies increasingly suggest that how clearly you hear stabilizes after you start wearing a hearing aid. If you wait too long, we can turn the volume up as loud as you want but the highway to the brain to send the sound is so damaged that it can never get there in its entirety. You have probably met these people. They have hearing aids and they constantly tell everyone within earshot (and beyond) that, sure the hearing aids make things louder, but I still don’t understand what people are saying all of the time.

Hearing aids will still help in this situation because at least they have raised the volume up to a level where it can actually be heard. But now you will have to add in a little lip reading and really pay attention to the context of the conversation to “fill in the blanks.” How much will it help? That depends on how much of the clarity nerves have died off.

There are still options for the person with poor clarity but this usually involves purchasing what are called FM systems. These add extra expense and complexity to the whole process, which we won’t go into at this time. The main point I am trying to get across is that things are a lot easier if you do something sooner rather than later!

Other studies suggest that people with a hearing loss that wear hearing aids are also less likely to acquire Dementia and Alzheimer’s disease. This makes sense as the brain is constantly being stimulated by sound when one is hearing properly. Losing that stimulation causes the brain to be used less which studies suggest may be a contributing factor leading to dementia and Alzheimer’s.

To summarize, people should get a hearing test done yearly starting at the age of 45, when your spouse or significant other indicates you may have a loss, if you hear noises in your ears, especially when it’s quiet, when more than one person has suggested that there may be an issue and when you notice that you are not hearing well.

Remember that not hearing softly is only one stage of hearing loss. If left for long periods of time, this can lead to not being able to hear clearly and also slows down the activity generated in the brain. Monitor and take preventative action with your hearing as you do with the rest of your body and you will be rewarded with hearing that will let you stay connected with family and friends for a long time to come.

Ned Radenovic is a Hearing Instrument Specialist registered with AHIP and he sees patients at our Hearing Solutions in Oakville Place