A good number of people are aware their hearing has deteriorated over the years but are hesitant to seek help. Maybe they're somewhat in denial over their hearing loss, maybe they're a little embarrassed over acknowledging a shortcoming or weakness, or maybe they believe they can "get by" without the assistance of a hearing aid. And, unfortunately, too many people wait too many years before getting treatment.

But time and again, research demonstrates the considerable negative social, psychological, cognitive and health effects of untreated hearing loss. There are far-reaching implications that go well beyond hearing alone. In fact, many people who have difficulty hearing can experience such distorted and incomplete communication that it seriously impacts their professional and personal lives, at times leading to isolation and withdrawal.

• Reduced job performance and earning power
• Impaired memory and ability to learn new tasks
• Irritability, frustration, negativism and anger
• Fatigue, tension, stress and depression
• Social rejection and loneliness
• Diminished psychological and overall health

Hearing loss is just not a part of growing old. It can strike at any time and at any age, including childhood. For the young, even mild or moderate hearing loss can bring difficulty to the learning process, speech development and building the important interpersonal skills necessary to foster self-esteem and success in life.

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To understand how we hear, it is important to understand the anatomy of the hearing system. The hearing system can be divided into four different components with each component having a different function.

• Outer Ear
• Middle Ear
• Inner Ear
• Central Auditory Pathways

The outer ear is made up of the pinna or auricle and the external auditory canal. The pinna collects and funnels sound down the ear canal. The ear canal is curved, "S" shaped, and about 1 inch long in adults. It has hairs and glands that produce wax called cerumen. Cerumen helps to lubricate the skin and keep it moist.

The eardrum (tympanic membrane) is a membrane at the inner end of the ear canal. On that inner side of the tympanic membrane is an air-filled space called the middle ear cavity. The vibrations of the tympanic membrane are transmitted through the malleus (hammer) incus (anvil) and stapes (stirrup), also called the ossicles. The stapes footplate transmits the vibrations into the inner ear.

The inner ear has two divisions: one for hearing, the other for balance. The hearing division consists of the cochlea and the nerve of hearing. The cochlea is a snail-shaped, bony structure that contains the sensory organ for hearing called the organ of Corti. The organ of Corti releases chemical messengers when the vibrations from the stapes activate its tiny hair cells. These then excite the nerves of hearing which carry sound to the brain.

The central auditory system is a complex network of neural pathways in the brain that is responsible for sound localization, speech understanding in noisy listening situations and other complex sounds, including music perception.

The process of "hearing" is quite complex. Sound is transformed into mechanical energy by the tympanic membrane. It is then transmitted through the ossicles to the inner ear where it is changed again into hydraulic energy for transmission through the fluid-filled cochlea. The cochlea's hair cells are stimulated by the fluid waves and a neurochemical event takes place that excites the nerves of hearing. The physical characteristics of the original sound are preserved at every energy change along the way until this code becomes one which our brain can recognize and process.

Hearing loss misleads our brain with a loss of audibility and introduces distortion into the message that reaches the brain. Changes in the effectiveness of the brain to process stimuli, from head trauma, disease, or from aging, can result in symptoms that mimic hearing loss. The ears and the brain combine in a remarkable way to process neural events into the sense of hearing. Perhaps it's fair to say that we actually "hear" with our brain, not with our ears!

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The signs of hearing loss might be gradual and emerge slowly, or they might be significant and come about suddenly. Either way, there are common indications. You might have a hearing loss if you:

• Answer or respond inappropriately in conversations
• Think other people's speech is muffled or it appears they're mumbling
• Have difficulty following conversations involving more than 2 people
• Require frequent repetition
• Have trouble hearing and understanding women and children
• Find yourself reading lips or watching their faces when they speak
• Have difficulty hearing in noisy surroundings such as restaurants
• Require your TV or radio turned up to high volume

• Feel stressed out from straining to hear what others are saying
• Feel annoyed with others because you can't hear or understand them
• Feel embarrassed from not being able to understand others
• Feel nervous about trying to hear and understand others
• Avoid social functions you once enjoyed because of difficulty hearing

• Have a history of hearing loss in your family
• Take medications that can harm your hearing system
• Have diabetes, heart, circulation or thyroid problems
• Have been exposed to loud noise over a long period of time
• Have been exposed to a single, explosive noise

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Generally, there are two specific types of hearing loss:

• Conductive hearing loss is caused by a mechanical problem in the ear canal or middle ear that blocks the conduction of sound

• Sensorineural hearing loss or nerve hearing loss, is caused by damage to the inner ear, auditory nerve, or auditory nerve pathways to the brain

A mixed loss is a combination of a conductive and a sensorineural hearing loss. Hearing aids can be beneficial for persons with a mixed hearing loss, but caution should be exercised. Conductive hearing loss is often reversible; sensorineural hearing loss is not.

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During normal hearing, sound waves travel through the ear canal and strike the eardrum causing it to vibrate. The eardrum is attached to three tiny bones in the middle ear. The last bone, the stapes, pushes on a fluid-filled chamber in the inner ear, called the cochlea. The fluid movement causes sensitive hair cells within the cochlea to bend. When the hair cells bend, they generate an electrical signal that is sent to the brain. Age, disease, injury, or repeated exposure to loud noise can damage the various structures of the ear and interfere with one's ability to hear.