Why is Hearing Health so Neglected?

The statistics tell the story. From Wikipedia: As of 2013 hearing loss affects about 1.1 billion people to some degree. It causes disability in 5% (360 to 538 million) and moderate to severe disability in 124 million people. Of those with hearing loss, it began in 65 million during childhood.

According to a 2012 report by WHO on global prevalence of hearing loss:

  • The prevalence of disabling hearing loss in children is greatest in South Asia, Asia Pacific and Sub-Saharan Africa.
  • Approximately one-third of persons over 65 years are affected by disabling hearing loss.
  • The prevalence of disabling hearing loss in adults over 65 years is highest in South Asia, Asia Pacific and Sub-Saharan Africa.

Hearing loss is also the third most chronic disability affecting adults in the United States after arthritis and heart disease. In India, it's the second most common impairment, affecting nearly 10% of the population.

Yet, hearing health remains a neglected aspect of overall physical health awareness and maintenance, even though it leads to some serious medical, social and psychological issues, such as memory loss, social isolation and severe depression (Read more: Consequences of Untreated Hearing Loss).

Untreated hearing loss has serious medical, social and psychological consequences

Untreated hearing loss has serious medical, social and psychological consequences

Some reasons why hearing health is neglected:

  • Stigma associated with wearing hearing aids.
  • Lack of awareness and cohesive reference points.
  • Acclimatization to noise in surroundings.
  • Ability to turn up thevolume to dangerous levels to counter hearing problems.
  • Inability to distinguish between natural progression of hearing loss due to age and actual hearing loss.
  • Gradual manifestation and appearance of hearing loss.
  • Incompletely cured conductive hearing loss.
  • Affordability of hearing aids.
  • Scarcity of available services.

Stigma

Deep stigma is associated with hearing loss with people viewing wearing hearing aids negatively. Unlike the normalcy associated with using spectacles for vision loss, for example, wearing hearing correction mechanisms is viewed as a sign of declined abilities and cognizance, thus leading to a mindset of just "living with it".

Few people who suffer from hearing loss take any action and many shy away from any correction due to social stigma, leading to an increasing aloofness from family and society.

Lack of awareness and cohesive reference points

Ear hair cell damage cannot be cured; only compensated via hearing health management.

Hearing loss is called the invisible disability. There is little understanding about hearing health, impact of noise, the sound level that affects hearing or the fact that hair cells in the inner ear that are responsible for hearing cannot be regenerated.

Due to lack of knowledge, there is no perception about when hearing starts getting damaged; no well-known cohesive reference points that make people aware their hearing may be damaged.

If you have to speak loudly over noise or shout to make conversation in a restaurant, it's too loud and your hearing may be getting damaged.

In everyday life, there are many situations that constantly stress your ear. For example, an article in the The New York Times states:

[] ... in restaurants and bars, but also in stores and gyms, loud noise has become a fact of life in the very places where people have traditionally sought respite from urban stress. The New York Times measured noise levels at 37 restaurants, bars, stores and gyms across the city and found levels that experts said bordered on dangerous at one-third of them.

Just 15 minutes in a loud night club is enough to damage hearing (Noise Pollution - Noise And Our Hearing).

Acclimatization to loudness

Noisiness is the new normal

Noisiness is the new normal

The world around us is loud and with the shrinking of quiet spaces and a devastating increase in noise pollution, people are acclimatized to loudness. Noisy environments are the new normal with most people not even realizing that the constant noise around them affects hearing.

Consider that the Centers for Disease Control and Prevention deems exposure to noise above 85 dB an occupational hazard. Experts find that busy city traffic noise regularly measures 85 dB and above. A study by Awaaz Foundation, Mumbai cited in the Hindustan Times pointed out:

A detailed study carried out by Awaaz Foundation in 2015 for noise generated from different vehicles in the city, two-wheelers showed average noise levels up to 90dB.

Noise above 85 dB causes hearing damage; even noise above 70 dB stresses the body's hearing apparatus.

Whether it is busy traffic, noisy festival celebrations , deafening music in clubs or listening to music on headphones for long periods without a break, everyone is just used to a noisier environment around them.

Just turn up the volume

If you cannot hear, the response is to just turn up the volume of your television, music player or phone and keep listening. A recent article, Digital Age Destruction: Technology's Role in Children's Hearing Loss,  pointed out:

A new survey conducted by the American Speech-Language-Hearing Association finds that teens and parents both average five hours a day on personal tech devices outside of school and work hours.

Loud music on headphones can go up to 100 dB. The recommended time of exposure to this noise level is just 15 minutes. With the increasing use of personal devices, the amount of time spent listening to audio at a loud volume and for a long time is steadily increasing.

The ability to adjust volume up to a listening level causes more damage

The ability to turn up the volume on devices to a needed listening level becomes a continuous loop - when hearing is damaged you cannot hear at normal levels so you turn up the volume and that damages hearing further!

Hearing loss is natural as you age

Decrease in hearing ability as you grow older is natural. The figure below shows the frequency levels heard by people in different age groups.

However, an assumption that hearing loss is a part of the natural aging process and being unable to distinguish between normal decline of hearing and actual hearing loss also leads to unintentional neglect of hearing health.

Try this simple test to check how old your ears are and if you are hearing correctly for your age group. The test displays the typical frequencies heard by people in various age groups:

Source: AsapSCIENCE - How old are your ears? (https://www.youtube.com/watch?v=VxcbppCX6Rk)

Hearing loss manifests itself over years

From Wikipedia: There are four main types of hearing loss, conductive hearing loss, sensorineural hearing loss, central deafness and combinations of conductive and sensorienural hearing losses which is called mixed hearing loss.

  • CONDUCTIVE - Caused by problems in the outer or middle ear, such as an ear infection. It is temporary in some cases and, depending on the underlying cause, can be treated with either medication or surgical procedures.
  • SENSORINEURAL - Usually due to damage to hair cells in the inner ear, this type of loss is permanent and affects sensory organs and/or neural structures.
  • MIXED - A mix of conductive and sensorineural hearing loss caused by damage to both inner and middle or outer ear.
  • CENTRAL DEAFNESS - Caused by damage to the auditory nerve in the brain.

Sensorineural hearing loss is the most common type of hearing loss. Causes of sensorineural hearing loss are many (for example, loud noises) and complicated interactions of contributing factors can gradually deteriorate hearing without active knowledge. Awareness sets in when hearing loss starts interfering with communication in quiet surroundings, such as normal conversations at home.

Owing to the sensory deficits arising out of hearing loss, the brain gets adjusted to reduced hearing levels. Over a period of time, the auditory deprivation results in loss of auditory memory of various sounds once stored in the brain's reference, whereby sufferers with sensorineural hearing loss lose touch with their surroundings.

Estimates determine that by the time a patient suffering from sensorineural hearing loss is ready to do something about it, a good 7 years (on an average) are lost.

Incompletely cured conductive loss

Conductive type hearing loss, for example arising out of ear infections in children, does not always get completely cured and remains, or sometimes even progresses. Though some cases of conductive hearing loss can be treated with medication and/or surgery, chronic pathology (such as, regular ear infections) renders less hope for a permanent remedy.

More often, long-standing conductive loss goes on to affect the sensory structures (via infection, side effects of medication, bone erosion). In such conditions, the loss becomes a mixture of conductive and sensorineural hearing loss (mixed hearing loss).

Affordability of hearing aids

Hearing aids are expensive with the cost putting them out of reach for many people. The more "invisible" hearing aids (for example, completely-in-canal and in-the-canal) are far more expensive than their more "visible" counterparts.

Scarcity of available services

India has about 2000 practicing audiologists for a population of 1.2 billion. For many, access to hearing health services remains difficult. Compounded with difficult access is a lack of education about hearing loss, leading to hearing health neglect.


Damage to hearing hair cells cannot be "cured"; existing damage can be compensated by hearing mechanisms, such as hearing aids, or by hearing health rehabilitation, for example, in the case of vestibular (body-balance related) damage. It is paramount to ensure that if there is hearing loss, it should be diagnosed and treated properly to slow down further loss of hearing.