Ask the doc: What can I do about hearing loss?

Jun 28, 2017

Ear protection is designed to prevent damage, but is still a good idea even if you have some damage, to prevent more. But what can you do if you have already sustained major hearing damage or are nearly deaf from noise-induced hearing loss (NIHL)?

Aside from having a great excuse to explain “male selective hearing,” both tinnitus (phantom noise when no external noise is present) and impaired hearing are serious problems related to sustained noise exposure.

Tinnitus affects one in five individuals and can be a symptom of an underlying condition.  The phantom sounds include ringing, buzzing, hissing, clicking or roaring sounds that only you hear when there is no sound like it that anyone else hears.  This is termed subjective tinnitus.  Strangely enough, there is a companion condition, objective tinnitus, that you and an observer hear (i.e. the examining doctor) that is related to vascular or middle ear disorders. Either way, if you have tinnitus, you should be evaluated by an ear specialist known as an otologist, a specialist in the ear portion of ENT, or Ears, Nose and Throat. The causes are vast and include everything from noise-induced inner ear damage to aneurysms.

Once you have NIHL, what can you do? There are four options, but only two allow you to continue to ride in a reasonably safe fashion.

Option 1: Do nothing

This is helpful if you wish to ignore what others are saying to you, but otherwise, not helpful for riding safely.

Option 2: Service animal aid

These specially trained dogs (no, your pet monkey does not qualify under the American Disabilities Act) can help by alerting you to certain sounds and, in particular, safety-related hearing cues to which you need to respond. While you can ride with your service animal, animal cueing of the rider is not yet well worked out, and may not be safe as it requires animal-human contact for the hearing-impaired person to get help. On to more useful options for riding…

Option 3: Hearing aids

Hearing aids are great if your hearing damage is not severe. Current devices are small, adjustable in terms of how much amplification they provide, and will fit under a helmet without issue. In order for them to be useful, you must have some hearing ability that remains and still have speech discrimination (you can still understand one word from another and identify them as separate from other noise). If you have lost speech discrimination (cannot hear words even if the speech is as loud as your upset mother-in-law), then option four is specifically designed for you.

Option 4: Cochlear implant

This is a highly specialized surgical therapy to restore hearing. Since this is a unique area, I consulted with a surgical expert — Jason Brant, MD, an otologist at the Perelman School of Medicine, University of Pennsylvania, as well as the Corporal Michael J. Crescenz of the VA Medical Center in Philadelphia.

Dr. Brant explains that a cochlear implant has two parts. One is an external receiver that gathers sound and transmits it to the second part, which is an implanted device that electrically stimulates a nerve similar to how your undamaged ear would. This effectively bypasses and replaces the damaged portion of your hearing apparatus. Cochlear implantation technology can provide significant benefits but will certainly alter the fit of your helmet! The internal piece and the external piece link by magnets across your skull, so putting your helmet on must be done with care to maintain the magnetic link, or you will need to readjust once your helmet is in place. Specific pad alteration might be required to accommodate the space required for the external receiver as well. Riding with a cochlear implant without a helmet can be done but is not recommended. You will hear wind noise really well, but other sounds not so much.

Cochlear implant surgery is generally done as an outpatient procedure with the device activated about a month later, after healing has occurred, according to Dr. Brant, who is an expert in this procedure. The devices do not restore normal hearing, but can help restore the ability to hear environmental sounds and to understand speech. Best-case scenario? Good ability to hear words when there is not a lot of background noise. Even with an excellently functioning implant, music appreciation should not be an expectation.

Non-surgical therapies for noise-induced hearing

Are there non-surgical aids as well? Sort of.

Novel strategies to help prevent NIHL include, of all things, Ginkgo biloba extract, as well as lipoflavinoids. These agents seem to work best in lab animal testing, but have yet to be proven to work in animals like us. Lipoflavionoids are over-the-counter products that claim to improve inner ear microcirculation as the mechanism behind how they correct both NIHL and tinnitus. Caveat emptor (buyer beware), as there are no definitive studies supporting these claims once hearing loss is established.

Most of the data shows promise before being exposed to damaging noise, or immediately thereafter — but not days, weeks or months after injury. Promising compounds are also being investigated in sea anemones and drosophila (fruit flies), as they appear to sustain noise-induced injury in a fashion similar to humans.

Without convincing evidence that we have a good rescue strategy to preserve normal hearing after injury, an ounce of prevention goes a long way here — hear?