Diagnosing Hearing Loss — Should I See an ENT Doctor or an Audiologist?

by Beth Lueders

“People think hearing loss is an old-person thing,” says Keryn Maionchi, an audiologist. “Hearing loss occurs much earlier in life than most people think. My average patient is in their mid- to late 50s. Like with vision, hearing loss starts at age 40. Typically, your hearing just slowly starts to go away. It’s progressive.”

Maionchi helps patients with practical solutions — fitting them with hearing aids — to boost auditory clarity. The function of hearing aids, according to Maionchi, is to “give you your language back, not just to make things louder.”

The World Health Organization (WHO) tracks hearing loss across regions of the world and estimates that 360 million individuals have a disabling hearing loss and approximately one third of those with auditory issues are over age 65. In Europe, one in six adults aged 18 to 80 is reported with a hearing impairment, which is a hearing loss greater than 25 decibels. The Canadian Health Measures Survey indicates that 40 percent of Canadian adults aged 20 to 70 have at least slight hearing loss in one or both ears. South Asia, Asia Pacific and Sub-Saharan Africa experience the highest prevalence of hearing loss.

So if you have some pain in the ear and feel that your hearing is not as sharp as it used to be, do you go straight to an audiologist?

Audiologists vs. Ear, Nose and Throat (ENT) Physicians

While primary care physicians normally refer patients to audiologists for basic hearing screenings, audiologists work in a variety of settings, including hospitals, private and group practice, home health agencies, nursing homes and assisted living facilities.

In Maionchi’s case, she works in tandem with an ear, nose and throat (ENT) physician, Dr. J. Louis Romett. You may have asked the question: “Aren’t audiologists doctors?” The short answer is no. Audiologists are health professionals who study the function of the inner ear. They all have a degree in their field, but a medical degree is not a requirement for the work they do.

Audiologists help diagnose hearing difficulties through a number of diagnostic tests, including pure-tone testing where the patient wears earphones to listen for a series of tones at selected pitches from low to high.

ENT physicians specialize in diagnosing and medically and surgically managing diseases and disorders of the ears, nose, sinuses, mouth, throat, larynx (voice box), and structures of the face and neck. Many patients who visit Dr. Romett have conditions ranging from earwax buildup and infections to ringing noises (tinnitus) and nerve damage.

Causes of Hearing Loss in Adults

“As we age, the nerve circuits in the inner ear deteriorate,” Dr. Romett explains. “The nerves that carry information to the brain and the nerves that filter and refine sound will become less efficient. It takes longer to decode sound signals. The filters that purify the sound do not work as well, so background noise can become troublesome. The inner ear becomes more fragile. For instance, a loud sound will injure the inner ear of a older person more than a younger person. In addition, the injury can take longer to heal, if it heals at all.”

Dr. Romett notes that noise exposure is the most common cause of hearing loss in the elderly. The effects of loud noise on the inner ear are cumulative as a person ages. “It’s important to protect your hearing health by decreasing or eliminating noise exposure,” Dr. Romett says. “Wear protective earplugs or ear guards when working around noisy equipment or listening to loud music.”

Some medications, especially cancer chemotherapies, are associated with hearing loss. Genetics is another known cause of hearing loss in the elderly. Some families have hearing loss that presents and worsens with age even if there is no other obvious cause for the hearing challenge.

Changes that improve general health — such as adopting a low-sodium diet, and managing diabetes, hypertension, vascular disease, kidney disease, thyroid disease, and cholesterol and lipids — are also important to hearing health. “Caffeine can affect the inner ear in some people, causing hearing loss, tinnitus, ear pressure and dizziness,” says Dr. Romett. “So making some lifestyle changes may actually prevent hearing loss.”

Hearing Aids and Dementia

For patients who cannot correct their auditory deficit through treatments and surgery, audiologists will fit them with hearing aids that range from a basic self-adjust model to a full self-adjusting Bluetooth design that can pair with televisions and mobile devices.

Maionchi also coaches elder patients on how to care for their hearing aids. Decreased vision or stiff or arthritic fingers can be a challenge for the elderly in replacing batteries or handling the smaller components of hearing aids. “I have patients with memory issues or Alzheimer’s,” says Maionchi. “In those cases, we work closely with the family or care staff and actually put cords on the hearing aids, so even if the person took a hearing aid out, it would stay attached to their clothing so they don’t lose it. Newer hearing aids with Bluetooth compatibility have a Find My Hearing Aids app.”

 

Both Maionchi and Dr. Romett are attune to the holistic health of their older patients, particularly how hearing loss affects emotions and relationships. “Hearing is important as we grow older,” Dr. Romett states. “People with poor hearing often isolate themselves. Good hearing allows older patients to interact meaningfully with their peers and family. Meaningful communication with family and friends improves the quality of life as we age.”

When asked about the growing research on hearing loss correlating with cognitive decline, Maionchi says, “I always tell patients, ‘You have a hearing loss. It is always better to get fit with hearing aids earlier, to maximize all of the neural pathways and keep the brain as active as possible.’”

An award-winning journalist who has documented stories in nearly 20 countries, Beth Lueders is an author, writer and speaker who frequently reports on diverse topics, including aging and health issues for both U.S. and international corporations.